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Drainage and Swelling After Smart Lipo and Tummy Tuck

I had a Tummy Tuck a week ago. The doctor did Smart Lipo and then the Tummy Tuck. I ended up with a huge incision from waist to waist, and I am actually larger in my midsection than I was pre-surgery from all the swelling. I don't see any way for the liquid to come out, I don't have any drainage. My doctor wants me to do 3 sessions of ultrasonic therapy to help my healing and drainage. I am already unhappy with the results. Is this normal? Is this worth the extra pay for the treatments? Please advise.

Doctor Answers (14)

Not all plastic surgeons use drains


Dear Sunnysideup (sounds to me like someone very optimistic)

Not all plastic surgeons use drains. There is a technique that some of us use all or part of the time using quilting stitches to hold the fascia down to the muscle. In some patients drains are not used, but I personally use drains for at least 6 days on all tummy tucks.

I am a little concerned about using smart lipo or any lipo of the abdomen in conjunction with a tummy tuck. There are many doctors that perform this but I prefer to separate it into 2 procedures as I can be much more aggressive with the suctioning when I do.

You must also consider the psychological roller coaster you are on during the healing period and take this into account. Excitement of the surgery followed by the letdown that you are swollen, sore and not ready to be in a bikini.

Swelling can easily take 3 to six months to fully resolve. Speak to your plastic surgeon and express you concerns. You may need to have a seroma drained or a drain inserted, but continue your follow up with your doctor. I am sure you will be happy with your result in the end.

Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

Swelling and drainage is normal


To assist with pain control and to prevent bleeding, fluid is first injected into the tissues prior to beginning liposuction. This fluid often drains out over the first 72 hours post operatively. I am a bit surprised that after a tummy tuck in combination with smart lipo that you do not have drainage tubes. Have they already been removed? If no tubes were used, then I would be concerned that you are developing some fluid underneath your surgical site. If this is the case, you may need to have this fluid removed which can be done in the office. Multiple removals will most likely be needed unless a drainage tube is placed. This is a problem that can be treated and still leave you with a very nice result. A tummy tuck takes months to fully recover from.

David Rankin, MD
Jupiter Plastic Surgeon
5.0 out of 5 stars 51 reviews

Hang in there after Smartlipo and Tummy Tuck


As the other doctors have mentioned, it is still very early in the postoperative period for you. Swelling can persist for up to 4 months time. For patients who have liposuction at the same time as abdominoplasty, the swelling may even take longer before going away.

As it appears in the pictures, you don't have any drainage tubes. My only concern at this point would be that there may be fluid (seroma) under the skin and fat (abdominal flap). Your doctor can determine this by simple physical exam and look for what we call a "fluid wave".

If there is fluid, then it can simply be aspirated in the office. That would be the first thing to rule out prior to the ultrasounds and hopeful waiting.

Hang in there, you still have a while to go to see your final results. Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 39 reviews

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One week is very early post op.


SunnySideUp, One week is very early post op to determine whether you are happy with the outcome. You will still have significant swelling and bruising and discomfort. However, you should have some drainage. Did the surgeon place drains in you and take them out already. If not, you may have a fluid collection which needs to be drained in the office. Good luck with your recovery. David Shafer, MD New York City

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 57 reviews

SmartLipo and tummytuck


You need to find out if you have a fluid pocket (seroma) which can and should be drained, or if it is just swelling or fluid in the tissues that can't be drained but can be reduced by other means. Be patient! It's tough but it takes weeks to months to really begin to see the results of an operation like you had!

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 17 reviews

Smart Lipo


I would recommend you see a Board Certified Plastic Surgeon for an opinion.  Swelling is normal and should reabsorb.  However, you should be evaluated in the event you have fluid collection, especially if you did not have a drain. 

Sonia Badreshia-Bansal, MD
Bay Area Dermatologist
4.0 out of 5 stars 10 reviews

Drainage issues after Tummy Tuck and Lipo


You have gotten some good advice about swelling and drainage after abdominoplasty and Lipo, mainly that one week is too early to tell much. I am a fan of the pregressive tension sutures that seem to be very helpful in reducing fluid build-up. There are those who believe that no drains are necessary with this technique, though I still use them most of the time for a day or two. One thing I have noticed is that when lipo is done simultaneously (usually in the flanks or other areas adjacent to the tummy tuck), there is more drainage since additional fluid has to be injected where the lipo is done.

One thing I can't tell in your case is where the lipo was done. If it is an area adjacent to the tummy tuck surgery then swelling is certainly normal (it woulnd't have been necessary in the same area).

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 25 reviews

Swelling after Smart Lipo and Tummy Tuck


Having swelling after this procedure is common and should be expected.

Definitely give it time.

Each surgeon has different methods of managing their outcomes and your surgeon may feel strongly about ultrasound.

It is not unusual for patients to weigh 5 pounds or more over their preoperative weight.

Take care.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Fluid may need to be drained


It is not unusual for the patient to be larger than preop in the first week due to swelling.

I do not see any drain tubes - do you have any? It must be ascertained if you have free fluid under the flap (seroma), in which case it must be drained, or you just have swelling.

Swelling will usually resolve over time, with the assistance of compression garments, etc.

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 47 reviews

Hang in there...


It is very common during the early recovery period after an aesthetic surgical procedure for patients to experience feelings of apprehension and doubt, and even distrust of the professional that only days before they themselves had selected to perform an operation on them. It's human nature to be excited and full of anticipation for your new, more shapely contour, and when all you can see is your long scar and a bloated belly full of swelling, it's difficult for you to imagine how you'll be able to get to where you thought you were going.


It's really important that you keep all of your follow up appointments, and discuss your concerns openly with your surgeon. The doctor patient relationship is just like any other- it works best when both parties communicate openly and honestly with each other.

I don't perform Smartlipo, preferring the VASER- but I know that what you are experiencing is common, and usually will subside with time, compression, and yes, with massage.

I agree with the other responding physicians that your best bet is to talk with your doctor, follow all of their instructions carefully, and give yourself time to recover and heal before passing judgement on your outcome.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 103 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.