7 months post op - What are some solutions that can help with healing seroma? (photos)

Hello and thank you for your question regarding the persistent seroma you are experiencing seven months post-op from your thigh lift surgery.

You have a fluid collection that has been recurrent despite the use of drains and manual aspiration. This is indeed a challenging situation, especially since the fluid collection is not capsulized, which complicates typical management strategies.

Given that aspiration and drain insertion have not been effective and are causing you significant discomfort, a more definitive surgical intervention may be necessary. One surgical option involves local anesthesia to open the fluid capsule and insert a sterile surgical rubber tube, such as a Penrose drain. This tube would typically be placed to extend from the top to the bottom of the capsule (from 12 o'clock to 6 o'clock position). The drain allows the seroma fluid to continuously leak out until the fluid production ceases, which can take several days to weeks. Once the drainage stops, the Penrose tube can be removed, and the capsule should ideally seal and heal without further intervention.

Another surgical alternative is to reopen the incision and completely remove the capsule. However, there is a risk that another seroma may form in the same area.

Injecting the capsule with a sclerotic agent to scar down the seroma cavity is another option, although you mentioned it usually does not work well. Given your circumstances, opening the capsule and inserting a Penrose tube appears to be a practical solution.

I recommend consulting with a plastic surgeon who specializes in body contouring and revision surgeries. It’s crucial to find an expert who has extensive experience with thigh lifts and their complications to ensure you receive the best possible care.

Good luck, and I hope this solution provides you with the relief you need. Thank you for reaching out with your concerns, and I wish you a smooth recovery moving forward.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Surgery needs to be performed to treat this problem. Most commonly, the scar would be incised to expose the chronic seroma's lining, which would be removed. Another drain is almost always placed. Alternatively, some or all of the lining can be removed or cauterized, followed by placement of quilting sutures to obliterate the space. No drains required. Given the location and speed of seroma formation, this likely due to larger lymphatic vessels draining into the space. My preference would be to NOT place another drain once the space has been obliterated tightly with sutures.

I'm sorry to hear of the issues you have had from your thigh lift. Seromas can be frustrating. I encourage you to continue to closely follow the advice of your surgeon and discuss all questions. Because of the persistent nature of your seroma further surgery may be indicated in order to address it.