Everyone wants smooth, even results after liposuction, and it’s certainly something that every surgeon endeavours to achieve. Imperfections and irregularities can occur; however, many such issues can resolve on their own with time. In other cases, further treatment may be needed.
This article explains the causes of post-liposuction unevenness and how to prevent them.
What causes unevenness after liposuction?
Post-operative swelling
Post-operative swelling is often uneven, and this unevenness is a normal and common part of the healing process. Your body’s lymphatic drainage system works at different speeds in different parts of the body, and areas with more disruption tend to swell more than other parts.
Action required: Swelling will intensify within the first 72 hours, then reach its peak around two weeks, but it’s quite common to experience uneven fluid resolution for weeks or even months as you heal.
Fluid accumulation (seroma)
A seroma is a pocket of clear fluid that builds up under the surface of your skin. It is composed of lymphatic fluid and blood plasma that leak from damaged vessels. A seroma usually feels soft and squishy and can cause localised swelling or bulging.
Seromas typically develop after tissue is removed or disturbed during surgery, leading to leakage into the space. As your body heals, the fluid seeps into this space and accumulates before the tissues can seal off the area.
Action required: Often, seromas heal on their own. Over the following weeks, the fluid naturally resorbs back into the body. Your treating doctor can also diagnose a seroma early and, if required, drain it with a needle aspiration.
Haematoma (blood collection)
A haematoma is a localised collection of blood that is pulled outside of a blood vessel. It typically occurs because the vessel wall was damaged by surgery or injury. It can present as a minor, shallow bruise or as a large, firm swelling, depending on how much blood accumulates.
Haematoma differs from a bruise in that it is not just discoloured tissue. Instead, a haematoma involves enough clotted blood to form a spongy or rubbery lump.
Action required: If the haematoma is minor, it usually heals on its own, with the clotted blood slowly resorbing over time. If it is severe, it may require surgical drainage or removal.
Fibrosis (scar tissue formation)
A fibrosis is the development of fibrous subcutaneous connective tissue (primarily collagen) as an excessive response to injury or trauma. Fibrosis is like a scar, but with rigid bands of tissue beneath the skin’s surface. It can cause lumps, bumps or firm, uneven patches.
Following liposuction, fibrosis may occur if the cannula was handled too aggressively, leading to trauma to the area.
Action required: To minimise the risk of fibrosis, the surgeon must be experienced in the technique. Also, you should diligently wear your compression garment following surgery. If the fibrous persists, treatments such as massage, ultrasound therapy, or steroid injections may help break down the tissue.
Uneven fat removal
An inexperienced surgeon can fail to remove an equal amount of fat on both sides of the body. This can lead to dents or asymmetry.
Action required: If the unevenness/asymmetry is highly noticeable and is a concern, further liposuction and or fat transplant surgery may be recommended.
Skin elasticity issues
Poor skin elasticity is skin that will not retract well. This is common in older patients or after large-volume liposuction.
If a surgeon performs liposuction on an individual with poor skin elasticity, the treated area can appear loose or wavy. This is why you must have a thorough consultation with your surgeon, who can carefully assess you first.
Action required: Depending on the individual and their presentation, skin tightening procedures may be recommended.
Poor compression or after-care
Patients MUST wear their compression garment 24 hours a day for the first two weeks, then 12 hours a day for the following two weeks. Failure to wear the garments properly can allow fluid to accumulate unevenly and tissue to heal irregularly.
Poor surgical technique
A good, experienced surgeon will choose the appropriate technique and tools for your body that adequately address your needs. If a surgeon is not highly skilled, the following may occur:
- Uneven fat extraction – More fat is taken from one side or the other, or the fat is removed more superficially in one area than the other.
- Use of inadequate cannulas – The choice of cannula diameter, depth of cannula penetration, and the skill with which it is used are all highly important factors.
- Speed over precision – Rushing through the procedure increases the risk of tissue trauma.
- Aspiration without layer control – Failing to respect the correct depths may lead to over-resection in some areas and under-resection in others.
Action required: Choose your surgeon wisely. It is one of the most fundamental actions you can take to prevent issues and complications during your procedure, including liposuction.
How to prevent or manage unevenness after liposuction
If you experience unevenness after your liposuction procedure, you must remain in close communication with Dr Attalla and his team. They can advise you on the best course of action, which may include conservative treatments or, in persistent cases, revision surgery.
Generally speaking, managing unevenness involves the following activities.
Early phase (first weeks to 3 months)
During the early phase, conservative treatments are typically recommended, including:
- Compression Garments: Helps reduce swelling and encourages smooth contouring.
- Foam pads and compression binders: A vital part of post-liposuction recovery and contour optimisation. They are typically introduced 3–4 days after surgery and worn underneath the compression garment for several weeks.
- Manual Lymphatic Drainage Massage: Improves fluid movement and reduces swelling. (At Chelsea Cosmetics, all liposuction patients are required to return to the clinic following the procedure for four weeks of complimentary lymphatic drainage massage).
- Massage (firm but controlled): Firm massage helps soften fibrosis and break up lumps.
- Ultrasound/radiofrequency therapy/ Zwave(R) shock waves: This is sometimes used to address tissue healing. It can reduce swelling and prevent a buildup of hardened, fibrous scar tissue (fibrosis).
- Time: Simply letting time pass often results in many irregularities naturally resolving over 3 to 6 months.
Intermediate phase (3 to 6 months)
- Continued massage and compression
- Steroid injections (For stubborn fibrotic nodules)
- Non-invasive treatments such as Zwave® shock wave skin tightening or laser therapy.
Late phase (after 6 to 12 months)
If unevenness in your treated area persists following 6 to 12 months, your doctor may suggest further options, such as the following.
Surgical options:
- Revision liposuction – to smooth out remaining fat deposits that may be causing the appearance of unevenness or irregularity
- Fat grafting (lipofilling or fat transfer) to fill dents or depressions. The patient’s own fat is processed and injected into the deficient areas.
- Subcision – to release tethered scar tissue. This is a minimally invasive procedure that uses a small needle or cannula beneath the skin to break up the fibrous bands that cause skin tethering.
- Skin tightening procedures – if lax, inelastic skin is the issue, nonsurgical procedures may be suggested to increase collagen and elastin production, aiming to tighten the skin.
Prevention: Why after-care, the surgeon and technology matter
The best surgical correction is arguably the one that never happens. And the best way to prevent unevenness, asymmetry or poor results rests on three pillars:
- The patient’s after-care. Patients must diligently follow all after-care instructions. Of particular importance is wearing their compression garment and attending all follow-up appointments and lymphatic drainage massage sessions.
- The surgeon’s skill and judgement. The surgeon must carefully plan the procedure and evaluate skin quality, adipose thickness, skin elasticity, and natural adhesion zones to ensure an optimal understanding of the patient and a tailored surgical plan.
- Technology. The use of advanced liposuction technologies, such as VASER (ultrasound) liposuction and water-assisted liposuction (WAL), allows fat to be removed more precisely and with less tissue trauma.
