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The happy, healthy mother of two had a slim physique many would envy. However, like many women, Bethany (not her real name) was dissatisfied with one part of her body. “I thought ‘I can’t get rid of my belly,’” she said. “Looking back, though, it probably wasn’t really that in the first place.”

She decided to get liposuction, choosing a popular company promising a quick surgery, excellent results and low prices. After being given what she calls a “hard sell” Bethany decided to have liposuction done on several parts of her body including her stomach. But the results weren’t what she expected. “It looked uneven and like they had taken too much out,” she said. “At first they told me I just needed more time to heal, but then they called me in for a touch-up and took even more out.”

“I felt horrible,” Bethany said. “I was very self-conscious.”

“It looked like she had pebbles under her skin on her abdomen,” said Courtney Crombie, MD, a plastic surgeon with University of Utah Health. Bethany was referred to Crombie after seeking help to fix the damage done by the two liposuction procedures. “This was the first time I had ever seen anything like this and it was a big problem,” Crombie said.

The bumpy, uneven appearance of Bethany’s stomach was caused not only by taking out too much fat, but also taking fat from the wrong layer. People have two layers of fat: superficial and underneath the fascia. Skilled plastic surgeons know it’s best to take from the fascial layer.

“It is not recommended to suction right underneath the skin,” said Crombie. “That way you don’t create defects where you might create a divot or a tunnel or make it uneven.”

Some surgeons suggested Bethany get a tummy tuck to fix the problem, but Crombie saw that wouldn’t resolve the issue. With an abdominoplasty, or tummy tuck, excess skin would be removed to make the stomach flatter. However, that wouldn’t change the bumpy appearance. “Pulling the skin tighter might even make it worse,” said Crombie.

Instead, Crombie decided to do a procedure known as fat grafting. She would take the fat that was left on Bethany’s abdomen and from other sites on the body and then inject it back in to create a smoother look. However, there was a problem: Bethany didn’t have much fat. Even after taking from her back, legs, and arms more was still needed. “She had nothing to give up without creating more defects,” said Crombie. “We decided to also inject platelet-rich plasma.”

The plasma, which was also taken from Bethany, would act as a booster for the fat, encouraging it to take after being injected. In all surgeries there some of the injected material doesn't take. Because Bethany had so little fat to graft, every effort was necessary to help ensure successful regrowth of the injected fat.

Bethany has now had two fat grafts and she says she can see a difference. She is also planning to have another graft done next year to further improve the look of her stomach.

“It’s better, but it is not totally corrected,” Crombie said. “I will do as much as I can until she feels satisfied. I wouldn’t offer her another session if I didn’t think it would help. “

Crombie also wants to others avoid the problems Bethany has faced. “Make sure the plastic surgeon you are seeing is board certified,” she said. “The problem comes when you have non-certified surgeon doing this work.”

You can determine if your surgeon is board certified by checking with the American Society of Plastic Surgeons. Where they perform surgery is also an indicator of whether or not they are certified to perform plastic surgery procedures. “Make sure your procedure is done in a hospital or other accredited facility,” said Crombie. “They have to check that surgeons are board certified.”

Crombie said that by choosing a board-certified physician you are protecting your finances as well as your health. “Plastic surgery is expensive and usually not covered by insurance,” she said. “If you have to have more procedures to fix defects made by someone who didn’t know what they were doing that’s even more money out of your pocket.”

Bethany has her own advice for those seeking plastic surgery. “Do your research on who is going to perform surgery on you,” she said. “Get recommendations and know as much as you can about them before going in.”