Liposuction is a surgical procedure with its own set of risks. As with any surgery, aftercare considerations are important and vital to ensure a smooth and safe recovery. Post Tumescent liposuction there is usually residual blood-tinged, Tumescent anaesthetic solution under the skin and there are several ways this can be removed.
Traditional Liposuction Aftercare
Prior to modern approaches to aftercare, surgeons relied on two primary practises. The first was to close the incisions using sutures and the second method was the use of high compression elastic garments for 4 weeks or more.
These methods, whilst common practise among surgeons in the early days of liposuction, were plagued by swelling, bruising, tenderness and several post-operative follow up visits to the surgeon.
Before the emergence of Tumescent liposuction, post-operative bleeding was commonplace. After the procedure, patients were asked to wear high compression garments around the operated area for several weeks to minimise blood loss and encourage faster clotting. Often, depending on the patient’s individual circumstances these compression garments had to be worn for up to six weeks to minimise swelling caused by the blood trapped under the skin.
Tumescent liposuction has changed all this. As postoperative bleeding is minimised and practically no blood remaining under the skin, the traditional aftercare methods are obsolete and may in fact, have negative effects by delaying healing and prolonging the swelling. The compression technique puts pressure on the lymphatic capillaries and adversely affects the lymphatic drainage system.
Open Drainage and Bimodal Compression
These are modern techniques that present the best results in terms of patient comfort, short healing times and reduced postoperative visits to the doctor.
The liposuction procedure results in some amount of bruising, swelling and tenderness primarily due to blood-tinged Tumescent solution remaining trapped under the top layer of the skin and injury to the subcutaneous lymphatic capillaries due to the incisions. Although, damage to the capillaries cannot be avoided during the procedure, the prolongation of the blood-tinged solution can be minimised using the open drainage method.
The open drainage method uses small adits (tiny round holes 1mm, 1.5mm or 2mm in diameter), made by a skin biopsy punch to encourage drainage after the operation. The adits are placed in strategic locations to maximise gravity-assisted drainage and are left open rather than being sealed with sutures to encourage open drainage. Bruising is reduced by the use of special pads that absorb the messy drainage and by using special elastic compression garments designed for optimal drainage and patient comfort.
As there are no sutures to be removed and less swelling and bruising with open drainage, patients don’t need to see the surgeon and have time consuming follow up examinations. Of course, patients should feel comfortable to see their doctor should they have any concerns, but regular follow ups for post-operative care are unnecessary.
Super – Absorption Pads
The open drainage method comes with the large quantities of blood-tinged Tumescent solution being discharged from the body. Super Absorption pads are used to prevent staining of clothes and furniture. These pads that measure 12×20 inches weigh just 6 ounces and can absorb more than a litre of water or more than 5.5 times their own weight. These absorbent pads have two primary functions; firstly, they absorb large quantities of the Tumescent solution improving patient comfort and hygiene and secondly they help in distributing the elastic compression garments force more uniformly throughout the body. This uniform compression narrows the gap between the interstitial collagen bundles in the skin and prevents red blood cells from moving towards the skin surface where it presents itself as a bruise.
Bimodal compression is a technique that uses 2 degrees of compression after liposuction. Initially, high compression is used whilst the Tumescent fluid is draining out and for a further 24 hours after drainage has stopped. Thereafter, the level of compression is either reduced or eliminated to avoid the formation of blood clots in the legs and lungs. 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 achieved by initially using two compression garments, one on top of the other. After all drainage has stopped 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.
Why isn’t the use of open drainage widespread?
There is still resistance to the open drainage method by some surgeons who prefer the traditional compression methods and garments. Putting on the traditional compression garments without super absorption pads is a very messy affair. It’s easier to just suture up the incisions and not have to contend with blood-tinged fluid draining all over clothing, bedding and furniture.