Policies regarding the timing of follow up visits after liposuction vary from surgeon to surgeon. Some surgeons have patients return within a day or two after surgery and again a week later. For example, if a surgeon closes incisions with stitches, then the patient usually must return a week after surgery for suture removal. On the other hand, when the tiny incisions are not closed with stitches, then the surgeon can usually follow up with the patient by telephone. Thus, while patients are informed that they may return at any time for a follow-up visit, most patients will only return for a personal encounter if there is a specific concern or problem.
When liposuction is done totally by local anesthesia, patients can usually depart from the surgical facility within 30 minutes of the completion of surgery. When general anesthesia is employed, then patients usually require one to three hours of post-anesthesia observation before being discharged home.
After liposuction when general anesthesia is used, patients must be observed in a recovery room until it can be determined that blood pressure is not too low, and that there are no significant post-operative problems such as dizziness or nausea and vomiting. With the Tumescent Technique, there is virtually no blood loss and with local anesthesia there is rarely any nausea. After completion of liposuction by the tumescent technique, patients are discharged home in about 30 minutes.
The length of time until the post-operative swelling has decreased and the permanent results of liposuction become visible depends on the surgeon’s technique. If the surgeon uses the “open-drainage” technique where incisions are not closed with stitches, then most patients can expect 90% of the swelling to resolve in about 4 weeks. If the surgeon closes all of the incisions with stitches, then significant swelling may persist for 8 to 10 weeks.
5. What is a seroma?
A seroma is a collection of serum (also known as lymph fluid) within a cavity inside the body. Serum is the yellowish liquid portion of blood that remains after the red blood cells (which transport oxygen to the body’s tissues), and white blood cells (which fight infections) have been removed. A seroma can occur after liposuction. It is generally a nuisance, but not a serious complication. Without treatment, a seroma will usually resolve slowly over several weeks to many months. To accelerate the disappearance of a seroma, the surgeon may remove the serum by inserting a needle and draining the seroma into a syringe. Seromas may be caused by the use of large diameter liposuction cannulas, or excessively aggressive liposuction in a localized area of fat. Seromas are a common adverse result of ultrasonic assisted liposuction (UAL). Seromas rarely occur when surgeons use the tumescent liposuction with microcannulas and use the “open-drainage” technique for post-liposuction care.
Seromas after liposuction are the result of surgical trauma which injures or destroys the lymphatic vessels within the targeted fatty tissue. Lymphatic vessels are tiny, thin-walled tubular structures located throughout the body, and have the specific function of draining tissues of fluids that leak out of capillary blood vessels. Excessively large liposuction cannulas not only create large empty pockets within targeted fatty tissues, but also remove lymphatic vessels. Both of these conditions encourage the formation of seromas after liposuction. Unfortunately, seromas are a common problem after ultrasonic assisted liposuction (UAL). Ultrasonic liposuction cannulas create a considerable amount of heat which injures blood vessels as well as the delicate lymphatic vessels. Without lymphatic vessels to drain away excessive lymph fluid, the fluid collects within the excavated spaces in the fatty created by the liposuction process.
Seromas are prevented by 1) avoiding excessive surgical trauma to the delicate lymphatic vessels within fat, and 2) by encouraging post-operative drainage of lymph fluid (serum) from the fatty tissues treated by liposuction.
First, the use of microcannulas can reduce the risk of seromas. Micro-cannulas are relatively small liposuction cannulas having an outside diameter less than 3 millimeters. By making relatively small tunnels within the targeted fat, micro-cannulas do not create large empty cavities within which a seroma can form as readily as larger cannulas. Large cannulas remove fat more rapidly, but are more likely to cause seromas because large cannulas tend to damage lymphatic vessels, and create larger cavities within the fat.
Second, when incisions are closed with stitches, a relatively large amount of fluid is trapped under the skin where it collects and stagnates in the tunnels within the fat, thus causing a seroma. By not closing incisions with stitches (the “open-drainage” technique) and by using efficient compression garments, the drainage of blood tinged tumescent anesthetic solution and the lymphatic exudates is encouraged. Compression garments squeeze the walls of the empty tunnels together, which encourages the tunnel walls to adhere and grow together thereby obliterating the empty cavities in which seromas tend to form.
Compression garments can help prevent seromas. Compression garments reduce both the number and size of seromas. The most important measure in the prevention of seromas is the use of micro-cannulas to reduce the degree of surgical trauma caused by liposuction. The surgical trauma is reduced by doing liposuction using only micro-cannulas (outside diameter less than 2.8 mm) and by not using ultrasonic assisted liposuction (UAL).
