Fibrosis after lipo: what causes it and how to get rid of it

“TL;DR: Fibrosis, adhesions and hard lumps almost always develop, to some extent, after liposuction and can last from weeks to years.

You can prevent/reduce fibrosis with hand massage and ultrasound massage and can also tighten up the loose skin with deep-acting, high-power radiofrequency.”

What is fibrosis after lipo and how to prevent and reduce it? What about adhesions and scar tissue lumps?

• Fibrosis after liposuction / BBL / tummy tuck? Does lipo cause scar tissue?

• What causes fibrosis after lipo?

• Fibrosis = adhesions ± hard lumps

• Fibrosis / adhesions depend on…

• When does scar tissue develop after liposuction?

• Does fibrosis after lipo go away? Is fibrosis after lipo permanent? How long does it last?

• How to get rid of fibrosis after lipo

• How many post-lipo massage treatments should I have after surgery?

• How to get rid of fibrosis after lipo, Step 1: minimise/prevent it from occurring in the first 1-3 weeks after lipo

• How to get rid of fibrosis after liposuction, Step 2: minimise it in the 3-8 weeks after surgery, when it is still fresh

• How to get rid of fibrosis, Step 3: break it down From week 8 after surgery, onwards

• Ultrasound to break down fibrosis

• Be patient, fibrosis needs time to break down and fast results are not going to happen

• Remove cellulite and tighten up loose skin from week 8 after surgery, onwards

• Using a real cellulite cream to help prevent and reduce fibrosis

• What if I had laser lipo, ultrasound lipo or radiofrequency lipo?

• If scar tissue, skin laxity and more pronounced cellulite occur after lipo, what is the point of having lipo?

• Have a skin tightening, cellulite removal or fibrosis reduction treatment in London with the experts

• Discover our professional training in cellulite, skin tightening, radiofrequency and ultrasound

Fibrosis after liposuction / BBL / tummy tuck? Does lipo surgery cause scar tissue?

Inflammation and oedema/water retention always occur, to a lesser or greater extent, after all forms of fat/cellulite removal surgery:

• Liposuction

• Liposculpture

• Laser lipo/smart lipo

• Vaser lipo

• Bodytite

• Abdominoplasty/tummy tuck

• Brazilian butt lift/BBL

• Cellfina

• Subcision

• Cellulaze

• Cellutite

• Profound RF

• Etc

Inflammation and oedema are usually followed by scar tissue development (known as ‘fibrosis’, ‘adhesions’ or simply ‘hard lumps’) in either several distinct small areas or throughout the operated area.

Fibrosis after lipo is very common - if not universal - in the first few weeks and months after surgery, with some hard lumps persisting for years.

What causes fibrosis after lipo?

Fibrosis refers to hardened / scar tissue that forms as a reaction to injury from:

• The suction of fat

• The liposuction cannula itself as the surgeon “pokes” under the skin

• The ultrasound/radiofrequency/laser tip of the cannula, as used for vaser/bodytite/smart lipo, respectively

Injury causes inflammation and oedema, which in turn lead to the deposition of excess collagen fibres with random orientation on the tissues. This fibrous scar tissue development is called ‘fibrosis’.

Fibrosis = adhesions ± hard lumps

Adhesion refers to internal scar tissue / fibrosis between tissue layers, such as skin and underlying fascia, literally sticking together with existing collagen tissues.

Adhesions are a form of fibrosis / scar tissue which acts as a glue for tissue layers, hence the name ‘adhesions’.

When excessive fibrosis is concentrated in small spots then we have hard lumps forming.

Usually the term fibrosis is used for hard lumps or overall hardened skin, while adhesions are used for scar tissue that leads to movement restriction.

Fibrosis / adhesions depend on the:

• Equipment used (for example our post smart-lipo clients generally report more fibrosis than our post-vaser lipo clients)

• Intensity of laser/ultrasound/radiofrequency used during the procedure

• Type of procedure (e.g. cellulaze is based on producing controlled fibrosis)

• Skill of your surgeon

• Reactivity of your skin (some people have very reactive skin, in which case even the best surgeon cannot avoid causing some fibrosis)

Furthermore, the most inflamed areas also tend to cause hyperpigmentation on the surface of the skin, which may require treatment with a skin lightening formulation.

When does scar tissue develop after liposuction?

