In the early days of liposuction, before the tumescent technique had been invented, elastic compression garments (specially designed girdles) were intended 1) to reduce bleeding immediately after surgery and 2) to reduce swelling the time that the body is healing. Tumescent liposuction has eliminated surgical bleeding. (See About Tumescent Liposuction).
With the tumescent technique, there is always a certain amount of blood-tinged anesthetic solution which remains beneath the skin where the fat has been suctioned. This blood-tinged fluid causes bruising and the post-operative swelling known as “osmotic-edema”. With tumescent liposuction, the function of the compression garment depends on the whether or not the surgeon closes incisions with stitches. With the modern “open-drainage” technique for post-liposuction care, the tiny incisions/adits are allowed to remain open (not closed with stitches), and the reason for using compression garments (need only be worn for a few days) is to encourage the rapid drainage of the residual blood-tinged tumescent anesthetic solution from beneath the skin. With “closed-drainage”, the reason for using compression garments (which must be worn for several weeks) is to force the absorption of the blood-tinged anesthetic solution into the body’s blood vessels.
Most surgeons require that patients wear an elastic compression garment for a certain length of time after liposuction. Such garments are intended to provide continuous postoperative compression to areas treated by liposuction. Some garments are constructed from Lycra type cloth. Other garments are made from elastic cloth typical to that used for girdles. The garments are usually crotchless so that the patient can urinate and defecate without having to remove the garment.
The length of time that a patient must wear an elastic compression garment depends on the type of aftercare technique preferred by the surgeon. If the surgeon closes the incisions with stitches then patients are typically instructed to wear a garment for 2 to 6 weeks. If the surgeon places stitches in the skin incisions, then the blood-tinged tumescent solution remains trapped beneath the skin causing prolonged bruising, swelling, and tenderness, which in turn requires the patient to wear an elastic compression garment for an extended length of time.
With the open drainage technique (skin incisions/adits are not closed with stitches) for post-liposuction care, an elastic compression garment is typically worn for an average of only 3 to 6 days. With “open-drainage” patients must wear compression garments for 24 hours beyond the time when all drainage has stopped. For example after tumescent liposuction of the outer thighs, if all drainage stops after 3 days, then the garments must be worn for 4 days.
After tumescent liposuction there is always some residual blood-tinged tumescent local anesthetic solution that remains under the skin within the treated areas. If this blood-tinged fluid is allowed to remain under the skin, it increases the degree of bruising, swelling and tenderness. By using “open-drainage” with good compression, most of this fluid is “squeezed out” within the first 24 hours after surgery, and healing is more rapid. When surgeons close the incisions with stitches, then the blood-tinged tumescent fluid is trapped under the skin, and can cause prolonged inflammation, swelling and the formation of seromas.
Yes, the large volume of blood tinged drainage is readily controlled by placing super-absorbent pads (sterile HK Pads, available from HK Surgical, Inc.) directly on the skin over open liposuction incisions, and then applying elastic compression garment(s) over the pads.
“Bimodal compression” describes a technique that uses two degrees of compression after liposuction. Initially, a high degree of compression is used to accelerate the drainage of blood-tinged tumescent anesthetic solution from open incision sites (incision not closed with sutures). Next, the degree of compression is reduced after all drainage has ceased, in order to avoid excessive compression. If there is too much compression after all drainage has ceased, the lymphatic vessels are squeezed shut and prevented from absorbing the remaining blood-tinged tumescent fluid. Bimodal compression is easily achieved by initially using two compression garments, one on top of the other, which provide additive compression. After all drainage has ceased, wearing only one garment provides enough compression to reduce the risk of seroma formation, but avoids the risk of preventing the absorption of residual fluid by lymphatic capillaries.
Too much compression can prolong swelling and edema. Excessive compression after all drainage has ceased, can impair the normal function of lymphatic capillaries which is to absorb residual tumescent fluid and inflammatory exudate from the tissues of the liposuction site.
Too little compression will permit the accumulation of fluid within the tunnels created by the liposuction cannula within targeted fat.
Although Reston foam does reduce bruising after liposuction, its dangers far outweigh its benefits. Reston foam consists of a 3/8 inch thick sheet of sponge-like plastic foam pad with adhesive applied to one side. The intended use of Reston foam is to prevent bedsores by applying the adhesive-backed foam to the bed sheet beneath a patient’s heels or buttocks.
A bruise occurs when red blood cells leak out of blood vessels and move toward the skin surface. The application of Reston foam directly onto skin beneath a compression garment, tightly compresses the skin’s collagen fibers and prevents bruising by impairing the outward percolation of red blood cells from the liposuction wound toward the surface of the skin.
Reston foam applied directly to skin can compress capillary blood vessels. This impairs oxygen delivery to the skin, and can cause blistering and ulceration of the skin. Several patients have died from infection (necrotizing fasciitis) associated with the use of Reston foam after liposuction.
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Allure Medspa., Mumbai
Dr. Milan Doshi- Founder and Medical Director of Allure Medspa, He is (M.S, M.Ch) Indian Board Certified Plastic Cosmetic Surgeon with International Expertise and qualification (Member of ISAPS- International Society of Aesthetic Plastic Surgeon). Read more..