Dear Dr. Kim,
I’m a 36-year-old fit mom who has (perhaps delusional) fantasies about getting my 27-year-
old, pre-kids flat tummy back. I was lucky in that I didn’t get any stretch marks during my
pregnancies and I have no loose skin. I work out every day with running, swimming, weight
training, and of course, lots of ab strengthening. But no matter what I do, I still have some
stubborn fat that seems to have taken up permanent residence on my stomach. It’s not a lot, but
enough to be annoying. I’m 5’8″ and weigh 130 pounds.
I am interested in liposuction to solve my problem, but I’m worried about the freakish looking
rippling that I’ve seen on the cover of tabloids while standing in line at the grocery store. Y’know
the headlines I’m talking about, right? “TARA REID’S LIPOSUCTION NIGHTMARE!!” and
the like.
What causes this unsightly rippling and how can it be avoided? And what kind of results can a
person like me typically expect? Will I ever have washboard abs again?
Sonoma County
Dear CJ,
Thanks for the great question!
Every plastic surgery procedure has possible complications, and liposuction is no exception. Regarding the problem you see with rippling after liposuction, this complication is known as
contour deformity, contour irregularity, rippling or dimpling.
During any type of liposuction (regular/ traditional/ SAL/ suction assisted liposuction, UAL/
ultrasound assisted liposuction, LAL/ laser assisted liposuction, and even cryogenic or freezing
technology), if the plastic surgeon doing the liposuction lingers too long in a certain area, then
you will have too much fat removed in that spot.
Since the liposuction devices are usually long tubes, and the motion of liposuction is going back and forth, most complications will look like you have too much fat loss in a long, thin line. If you go over a large area repeatedly and have this complication, then you’re going to have an area where you will have visible lines, wrinkles,
divots and depressions of your skin. This is what you may have seen in some celebrity photos.
The way to correct this is to give it some time to heal AND to do aggressive massage in the areas that have depression (both literally and figuratively … haha ). If an area has a deep bruise or has some hardness, than your body is probably trying to form too much scar tissue in an area of normal liposuction.
As a patient, it’s important to realize that the surgery is not the end result. It’s the post-operative care,
given over 6-12 months, that will give you the best final result.
If a patient still has rippling after liposuction, and it’s been greater than 6-12 months, then the
way to correct it is to do FAT GRAFTING. That’s right- you actually need to inject fat into the
areas of rippling. This is done, usually in the OR/ operating room, where the wrinkles of the skin
are detached from the underlying scar tissue. There’s no subcutaneous fat there, so I/ a plastic
surgeon needs to harvest fat from somewhere else, process that fat, and carefully graft it into the
area of rippling.
It’s important to know that even very thin people have SOME fat under their skin and on
their body. Even if you have 6 pack abs, you’ll have some fat that you can barely pinch. It’s
unnatural to have NO FAT to pinch, and obviously, it’s unnatural to have an unusual randome
rippling pattern anywhere on your body.
How to avoid this problem? Well, obviously, choose your plastic surgeon wisely. There are
many “cosmetic surgeons”, but it’s important to know about board certification, and what it
really means.
The liposuction technology, IMHO/ in my humble opinion, is not the main culprit with rippling
or contour irregularity. Rather, it’s the technician/ surgeon that’s operating equipment, and their
experience with said technology/ machine/ equipment.
It’s very important to realize that taking care of your body AFTER SURGERY is crucial to
getting the best long-term result. I mentioned massage after liposuction, but there’s also wearing
your compression garment, taking antibiotics after surgery to avoid infection, hydrating after
surgery, wound care for the tiny liposuction cannula incisions, maintaining your weight after
surgery, and many other things that will give you the best long-term aesthetic results possible.
Interestingly, this technique of creating a divot or depression with liposuction is used
in “Abdominal Etching”. This is a technique to create an artificial “six pack” in your abdomen
area. I can, on purpose, create several lines in your abdomen area so that you end up with a
visible six pack. Of course, it’s good to be pretty thin to begin with- otherwise, it looks a little
odd to be overweight with an artificially created six pack.
So, washboard abs are possible- assuming you’re thin enough, liposuction WITHOUT
abdominal etching may be able to remove just enough fat to allow your visible six pack muscles
to be uncovered, shining, like a jewel while you wear your tube top.


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