Fibrosis starts developing 3-4 days after lipo and can keep developing for about 2-4 weeks after lipo:

• If inflammation and oedema (water retention) are minimised after lipo, fibrosis will be reduced

• If oedema / inflammation last long or are severe, or if there is a seroma or other complication, fibrosis will be increased

Generally fibrosis is the next stage after inflammation / oedema, so you should expect to get the last pieces of fibrosis materialise 1-2 weeks after the resolution of inflammation / oedema.

Does fibrosis after lipo go away? Is fibrosis after lipo permanent? How long does it last?

During the last two decades we have seen hundreds of clients at the clinic who underwent such procedures:

• In some cases fibrosis is very little, even if no post-lipo treatments are undertaken (very rare)

• In most cases there is some/considerable fibrosis for up to two years after surgery

• Occasionally we see people with fibrosis 10 years after surgery, especially after smart lipo / vaser / bodytite, which are based on creating scar tissue, in order to “tighten” (harden, really) the skin

• In some cases there is extreme and/or permanent fibrosis, at least in some areas

Furthermore, in most cases the area is sensitive to massage or any other treatment for up to two years after surgery. In a small number of cases the area is sensitive to massage or other treatments for even 10 years post surgery, due to the tissue damage that occurred during surgery.

How to get rid of fibrosis after lipo with massage and ultrasound

Aftercare professional massage treatments (or at least self-massages) and/or professional ultrasound treatment (do not administer ultrasound yourself at home) are essential after all types of ‘lipo’ surgery mentioned above, even if liposuction is performed by the most skilled surgeon.

This is because swelling and scar tissue/fibrosis always follow, to a lesser or greater extent, any intrusive procedure, including lipo and all related types of surgery.

However, most surgeons either don’t mention fibrosis at all or underplay its extent and importance. Otherwise, much fewer people would undergo plastic surgery.

The recommended post-lipo recovery treatments differ depending on the timeline after surgery.

How many post-lipo massage / ultrasound treatments should I have after surgery?

Personally I would definitely have 12 weekly or twice-weekly sessions, starting from Day 3 with MLD (manual lymphatic drainage) and gradually progressing with stronger massage.

If you are on a budget after splashing out on the surgery itself, I believe 6 sessions are absolutely indispensable.

If you don’t have any professional treatments, at least apply some self-massage, with care and caution (never overdo it for faster results).

After Day 56 you can have ultrasound treatment to break down any remaining or potentially more significant fibrosis - with or without massage.

How to get rid of fibrosis after lipo, Step 1: minimise/prevent it from occurring in the first 1-3 weeks after lipo

In the first few days after lipo (weeks 1-3) the emphasis is on reducing pain, swelling / oedema and facilitate tissue healing, which will also help prevent further complications, such as fibrosis and adhesions, later.

During that time, post-lipo aftercare treatment should initially be gentle and progressively become stronger.

Mild lymphatic drainage massage (MLD) by hand or with special electro-lymphatic drainage equipment (e.g. Hivamat) is needed in the first couple of weeks after any liposuction surgery.

A gradually firmer massage - according to your tolerance and never too strong - must be applied from the second or third week onwards.

How to get rid of fibrosis after liposuction, Step 2: minimise it in the 3-8 weeks after surgery, when it is still fresh

In the medium term (3-8 weeks) the emphasis is on preventing fibrosis / adhesions / hard lumps and then gradually breaking down some fibrosis which will unavoidably build up in araes.

During that time treatment can become progressively more vigorous: strong lymphatic stimulation massage is preferred to the “fluffy” lymphatic drainage (MLD) variety used in the first three weeks.

In addition to reducing water retention, stronger massage also helps with the breakdown of scar tissue / hard lumps that typically form after lipo surgery and uncouple skin that is stuck on underlying tissue (adhesions), consequently increasing range of movement.

Progressive stretching of the adhered areas as well as general movement will further help break down adhesions.

Pressotherapy can also be used during these weeks (week 3 to week 8) - and even earlier - to facilitate lymphatic drainage.

For an expert guide on fibrosis massage please click here. Or you can have professional massage at a clinic.

