Would you recommend stitching incisions up straight away after liposuction?

Question

A doctor I had a consult with for 360 lipo says that he doesn't use drains and he stitches the incisions up straight after surgery. My concern is draining. If the incisions are closed immediately where will the fluid go? I always thought surgeons either used drains or left the incisions open for a while first.

Yannis Alexandrides, MD, FACS · Answer

There is no wrong or right answer, as different Doctors use different practices. It also depends on the needs of each individual patient, therefore different approach has to be used to achieve the best results. The advantage of leaving the incisions open means that there will be the drainage of the fluids. Usually, the incisions heal really well without stitches, however, there are certain points of incisions that might have tension and in these cases, sutures might be necessary in order to improve the aesthetic result.

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  Drains are not necessary after having liposuction done.  I typically close all my incisions at the end of each case.  Fluid is absorbed on its own.  Each surgeon will have their own protocol they wish to follow.  I would suggest seeing a Board Certified Plastic Surgeon in person and they will be able to evaluate you and discuss your concerns.  Best of luck to you.

Ajay Mahajan, MD, FRCS (Plast) · Answer

Drains are not necessary after liposuction and the wounds can be sutured. There is bound to be some degree of tissue swelling after the procedure with imbibition of the fluid and bruising as a result of some bleeding, this gradually resolves as the body deals with it.For optimal outcome, please consult a fully qualified plastic surgeon, who has specialist qualification in plastic surgery 'FRCS Plast' after having being trained adequately in the field of plastic surgery, is registered on the 'Specialist register for Plastic surgery' with the General Medical Council and has been considered competent enough to be a member of the 'BAPRAS' (British Association of Plastic Reconstructive and Aesthetic Surgeons) and 'BAAPS' (British Association of Aesthetic Plastic Surgeons) at the least.

Jason Emer, MD · Answer

I disagree with most the other doctors I think most incisions need to stay open and I think especially for aggressive or HD liposuction you need certain areas of drains.
You need a formal evaluation by an expert in body shaping and contouring to determine what is best.  Traditional liposuction awake and smart liposuction are old methods and do very poorly for tightening skin or significant skin tightening or contouring.  Small problem areas can be improved slightly by these methods.  The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heat the skin with radio-frequency devices such as J PLASMA/RENUVION, InMode BodyTite, ThermiRF to heat the under surface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HIDEF VASER contouring and can only be done by a well . trained body contouring specialist. At the same time fat should be harvested, PRP and stem cells added and injected into muscles or indentations/cellulite to get body shaping and contouring.  This is known as a Brazilian butt lift when you inject the fat to the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with cellfina, sculptra, subcision and/or fillers such as bellafill, renuva synthetic fat, or sculptra.  If skin is very loose before surgery then it will need to be removed such as lower abdominal skin (tummy tuck/abdominoplasty), breast skin (breast lift), arm skin (brachioplasty).  Overall you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting.  Dr. Emer.

Daniel Barrett, MD · Answer

Dear Eleanoradoll,
a lot of plastic surgeons don't use drains for liposuction surgery and close their incisions so this is not unusual. Finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. 
You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations. 
Daniel Barrett, MD

Robert M. Tornambe, MD · Answer

EleanorI appreciate your concern, however most of us do not use drains after liposuction, as it is not needed. The fluid that we inject prior to the operation either trickles out through incisions that were made during the surgery if they were sutured closed or not. The rest of the fluid is absorbed by your body safely. Drains may leave worse scars, as suturing wounds closed usually allow for better healing. Consult with a board-certified plastic surgeon in your area to confirm my advice. Good luck.

Kenneth Hughes, MD · Answer

There are benefits to either method, and I would recommend that you decide the surgeon based upon experience and results.No drainage after liposuction is unusual, but the amount of drainage can vary quite a bit depending upon the number of areas liposuctioned, the volume infiltrated, the amount of lipoaspirate, and the use of sutures for closure of liposuction ports.  The fluid, if not present as a collection, should be absorbed.   I personally do not use drains for liposuction, but every surgeon has different protocols.  I make very few incisions which I close, and I place the incisions in discrete locations to minimize the appearance.

Yunus Dogan, MD, FEBOPRAS · Answer

hi and thanks for your question. There is no one truth in this issue, all of these are possible. When we close the holes after liposuction it will dissolve by time but it will take a little bit more time and it is comfortable than the others. Because you wont feel stitch pain which we use to fix drains. And also you need less dressing changes. In my practice I usually put drains. Sometimes I don’t. Good luck and get heal soon

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!
There is no consensus in the plastic surgery community regarding this issue. Even if a suture is placed at each incision, drainage will still occur around them. Advocates for suture placement  feel that there will be a batter scar. That has not been my experience. The 3-4 mm incision usually seals within a week and heals quite well with or without sutures.  Advocates for allowing for open drainage feel that the drainage is more adequate / complete if no sutures are placed.  Retained liposuction fluid and blood will usually be resorbed by the soft tissues of the body, unless excessive. In our practice, we do not routinely place drains during the procedure.
Choose your board certified plastic surgeon wisely and follow his / her directions.
Best wishes...

Kristen Aliano Messina, MD · Answer

Hi--There is no standardized approach to suturing vs. not suturing the incision sites.  There are pros and cons to both.  If they are sutured and no drain is left, your body will absorb the tumescent fluid that is not removed through liposuction.  You may get a bit swollen after the procedure as a result, but the compression garment should help.  I recommend that you have a thorough discussion about this with your plastic surgeon. Make sure your surgeon is certified and appropriately trained for the procedure.