Patient No. 494, Session 4: C-section depressed scar revision with fat grafting (without scar tissue release)

September 30, 2020 / 8 Comments

Before and after lower abdominal liposuction

WARNING: This is a medical blog intended ONLY for medical professionals!!! This blog contains nudity and graphic images of cosmetic surgeries. If you are offended by nudity and graphic images, or if your religion does not allow you to look at such images or to get cosmetic surgery done on yourself, please leave NOW!!!

WEBSITE INI TIDAK BOLEH DIPERTUNJUKKAN KEPADA ORANG INDONESIA MAUPUN DI WILAYAH NEGARA KESATUAN REPUBLIK INDONESIA. APABILA ANDA ADALAH ORANG INDONESIA, HARAP TINGGALKAN SITUS INI SEKARANG JUGA!!!!!!!

How do you deal with depressed C-section scar? Arthur Tjandra of Elixir de Vie thinks that the most effective way is to release all scar tissue which pulls the skin down with a sharp device, then inject fat underneath the depressed scar to raise it back.

After getting complication of lumpy breasts with filler injection done by an Indonesian doctor, this Chinese Indonesian patient from Medan, who is in her late 30s, a mother of 1 child, came to see Dr Arthur Tjandra of Elixir de Vie 2 years ago. Taking all the lumps out involved a major and complicated surgery. She opted to have fat injected above the lumps so that her husband could not feel her hard rock breasts. At the same time, she would like to increase the size of her breasts, as her husband stopped playing with her breasts and had been playing with other women’s breasts.

Her breasts increased from A cup to C cup after 2 years.

During the 4th visit, she returned for some touch-up liposuction as there was a slight bulging between her right inner thigh and right knee. This is a problem which may arise when you do not get liposuction of different areas of the body performed within the very same session. She had inner thighs liposuction during her second session and knees liposuction during her third session of autologous fat grafting to breasts. To prevent unevenness, we always recommend getting liposuction done on the entire length and entire circumference of the thighs, or at least half a circle, but the entire length, performed within the same session.

She now returned, complaining that her C-section scar appeared very obvious after her anterior abdominal liposuction was done and accused Dr Arthur Tjandra of creating a dent on her lower abdomen. She had previously complained about the 2 tangential grooves at the side of her abdomen, which Dr Arthur Tjandra attributed to normal human anatomy. If very thin layer of fat is left behind after liposuction, definition of the abdominal muscles can be seen through the skin. In men, this definition is often called 6-packs. Tangential grooves on both sides of the lower abdomen, which point towards the groins can be seen on very fit people. Dr Arthur Tjandra himself has these grooves! We have published a case study about this complaint:

Patient No. 494: Doc, you have created grooves on both sides of my tummy!

Now take a look at Dr Arthur Tjandra’s tummy on a photo taken in January 2020, during his Chinese New Year break in Da Nang, Vietnam. Can you see the 2 tangential grooves on the sides of his abdomen, pointing towards his groins? The only way to not have those grooves, is to have a layer of thick fat hiding those grooves! In this case, what is the point of getting liposuction done?

As for the more pronounced C-section scar after liposuction, it could happen, because when there was thick layer of fat surrounding the scar, it would not be so prominent, because the thick fat was somehow hiding the scar. But, once the fat surrounding that area is removed, the scar would become more prominent. The appearance is made worse by the fact that she has depressed type of scar, with scar tissue pulling her skin inside. C-section scars can be depressed, flat, or hypertrophied.

Credit: https://www.med-decisions.com/sex-after-c-section-should-you-do-it-or-wait/

To view the histology of such scar, please click on the link below. It is a copy-righted picture, so we cannot post it here.

https://www.researchgate.net/profile/Ardeshir_Bayat/publication/259354682/figure/fig1/AS:203061504024576@1425425043327/A-Transverse-view-of-biopsy-locations-from-normal-dermal-scar-tissue-and-adjacent-normal.png

To address depressed scar, Dr Arthur Tjandra of Elixir de Vie offered a 2-step approach: release of scar tissues attachment to the skin, which pull the skin down, using a sharp device, followed by fat grafting under the now, detached skin. Scar release using sharp device, however, may cause more bleeding and slightly more pain. Dr Arthur Tjandra had to explain the procedure to this patient. But, hearing that there could be some bleeding, she opted for only fat grafting, without scar tissue release. It was informed consent. Dr Arthur Tjandra could not perform a procedure without a signed consent, so he went ahead with only fat grafting, without scar tissue release.

Scar tissue release with fat grafting can also be performed only cellulite. We have published a case study on this issue, previously:

Patient No. 524, Session 2: Cellulite treatment with cellulite release and fat injection

This is a list of her case studies:

First visit:

Patient No. 494, Session 1: Autologous fat grafting to breasts, after complication of filler injection by another doctor

Patient No. 494, Session 1: Result of autologous fat grafting to breasts, 5 months later

Second visit:

Patient No. 494: Doc, you have created a groove on both sides of my lower tummy!

Patient No. 494, Session 2: Autologous fat grafting breasts augmentation and inner thighs liposuction

Third visit:

Patient No. 494: Result of autologous fat grafting breasts augmentation, 1.5 years later: from A to small C cups

Patient No. 494, Session 3: Autologous fat grafting breasts augmentation and knees liposuction