Internal Bleed After Full TT, Lipo, MR. 2 Wks PO and Still Super Hard, Swollen. Normal? (photo)

I am 5'5, 123lbs and a size 2. I had a full TT w/lipo, muscle repair 13 days ago. At my post op my PS said I had a bleed during surgery on my left side where the lipo was performed which is why it is really swollen, hard as a rock, painful & has redness that is working it's way downward. I feel fine besides the pain from the bleed but was told it would take longer to recover. Idea's on how long? The redness has subsided but the swelling & hardness has not changed. Will scar go down on L side?

Doctor Answers 5

Lump from hematoma will heal faster and give better result if it is evacuated.

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Your surgeon is certainly aware of the collection of blood within your tissues, and the location you have marked (thanks for including photos) seems to correspond to the hip roll area liposuctioned rather than beneath the abdominoplasty skin flaps. Since liposuction creates tunnels and tracts within your fatty tissues, bleeding in this area creates a stiuation much like a saturated sponge, rather than a blood-filled cavity.

In other words, this can act more like a "black eye" bruise (albeit a larger one) than a blood collection which can simply be drained or aspirated. That being said, at 2 weeks post-op, this size of hematoma may well be starting to liquefy, and a needle aspiration as my partner and other colleagues have suggested is certainly a reasonable, straightforward, quick, and not very difficult (or painful--you may still be partially numb here from your surgery) option to try. Any blood removed will be that much less your body has to remove, and your body does so molecule by molecule rather than by aspiration of an ounce or two all at once.

Massage therapy and ultrasound treatments can also help speed your recovery (we offer this to all our patients post-op at no additional charge), but you may still end up with some residual fullness or firmness in this area. Once everything has softened and matured for 6-12 months, revisionary surgery may be considered to improve your final result if needed.

Even when there is no hematoma or seroma after tummy tuck, it can take 6-12 months before the final result is seen, and having a hematoma does indeed slow the process of softening, settling, swelling resolution, and scar maturation.

For now, see your plastic surgeon and follow his/her advice. Best wishes! Dr. Tholen

Hematoma After A Tummy Tuck And Liposuction

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   Dear Shazaam333,

       Hematomas after liposuction are possible, but not very common. Your photos and descriptions are consistent with a hematoma on your left side. It is very difficult to aspirate a liposuction hematoma right after surgery and if it is not expanding (and yours wasn't) conservative management is warranted. However, you are now almost 2 weeks after surgery and many hematomas will have liquified by now and aspiration with a needle through the skin may be successful. This can make you feel better and will most likely improve your healing process. Good luck.

Bleeding and hematoma after tummy tuck

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Bleeding is very uncommon with liposuction and tummy tuck, though if the tissues are very swollen and tight, drainage is often the key to helping the tissue soften and heal faster. Your surgeon migh wish to start with an ultrasound to see what lies under the skin, and if the area can be drained the pain will rapidly improve as well.

Internal Bleed After Full TT, Lipo, MR. 2 Wks PO and Still Super Hard, Swollen. Normal?

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Sorry for the issue. I might ask for a scan to see if the "blood" is in an amount that would require operative removal. Otherwise try external ultrasound therapy. Please follow up with us 

Internal Bleed After Full TT, Lipo, MR. 2 Wks PO and Still Super Hard, Swollen. Normal?

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The hematoma from the liposuction certainly seems to be the cause of your current findings. It is not uncommon to have those finding after a hematoma, and in that regard may be considered  the norm. If it is still feeling so hard, it may be a consideration for your surgeon to give you a little local anesthetic and put a needle into the area. It would not be unheard of to have a fluid collection, that if aspirated will resolve, in part, the problem. 

The use of warm compresses should be avoided--in this setting, your skin is at least partly numb, and we have seen third degree burns occur.

Continue to follow up with your surgeon. Best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

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.