4 days post op, why is my skin bright red after liposuction? It is hot to the touch and very sore. (photos)

Itching is fairly common after surgery.  If there is any sign of rash or allergic reaction, that would be something different.  My patients choose to wear a soft cotton t-shirt under the garment to lessen the itching.  Follow up with your PS to determine if any of your medications could be the culprit.  Keep a positive attitude, and eat/drink enough complete protein to facility wound recovery.
Kenneth Hughes, MD, Board Certified Plastic Surgeon
Los Angeles, CA

seb860.  So sorry to hear you are having this issue, and obviously, in-depth evaluation and examination is needed. However, it appears from your photos that you are experiencing a rash or allergic reaction, probably from the garment. Your plastic surgeon should treat this issue immediately. In the meantime, either stop wearing the garment or wear a T-shirt and then place the garment over the T-shirt. Please see your surgeon right away.

This appears to be an allergic reaction given the distribution on your skin but an infection cant be ruled out.  If you develop fevers or chills you should be seen immediately by an ER or your surgeon.  Most likely you need a course of oral steroid to get the reaction under control.  Usually within a few days after starting an oral course of steroids it will subside and you will feel better.