Is having a drain for the BBL procedure necessary? Does the cell saver have to be requested or required?

Question

I’m curious to know...is having a drain for the BBL procedure necessary? I’ve seen videos about having a cell saver and ppl stating that it made recovery a lot easier. Does the cell saver have to be requested or required?

Kenneth Hughes, MD · Answer

I have not used drains after liposuction or BBL surgeries as I have not found them to be necessary.  The fluid usually drains through the portals of entry for a few days and that is the end of it.Cell saver is not typically utilized or necessary for these procedures.

Ayman Hakki, MD · Answer

Drains are not needed in BBLs. Cell savers are used but have not proven to be of great value. The real trick is finding a  board certified plastic surgeon, who operates at a certified facility, and has done a ton of BBL’s. Do not shy away from asking; how many Brazilian butt lift did you do last year, doctor? You’re not settle for vague answers and shop around until you find someone you like. Good luck.

Ron Hazani, MD, FACS · Answer

Thank you for your question. I normally do not use drains for BBL. Patients need to be seen normally a few days days after surgery to be evaluated and examined and if there is seroma I drain it during the post op appointment. Cell savers are not normally used in BBL either.Seek a board certified plastic surgeon who performs many of these procedures, has great reviews and photos, and is an expert in this field.

Daniel Zeichner, MD · Answer

Hi and welcome to our forum!In our practice, we do not routinely place drains during the procedure. If one weighs the advantage of preventing seroma or hematoma against the risk of infection resulting from an indwelling catheter, it is not worth the added risk as the risk of hematoma / seroma is quite low.The use of a cell saver is not routine in BBL. If anemic before surgery, its cause should be determined and corrected prior to any cosmetic procedure. The use of a cell saver is not necessary under these circumstances. Seek advice from a board certified plastic surgeon.

Mats Hagstrom, MD (license on probation) · Answer

Plastic surgeons will use drains primarily for two reasons. The first and by far the most common as to minimize the chance of patients developing a seroma. When seromas form they need to be drained frequently generally using a long needle. I also know of a plastic surgeons using the drains to help create a more intense contours  like after liposuctioning the lower back triangle in order to keep that area pressed in. Seromas are rare and after liposuction but they do happen occasionally and some surgeons seem more prone to get them another's. I would say the majority of plastic surgeons do not use drains for liposuction or fat transfer procedures. Liposuction including high-volume liposuction up to 5 L should not cost enough blood loss to need a blood transfusion. The main way we minimize blood loss during the liposuction procedure is by correctly using tumecsent solution which is injectable saline IV solution mixed with lidocaine or numbing medicine and a small amount of vasoconstrictive drug called epinephrine. Of these it's really only the epinephrine that helps decrease bleeding during the procedure. The key to working with epinephrine is to wait a minimum of 15 minutes after it's been injected before starting surgery. It also needs to also be injected so it's evenly distributed among all the tissues that are going to be treated. Failure to wait until the epinephrine has taken full effect will cause substantial bleeding during the liposuction procedure this will intern cause excessive bruising and blood loss. One potential problem or conflict of interest is waiting idle time waiting for the epinephrine to work before starting the surgery.  Some operating rooms cost as much is $1000 for the first hour so waiting 15 minutes for the epinephrine to work can be costly to the surgeon.  My experience has been most surgeons do not wait 15 minutes but give the epinephrine some time to start working. When doing liposuction with patients awake it is mandatory to let the local anesthetic with the epinephrine sit in at least 15 minutes in order for the patients to be comfortable enough to tolerate the procedure. The plastic surgeons  I see who most often talk about blood supply, blood loss and the need for blood transfusions are the plastic surgeons from the Dominican Republic. I don't know if this is a cultural phenomenon or sociopolitical. Patients are often told the actual cost per unit of blood should I need to plug transfusions. In the United States no patient would ever be denied a blood transfusion regardless of the ability to pay or not if they lost blood during any surgical procedure including a cosmetic surgery. In the United States blood transfusions from cosmetic surgery are generally considered a medical problem or a paid for by medical insurance if available. In the United States it is generally considered inappropriate medical  management to perform elective cosmetic surgery to the extent where patients will probably need a blood transfusion. Most of us simply consider that too much surgery for one session and recommend splitting the surgery into two or more procedures to avoid the complications and risks involved with extensive surgeries. Blood loss is only one of many complications related to excessive or extensive procedures that are combined. This is not to say that surgeons in the Dominican republic have a higher blood loss or do worse surgery nor have inferior medical judgment.  It is simply an observation of what I've seen on real self of how doctors from different countries communicate and prepare their patients befor surgical procedures. I suppose it would be favorable to be transfused with your own blood from a cell saver rather than random blood from the blood bank though cell saver blood has been shown to have its own set of problems and potential complications. In my opinion surgeons  who lose enough blood to warrant transfusions from cosmetic surgery should be questioning the extent of surgery they are performing in a single session or their surgical technique. There are simple techniques like waiting 15 minutes for the epinephrine to work which can dramatically limit blood loss in liposuction procedures.  Most plastic surgeons also agree with our societies safety guidelines that removing more than 5 L of fat during a single procedure is inappropriate.  It's simply in the patient's best interest to split this into two procedures I let the patient recover somewhat in between. You could make an argument that transfusing back any of the lost red blood cells using the cell saver will make you feel better and have an easy your recovery. It's hard to say if it it is worth the price for the potential or the very small chance of complications? In my opinion the best option is minimizing blood loss by not doing extensive surgery and using good surgical technique. Some plastic surgeons use cell savers more routinely some never cuse them so it is something you should ask your surgeon if they offer and recommend it and go by their recommendation. I would not attempt to negotiate the use of drains or not. This is something you should let the surgeon make the final decision on. Best, Mats Hagstrom M.D.

George Lefkovits, MD - Account Suspended · Answer

I do not use drains following a BBL.It is not worth the risk tof infection nor the discomfort with the use of drains. If a seroma or hematoma should occur in the first few days it can be drained.

Is having a drain for the BBL procedure necessary? Does the cell saver have to be requested or required?

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