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Should a Doctor Leave the Incisions Open After Tumescent or Smartlipo?

I am having a combo of tumescent and smartlipo on my inner and outer thighs, abdomen, hips and arms. My doctor plans on closing the incisions. I have read several places that this is not a good practice as it promotes swelling and a compression garment is required for a longer period. What is your opinion?

Doctor Answers (15)

Not closing the incisions can lead to a more visible scar and scar revision surgery.

+3

I routinely close the incisions because the few seconds it takes to do so will generally result in a less noticeable scar. Yes, many surgeons prefer not to close them to allow for drainage of the tumescent fluid thereby possibly but not necessarily reducing post-op swelling and bruising.

However, not closing these incisions can result in a wide and depressed scar that can be quite noticeable. I have seen them and have performed scar revision surgery on them. I would rather risk a longer recovery then a more visible scar and the need for scar revision surgery.


Chicago Plastic Surgeon
5.0 out of 5 stars 60 reviews

Liposuction - Some things matter; this one probably doesn't

+3

I always close my liposuction incisions, and most if not all board certified plastic surgeons I know do the same.

For some reason, it seems as if many non-plastic surgeons that do liposuction tend to leave the incisions open, placing bulky dressings to soak up the fluid. They make exactly the arguments you made in your question, namely that by leaving the incisions open the swelling goes away faster. They probably also would argue that the incisions are just as good.

In my experience, leaving the incisions open leads to soppy wet and gross dressings, and an even bigger mess on your bedsheets than when the incisions are closed. There is pain medicine in that tumescent solution, and I think patients benefit from having it stay inside of them. The amount of fluid we give patients is carefully calculated in liposuction, and there is no way to account for the exactness of the fluid resuscitation if you don't know how much is going to leak out. And since your body absorbs that fluid anyhow in just a few days, I don't see how it could reduce swelling beyond those few days.

Finally, and it may only matter to me because I am a board certified plastic surgeon, I think the incisions look much better when they are closed nicely with a fine stitch. It's not just that the line is thinner, but many of the incisions I have seen that were left open tend to indent.

But no doubt there are good and thoughtful surgeons who leave them open. This is just my opinion. But it is a far less important issue than choosing the best surgeon you can. Be sure your surgeon is certified by the American Board of Plastic Surgery: the only ABMS board recognized to credential plastic surgeons.

Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 28 reviews

No Need to Leave incisions open after liposuction

+1

Most Board Certified Plastic Surgeons close liposuction incisions regardless of the type of liposuction used (Smart Lipo, Ultrasonic liposuction, conventional or PAL - power assisted liposuction. In my more than 2 decades of practice and trying each of these devices, I have not found any prolonged recovery by closing incisions. On the contrary I feel that I have prevented the mess and hassle to the patient.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 38 reviews

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Should liposuction incisions be left open?

+1

It is really a matter of persona preference and how these incisions were created. I sometimes do liposuction thru 14 gauge needle sticks, I will leave these open, but if incisions are created with a blade , I will close them.

Jonathan Weiler, MD
Baton Rouge Plastic Surgeon
4.5 out of 5 stars 15 reviews

Liposuction Incisions

+1

I don't think it makes a big difference whether the incisions are left open or closed.  It is more a question of doctor preference.  Leaving the incisions open leads to a more messy dressing as the fluid draining from the incisions can require you to change your dressings more frequently.  Fluid that remains inside if the incisions are closed will be absorbed by your body.  If you feel comfortable with your physician and are confident enough to consent to surgery I would accept his/her approach and not worry about this relatively insignificant issue.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 29 reviews

Open or close liposuction incisions

+1

I prefer to close incisions. I know of no research that shows leaving them open increases swelling. It hasn't in my patients.

Closing the incisions is civilized - it reduces the pinkish,sometimes bloody fluid that drains onto your clothes and sheets after liposuction.  

Forgive my cynicism, but today when a surgeon leaves incisions open, I have to wonder if it's to save money (sutures cost about $10 each) or time spent on you. I think you've found a surgeon who puts your first. Well done! 

 

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.5 out of 5 stars 18 reviews

Leaving incisions open after lipo?

+1

Each doctor should do what works best in his hands. I close my incisions but I don't have any argument with those that choose to leave them open, as long as there are no infections.

Dr Foster

Lawrence Foster, MD
Sacramento Plastic Surgeon
3.0 out of 5 stars 12 reviews

Should You Close Liposuction Incisions?

+1

Dear ymiller,    I personally prefer to close my liposuction incisions. I believe they will heal and ultimately look much better than if left open. The issue with swelling is not really an issue in my opinion. There is little fluid that remains after liposuction is performed and what does remain is slowly absorbed by your body over 24-48 hours. Since we keep pads and compression garments on for 5-7 days, the swelling is minimal. Leaving the incisions open leads to wet and messy garments, sheets and furniture. Most board certified plastic surgeons that I know, close all their incisions as well. Good luck.

 

 

Douglas L. Gervais, MD
Minneapolis Plastic Surgeon
5.0 out of 5 stars 74 reviews

A matter of opinion

+1

Hello,

I close the incisions but surgeons have differing opinions on this. The arguments for leaving them open are drainage and swelling reduction related. The arguments for closing them center upon better looking scars.

Best Regards,

John Di Saia MD

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

Best to leave incisions open after liposuction

+1

1)  We don't believe in Smart Lipo.  No science.

2)  We leave incisions open after liposuction to allow drainage.  Less bruising, and the scars are hard to find.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 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.