IMCAS - Congresses on Dermatology and Aesthetic & Plastic Surgery

Fibrosis after endolift laser treatment

Lasers & EBD

Keywords:

Energy-based devices (EBD)

Anonymous

Posted on November 6th, 2025 00:43

Patient description

Case description

A patient presented to our clinic after receiving an endolifting laser treatment on the neck in which we believe was done to superficial. She reported taking high doses of collagen supplements that were not prescribed by our clinic. She developed persistent swelling following the procedure and underwent five sessions of lymphatic drainage massage. She mentioned that the individual performing her lymphatic massage directed the fluid upward toward the face rather than downward toward the neck, after which the swelling did not resolve.

She wore compression continuously (24 hours a day) for 15 days, and approximately 18 days later, she returned with a seroma and severe fibrosis. Serous fluid was aspirated daily for seven days. She has undergone enzyme injections, ozone therapy, and PRP treatments, with only partial improvement in swelling. Two days ago, the fibrotic tissue was surgically extracted, but residual fibrosis remains. The patient continues to experience palpable nodules, swelling, pain, and bruising.

Over the past seven days, she has been wearing daily compression and has completed three sessions of hyperbaric oxygen therapy and red-light therapy. Her current medications include Danzen 10 mg every 8 hours, Keflex 500 mg every 8 hours, Ketorolac 30 mg, and Tylenol 1 g.

The fibrosis appears to be adherent to the SMAS layer; therefore, once the seroma resolves—expected within the next two days—we are considering HEUS-assisted lipolysis with a cannula as a potential treatment to address the residual fibrosis and surgical release of the overlying skin from the SMAS layer.

How would you approach management in this type of post-endolifting fibrosis and seroma case?

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Dr. Fadi HAMADANI

Alert coordinator

Plastic Surgeon, Palestine

Posted on November 6th, 2025 01:07

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Thank you for sharing this complex and challenging case.

I have a few questions to clarify the timeline.

1. When exactly was the endolift laser treatment performed?

2. The image on the right seems to show a hematoma/seroma — could you confirm when this was taken relative to the initial procedure? And when was the left image, showing the fibrotic undulations and skin tethering, taken?

3. Was the laser passed along the SMAS plane, subcutaneous plane, or more superficially? Understanding this could help determine the mechanism of fibrosis formation.

4. Has ultrasound been performed recently to evaluate the extent and depth of fibrosis, as well as any residual fluid collection?

5. You’s instigated a lot of measures. Has there been any improvement with enzyme injections, red-light therapy, or compression in the last week?

Once these points are clarified, I’d be happy to share several approaches I’ve used in similar post-energy fibrosis and seroma cases, particularly in the neck and jowl region.

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Anonymous

Posted on November 18th, 2025 02:10

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Dr. Dianne QUIBELL

Alert coordinator

Internal medicine, United States

Posted on November 6th, 2025 12:34 Edited on November 6th, 2025 12:34

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Dr. Juliah TBARANI O SHEA

Cosmetic Surgeon, Ireland

Posted on November 9th, 2025 14:44

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Dr. Jameel Ismail SAYED

Dermatologist, Qatar

Posted on November 12th, 2025 12:59

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Anonymous

Posted on November 13th, 2025 22:29

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Dr. Fadi HAMADANI

Alert coordinator

Plastic Surgeon, Palestine

Posted on December 3rd, 2025 17:59

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This is a structured approach I use for early post-traumatic or post-inflammatory fibrosis. The goal is to act quickly, combine enzymatic therapy with anti-fibrotic injections, and incorporate mechanical remodeling to prevent long-term tethering and contour abnormalities.

1. Home-Based Measures
	•	Warm compresses twice daily.
	•	Follow each session with a gentle massage roller to support lymphatic drainage and help soften early fibrosis.
	•	Continue manual lymphatic massage.

2. PB Serum HIGH (no disclosures)
	•	Order PB Serum HIGH, ideally 3–4 vials, as repeated sessions are typically required.
	•	Enzymatic treatment remains one of the most effective ways to target and break down early fibrotic tissue.

3. Interim Protocol (While Waiting for PB Serum)

Start hyper-diluted triamcinolone + 5-FU:

Preparation:
	1.	Draw 0.25 mL of triamcinolone 40 mg/mL (10 mg) and dilute to 2 mL.
	2.	Add 1 mL of 5-FU 50 mg/mL.
	3.	Add 1 mL diluent → final volume: 4 mL.

Technique:
	•	Use a long 25G needle to reach the deep fibrotic bands.
	•	Inject small aliquots along each band.
	•	For the first sessions, use a needle.
	•	Once the bands begin to soften, switch to a cannula to mechanically break the bands and deliver the same solution.

Frequency: every 2 weeks.

4. Alternating Protocol (Once PB Serum Arrives)

Alternate weekly:
	1.	Week 1: PB Serum
	2.	Week 2: 5-FU + triamcinolone
	3.	Week 3: PB Serum
	4.	Week 4: 5-FU + triamcinolone

Repeat this cycle and adjust based on tissue response.

5. Advanced Remodeling (Later Stages)

As the fibrosis softens, additional options can be integrated to enhance skin quality and contour, such as:
	•	Profhilo,
	•	Biostimulators,
	•	Other targeted remodeling techniques.

Final Thoughts

This is a time-sensitive process—early intervention is critical. A combination of enzymatic therapy, anti-fibrotic injections, and mechanical remodeling gives the highest chance of reversing fibrosis before it becomes permanent.

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Fibrosis after endolift laser treatment

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