How to get rid of fibrosis, Step 3: break it down From week 8 after surgery, onwards

If fibrosis / scar tissue establishes itself after week 8 (Day 56), then you can reduce it with:

• Stronger self-massage or professionally applied massage at a specialist clinic, up to 3 times a week

• Have professional ultrasound treatments at a specialist clinic, up to twice a week

Ultrasound massage to break down fibrosis

If you still have fibrosis, from Week 8 / Day 56 after surgery, in addition to manual massage, you can also have ultrasound massage to break down fibrosis at a clinic that specialises in this service (do not do this at home).

• The manual massage applied with your hands acts on the macroscopic levels, i.e. affects larger connective tissue structures.

• Ultrasound provides a micromassage at the microscopic level, i.e. it affects smaller connective tissue structures (ultrasound has been used in physiotherapy to break down scar tissue / fibrosis for decades)

Both are great for fibrosis reduction and you can combine them for faster results. You can do massage at home 1-3 times a week. And you can also do ultrasound at a clinic that specialises in this service, 1-2 a week.

For safety reasons, I do not recommend ultrasound treatment at home on your own: you can easily overdo it (and many people do overdo it) and cause damage rather than healing.

Be patient, fibrosis needs time to break down and fast results are not going to happen

In any of these two cases (manual massage / ultrasound massage), don’t expect fast dramatic results. When it comes to breaking down fibrosis, three elements are necessary:

• Lots and lots of patience

• Lots and lots of time

• Lots and lots of sessions

Sounds boring and slow but that’s how it is. Your body does not care if you are impatient or if you have already spent thousands of pounds on surgeons and do not want to spend a few hundreds of pounds on therapists.

Or vice-versa, your body does not care if you can splash thousands of pounds on extortionately priced miracle treatments that are supposed to break down fibrosis in 1-3 sessions - it ain’t gonna happen and you may even get worse, depending on what is that miracle treatment.

This is because:

• Fibrosis does not break down faster if you do stronger massages or stronger intensity ultrasound - you will just cause inflammation, which will delay improvement, not accelerate it. You will not be better with just 3-4 super-strong sessions. It ain’t gonna happen, no matter what different cowboys promise you. You will need many, many sessions of average intensity massage and/or medium intensity ultrasound. Think of 12+ sessions of massage, ultrasound or, ideally, both. And if your fibrosis is really bad, even more sessions and time will be needed.

• Fibrosis will not break down faster if you have massages / ultrasound more frequently, say every day or twice a day. You still need to allow time to recover between sessions, which is 1-7 days, depending on each case. You will not be fibrosis-free in 4 weeks. Think of several weeks and - most probably - months.

Of course, there is always the option of going to one of those cowboys who will promise you fast results with 1-3 sessions of HIFU, RF microneedling or extreme intensity RF. These are totally the wrong techniques and will make the situation even worse - not better.

Building more scar tissue collagen, that HIFU, RF microneedling or extreme intensity RF are designed to do, is obviously the exact opposite of breaking scar tissue collagen. Don’t be a victim.

Professionally applied normal intensity RF does not cause fibrosis but definitely does not reduce it either. Scar tissue / fibrosis is too much collagen in all the wrong places and RF is there to build up more collagen, not reduce it.

Sadly, many surgeons are ignorant about radiofrequency, HIFU and RF microneedling and suggest those treatments to their patients, compounding the problem of fibrosis that developed after surgery with the wrong prescription for that fibrosis.

Remove cellulite and tighten up loose skin from week 8 after surgery, onwards

After about 8 weeks you may start working on the skin looseness, which always develops after lipo, and the cellulite, which of course can not be removed by liposuction.

After the removal of excess fat from the area there is too much skin, and that manifests as loose/saggy skin. This excess skin makes cellulite more visible (there is no more or less cellulite after lipo - it just looks more pronounced, as skin is less taught).

The vast majority of cellulite bumps can not even be removed by cellulite surgery. For example, cellfina or subcision only remove (and sometimes make worse) about 30 cellulite bumps - out of hundreds of smaller and larger such bumps existing in all of us. So the rest need to be reduced with non-surgical methods.

From around Week 8 / Day 56 onwards you can start having a strong, deep tissue radiofrequency and/or a strong ultrasound cavitation treatment:

• To remove cellulite, which always looks worse after lipo

• To tighten up the skin, which is always looser after lipo (even after vaser or smart lipo)

And, of course, you do not want to have RF applied on areas with significant fibrosis and your therapist should take care not to treat those areas with RF.

