When it comes to fleur de lis circumferential abdominoplasties, where do you stand on compression?

A patient cannot and should not be totally immobilized after lower body lift (LBL) surgery, so getting the skin flaps to heal and seal to the underlying tissues is critical to avoid fluid accumulation. I personally use one or two drains anteriorly (the tummy tuck area), whether it's a standard or fleur-de-lis, and one drain for each hiproll and buttock region. Plus a compression binder applied in the operating room, and adjusted daily for best compression, avoidance of folds, drain care, and inspection of circulation to the umbilicus, lower abdomen, and incisions.
Waiting a week seems silly, but the surgeon that recommends this is probably counting on patient discomfort to minimize activity that first week. Still, a week of fluid accumulation will prevent flaps from adhering to the underlying tissues. Activity is what causes fluid to develop and accumulate, which is why drains are necessary, and why compression makes sense from the beginning, continuing until the flaps adhere and heal.
You're going to have swelling, binder or not. What you don't want is fluid that accumulates under the flaps and prevents those skin/fat flaps from adhering/healing to the underlying muscle/fascia layers. So you don't put in drains "later," you do it in the operating room. And if a binder is a good idea (I and most of my colleagues believe compression is), then it should be started right away. Not too tight that circulation is cut off, but not after one night, or one week! It seems that having your patient or their caregiver adjust the binder daily to look at things, do drain care, and flatten out wrinkles in the binder, is not only appropriate, but advisable. "Wrapping things up" and ignoring for a day or week may be acceptable, but does not seem prudent or proactive. Hope this helped. Best wishes! Dr. Tholen

For cases of just plain liposuction  I will usually put patients into a postoperative garment the day of surgery because there’s not a significant amount of undermining and there is very limited change in the blood supply to the skin flaps and the surgeries are of shorter duration. For my tummy tuck and lower body lift patients I will usually wait 5-7 days to get them into a garment. I do this because there is a lot of dissection of the skin flaps and there is more risk to the blood supply in these surgeries. Also there is a question of whether the tight garment soon after surgery might decrease venous return and increase the risk of a blood clot. Most of these risks are very small but my goal is to do as much as possible to reduce the risk of complications. Best of luck on your journey. 
Sincerely 
Dr Jonathan Amspacher 
Director of plastic surgery Mosaic Life Care

In almost all cases, I get patients in a garment in the operating room and they stay in it for a month before we switch to something lighter. We have a protocol to release the garment during recover as well to allow for more normal blood flow and to let the skin air out.  Fajas are very popular down here as well, and some patients prefer to be custom fitted with one of these with my approval.

I send all  my abdominoplasty  patients home with a special compression garment put on immediately after surgery AND  abdominal binder immediately after surgery. We use this compression for the first month and sometimes longer.     Compression helps reduce swelling and get better conforming of skin. (especially in the mons area)

I prefer not to use a compression garment after a FDL abdominoplasty because it can restrict blood supply in the skin and result in healing issues. The garment can be woren after a week. Garments are most helpful when you have liposuction performed where they will help prevent bleeding.