Christopher Chung, M.D.
American Board of Plastic Surgery
Chief Medical Officer
While there has always been a fairly predictable framework for liposuction recovery, we have had substantial enhancement of the process over the last few decades, following scientific understanding and clinical correlation.
There are two fundamental evolutionary steps in the surgical delivery and recovery process that have improved outcome and reduced overall downtime:
– Establishment of superiority of Tumescent Technique. The use of a dilute solution of lidocaine and epinephrine for control of surgical bleeding and local anesthesia has become the standard technique for liposuction. This technique has demonstrated clear advantage in safety and cost-benefit over general anesthesia.
– Management of acute wound milieu. Changes in clinical practice regarding the encouragement of open drainage from wound sites and the titration of the amount and timing of phased compression garments have resulted in the sophisticated management of the inflammatory exudate following the surgical injury of liposuction.
A useful conversation of liposuction recovery should begin with a discussion of typical milestones.
– Days 1-2. During this time, the effects of the local anesthetic will wear off. The magnitude of the acute surgical discomfort may well require narcotic analgesic pain relief. The volume of serous drainage will be greatest during this time. The dressings will need to be frequently replaced. While the drainage will certainly be blood tinged, it should be emphasized that the actual amount of blood that is lost is very minimal. During this first 48 hours, the maximum impact of the original compression garment is realized.
– Days 3-14. Drainage will have completely stopped by day 4. The need for the early acute high compression garment Is now waning, and by day 7, the more comfortable second stage garment may be applied. The early garment is applied to help express the acute inflammatory exudate from surgery, and the second stage garment is intended to assist in comfort. This strategy in switching from an initially high compression garment to a lower compression garment is known as bimodal compression therapy. Typically, a clinical encounter will be arranged around days 7 to 10 to evaluate the progress of wound healing and to assess for any acute concern such as infection or retention of fluid. Many patients that are employed in sedentary positions find its possible return to work at this point. Those who are laborers and are more active may need an extended period of time to resume full work responsibilities.
– Days 15-28. The surgical incisions will have all completely healed. This period of time will be marked by substantial decrease in post-operative swelling that had been recognized in prior weeks. The general constitution will have improved to the point that light to moderate exercise can be introduced into the daily routine.
– Days 29+. This period is marked by the conversion of the acute inflammatory edema phase to a phlegmonous subacute wound healing phase. There is also substantial progress in exercise tolerance and ability to resume fitness routines. The period between the third and the sixth month is marked by ongoing resolution of the inflammatory phlegmon and the progressive reveal of the final contours.
While it is suspected that some individual variation will occur with the above, it is helpful to have consistent guidelines and establish expectations preoperatively.
Helpful secondary nuances in liposuction recovery:
– As in most health-related paradigms, diet has a substantial impact. Specifically, it is helpful to the patient to maintain hydration through an adequate fluid intake, but inadvisable to have foods or fluids that are rich in electrolytes and salts which promote edema.
– Activity is to be encouraged, as this helps avoid the pooling of blood in the lower extremities and pelvis and contributes to risk reduction of thromboembolic events.
– Massage has advantages that can be realized through encouraging lymphatic drainage reorganization of a scar, stretching, and stress mitigation.
– Of particular importance regarding the choice of clothing Is to avoid wearing tight waistbands and other focally constrictive garments, as substantial contour irregularities can be created by poorly fitting clothing.
The focus on the biomechanical details and improvements in the technique of surgical delivery and recovery is the hallmark of the collected experience of over 100 board certified plastic surgeons performing over 140,000 surgeries during the last ten years by the Sono Bello clinical team.
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