Chin Lipo (Tumescent): Open Versus Closed Drainage?

Question

I am considering submental liposuction to get rid of a smallish double chin, and have consulted with several plastic surgeons. One, who is highly recommended, says he puts in a stitch or two at the incision site under the chin. Why would a surgeon do this? I was under the impression that open drainage leads to faster recovery and less swelling. Can there be a stitch and still open drainage? Or does a stitch automatically mean closed drainage? is there any ultimate difference in outcome?

Larry S. Nichter, MD, MS, FACS · Answer

Open Incisions vs Closed for Liposuction is highly variable based on surgeon's preference. If they are to be closed then it would be right away, not 3 days later. 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. The ultimate scar has a better chance of being smaller if sutured. I do not see an advantage in not putting in a stitch.

Vivek Bansal, MD · Answer

No ultimate difference with or without a stitch. The scar just heals a bit better with a stitch. The body absorbs the fluid readily. Swelling after the surgery will have more fluid in the area, but it will not be draining, reabsorbing so don’t be too concerned about open drainage. Open drainage is more of an issue with abdomen or leg liposuction.

Kenneth D. Steinsapir, MD · Answer

Plastic surgeons are not the only type of specialist that offer this service. Chin liposuction is a very comfortable procedure that can be done in an office procedure room under local anesthesia. The procedure is best when performed with microcannulas. The largest of these are less than 2 mm in diameter. They can be advanced under the skin through a tiny poke that does not need a stitch. My patients have this procedure on a friday and are back at work on Monday with minimal swelling and often no bruising. However, the larger the cannula the surgeon used to do the liposuction, the bigger the incision. When the incision is big, it will need to be sutured closed to minimize the scar. Regarding "open" drainage, practically, there will be a small amount of drainage but within hours, these wounds will stop draining. This is normal and the volumes involved here are minimal so closing a small would with a stitch or leaving the small wound to close on its own really has no bearing on out come. It might be reasonable for you to consult a different specialty for this procedure like a derm surgeon who offers tumescent liposuction.

Elizabeth F. Rostan, MD · Answer

One of the greatest things about chin lipo is the ease and safety of the procedure and the rapid recovery. I use a small blade to make a tiny stab incision that disappears in about 10 days. I have never had trouble with poor healing or unsightly scars. Unless something happens to enlarge the tiny hole, I never close it with a stitch

Darryl J. Blinski, MD · Answer

Most suture this area. The concept of open vs closed is not usually used in chin liposuction. Closing also allows better scar formation.

Barry L. Eppley, MD, DMD · Answer

Liposuction of the submental area and neck is a limited size procedure. As a result, there is no need to employ the concept of drainage. The amount of fluid that needs to be resorbed is small and within the capability of the body to do so. Therefore, closing the very small submental incision simple helps it heal better and more quickly. If one really wanted to use drainage for neck liposuction, the incision would have to be at the bottom of the neck to work with gravity. You may be confusing the drainage principle with larger body areas of liposuction, particularly when Smartlipo is used, where keeping the small incisions open does help expell a lot of fluid in the first few days after surgery when combined with compression wraps. Unlike the neck, these body areas benefit from having larger amounts of fluid removed so the body has less to absorb.

Louise Ferland, MD (retired) · Answer

Since it is as you stated a small chin liposuction there is no advantage to leaving the incision open to drain as little to NO drainage is expected. Suturing the small wound(s) closed would help make a finer scar and possibly reduce the risk of infection. Choose your plastic surgeon based on his or her experience and your comfort level and not on whether they will leave the wound open. Tumescent liposuction is the norm for Plastic surgeons trained in the past 25 years since it was popularized. Best wishes.

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