Most patients can return to a desk-type job with two days after tumescent liposuction. Because of the significant decrease in swelling, inflammation and pain after tumescent liposuction, patients are able to return to normal physical activities very soon after tumescent liposuction. There is no limitation to physical activity other than what common sense would dictate. Some patients are able to return to jogging, golf, light aerobic exercise within a day or two after surgery. Some patients do find the soreness after surgery more significant than others, but on the average, most patients are quite surprised at how quickly they are able to return to normal activity.
Ideally one should never be confined to bed after liposuction. In order to avoid the risks of blood clot formation in the legs or lungs, most liposuction surgeons recommend immediate walking on the evening of surgery. The amount of liposuction attempted on a single day is probably excessive if the patient cannot get out of bed and walk around the house on the night of surgery, and walk around outside the house the day after surgery.
Most patients should be able to return to normal desk-type work within 1 to 3 days after liposuction. Although soreness and tenderness will limit the speed with which a patient can move about, patients should be reasonably comfortable while sitting at a desk or working at a computer.
The more areas treated by liposuction on a single day, the more soreness and disability the patient can expect. Patients, who have liposuction on only one or two areas, should usually be able to return to work in less than 24 to 48 hours. Thus, a patient who has liposuction on a total of 4 areas may not miss any time off from work if only two areas are treated at a time, and the two surgery days are at least one month apart. In contrast, after liposuction of four areas on a single day, a patient may require one week of bed rest and recuperation at home.
Within one to two days after surgery, all patients should be physically able to walk around inside the house and go for short walks around the neighborhood. Remaining in bed and not walking increases the risk for blood clots in the legs and lungs. One of the reasons that excessive liposuction surgery on a single day is so dangerous, is that too much surgery may require pronged bed rest, which increases the risk of fatal blood clots in the lungs.
Most patients can resume their routine exercising within a few days after liposuction. Initially, patients should not attempt too much exercise. It is recommended that patients start out by doing about 25% of their usual amount of exercise, and thereafter increase their daily exercise as tolerated.
Unless the surgeon gives explicit instructions to avoid flying, most patients can fly on a commercial airline within 24 hours after liposuction. For many weeks after surgery, patients must avoid prolonged sitting in a car or airplane. Prolonged sedentary inactivity (such as sitting in an airplane for long intervals) increases the risk for deep-vein thrombosis (blood clots) in the legs and the risk that such a blood clot might travel from a leg to the lungs causing a pulmonary thromboembolus.
There are no restrictions regarding sexual activity after liposuction other than limitations imposed by postoperative soreness and tenderness of the treated areas. Otherwise liposuction usually does not interfere with a patient having gentle sexual encounters.
The duration of bruising and swelling after liposuction usually depends on the post-operative care technique used by the surgeon. The amount of bruising varies considerably between patients.
The tumescent technique for liposuction used together with the “open-drainage” technique (skin incisions are not closed with stitches) reduces the amount of bruising after liposuction. With tumescent liposuction, bruising is nearly absent one to two weeks after surgery in most patients.
By not using stitches to close incision sites, the rate of drainage of the blood-tinged anesthetic solution is accelerated. This minimizes the amount of bruising.
With open-drainage (incisions are not closed with stitches) and appropriate compression garments (worn for 3 to 6 days) swelling is 90% resolved 4 weeks after liposuction. When incisions are closed with stitches (trapping residual blood-tinged tumescent fluid beneath the skin) swelling persists for much longer, and is typically 90% resolved after 8 to 12 weeks. With ultrasonic assisted liposuction (UAL) significant swelling can persist for many months.
New techniques for post-liposuction care allow more rapid recovery, less bruising, less swelling and less prolonged tenderness. This is achieved by encouraging rapid “open drainage” of residual blood-tinged solution of tumescent local anesthesia. By allowing the tiny incision sites to remain open without being closed by stitches and by using special absorptive pads (HK Pads) together with post-operative elastic compression garments bruising, swelling and pain can be minimized. With open drainage, patients can usually see dramatic improvements within two to four weeks after surgery, and they can expect to see 90 percent of the final result within 4 to 6 weeks. With older techniques that closed incisions with sutures, the ultimate results following liposuction usually require 12 to 16 weeks to become fully apparent.
There is no strict rule concerning the optimal amount of time between successive liposuction surgeries. Safety concerns are more important than is any consideration about convenience for the patient or surgeon. Experience has shown that performing sequential surgeries within 24 to 48 hours of each other is associated with increased risks of serious complications. Waiting approximately 3 to 4 weeks between sequential surgeries allows the body to recover sufficiently to minimize the risks of blood clots, excessive bleeding, skin necrosis and infections.
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..