Using a real cellulite cream to help prevent and reduce fibrosis

A real cellulite cream, i.e. one with multiple relevant high-purity actives in high concentrations, can really help in this process. This is because many anti-cellulite ingredients also have an anti-fibrotic action.

(Most so-called cellulite creams are really diluted and contain irrelevant active ingredients, hence the term ‘real’ above.)

For example asiatic acid, madecassic acid, asiaticoside, EGCG, esculin and curcumin, among others, are known for their combined action against:

• Oedema

• Inflammation

• Fibrosis

Such a cream can be used from day one (only on areas without open wounds) all the way to several months after the operation, to help skin heal, minimise bruising and water retention and minimise fibrosis.

What if I had laser lipo, ultrasound lipo or radiofrequency lipo?

If you had smart lipo (laser lipo), vaser (ultrasound lipo) or body tite (radiofrequency lipo), you may have some hardened skin as a result of the burning of your tissues under the skin caused by the laser / ultrasound / RF cannula tip.

This burning of the skin at 60-90ºC causes skin hardening (basically scar tissue) and surgeons try to pass this skin hardening / scar tissue-ing as “skin tightening”.

However, there is no functional skin tightening occurring from such burning, just controlled scar tissue, i.e. dysfunctional collagen.

This dysfunctional collagen / scar tissue will break down within about a year, leaving you with the loose skin that would have been left with after a normal lipo procedure.

In this case, you can have a course of deep-acting, high-power radio frequency skin tightening treatments to build some proper functional collagen on your skin instead, as soon as you see your skin getting looser, i.e. about 6 months after surgery.

If the scar tissue after those procedures is not that “controlled”, it will leave you with hard lumps / fibrosis / adhesions. In this case, the same advice mentioned above for fibrosis reduction applies: manual massage, ultrasound massage and no RF, RF microneedling or HIFU.

If scar tissue, skin laxity and more pronounced cellulite occur after lipo, what is the point of having lipo?

Quite often fat is concentrated in stubborn areas which just don’t slim with any amount of exercise and diet. For those areas the only option is topical fat removal: surgical or non-surgical:

• Non-surgical topical fat reduction methods do not work very well and may require too many sessions for large fat deposits. Think of about 12-24 sessions or more - not the claims of only about 1-4 sessions needed, that you read about in the tabloids.

• So surgical fat removal makes the most sense. Just make sure you know what to expect in advance and don’t believe all the hype from the media or the surgeons. In most cases, fibrosis, loose skin and more visible cellulite WILL unavoidably occur after lipo, so make sure you budget time and money for fibrosis reduction treatments after lipo (6-12 sessions, as mentioned above, or perhaps more).

Please note that if you keep consuming more calories than you burn after lipo, you WILL develop new fat either on another body area or even on the same area. Yes, on the same area too. It does happen all the time - not to mention the excess cellulite that forms faster on the operated area.

That will necessitate a new lipo procedure. We know people who have had three liposuction surgeries: initial area, adjacent area and then initial area again. Needless to say that is sooooo stupid…

So the best solution is to not develop excess fat in the first place - and definitely not to develop excess fat after lipo, due to naughty eating, drinking and/or lack of exercise.

Have a skin tightening, cellulite removal or fibrosis reduction treatment in London with the experts

At LipoTherapeia we have specialised 100% in skin tightening and cellulite reduction for more than two decades and 20,000+ sessions.

This is all we study and practise every day and have researched and tried hands-on all the important skin tightening equipment and their manufacturers.

As strong, deep acting radiofrequency and deep-acting, high-power ultrasound cavitation are the technologies of choice for skin tightening and cellulite reduction, we have invested in the best RF/ultrasound technologies in the world.

Furthermore, over the last two decades we have developed advanced RF and cavitation treatment protocols in order to make the most of our technologies, for maximum results, naturally and safely.

Our radiofrequency/ultrasound treatments are comfortable, pain-free, downtime-free, injection-free, microneedling-free, 99.5%+ safe and always non-invasive.

And our focus is on honest, realistic, science-based treatment, combined with caring, professional service, with a smile.

We will be pleased to see you, assess your cellulite, skin laxity or fibrosis, listen to your story, discuss your case and offer you the best possible treatment.

Learn more or check prices and book an expert treatment at our London clinic (49 Marylebone High Street, W1)

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