Why do some women bruise less than others after a BBL? Is it technique? Smaller women vs fuller women?

There is no way to completely avoid bruising after liposuction, but there are ways to minimize it. Taking Arnica and bromelain before and after surgery can reduce the visible bruising. Also, the technique used does matter. After injection of the wetting solution or tumescent solution, the surgeon should wait at least 10-15 minutes before starting liposuction, as this allows the blood vessels to shrink and therefore less bruising.
I hope this helps.

Best wishes,
Dr.Bruno

Bruising have a lot of origins. In talking specifically about BBL , have to do with the patients conditions, the surgeon and the technique. With the volumes that we are handling, the techniques for injecting and redistribution specially now that we have to avoid the “muscular plane”, and have to fit the fat into the “fatty tissues”, bruising is unavoidable. The use of sponges will definitely help, to reduce it , but it is not something bad, and will resolve, as all bruising ( not to confuse with hematoma) in less than three weeks. Best Regards

Hello darling,

This depends on multiple factors. Some patient have more delicate skin than others, depends on the technique of the doctor too and so many other reasons.

Talk with your plastic surgeon if you have more specific questions.

Best of lucks.

Dr. Luis Mejia.

Thank you for your question. There are multiple factors that are responsible for the extent of bruising after BBL. This is dependent on the physiology of the patient, the technique used as well as the procedure used. In my experience when water jet technique is used for fat harvesting there is less bruising and swelling. There are other precautions and measures that may limit the extent of bruising. These include checking for bleeding tendencies, discontinuing medicines that can thin the blood as well as herbal supplements etc. Please discuss your concerns and measures used by your Plastic surgeon to minimise bruising at the time of your consultation. All the best!

Bruising is not a particularly predictive factor for result. Bruising is blood collecting beneath your skin. The amount of bruising varies from patient to patient. Sometimes Arnica and Bromelain before and after surgery will reduce the duration of the bruising. You will notice that the bruise will change colors as your body breaks down and absorbs the leaked blood.

Dear photos1234,
every patient is different. Some women will cruise more than others. Also a good surgical technique is very important. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for your question. Post op bruising can be caused by a multitude of reasons liposuction technique, post op care, and the patients skin. Normally with aggressive liposuction a patient can expect bruising and swelling. We are causing a controlled trauma and it's the body's natural reaction. It shouldn't be anything to be alarmed about with having a BBL as long as you are going to a Board-Certified Plastic Surgeon in an accredited facility. The bruising should progressively improve overtime especially with proper post op care. Wearing properly sized compression garments and receiving lymphatic massages can help to promote healing and reduce bruising. If the bruising is prolonged it would be an important discussion to have with your Plastic Surgeon to ensure you are recovering properly.
Daniel Park, MD
Diplomate, American Board of Plastic Surgery
Diplomate, American Board of Surgery

There are many reasons some women may bruise less than others. Technique is not really a reason as most of us use tumescent liposuction which has a similar make up of medications in it including a medication that causes the blood vessels to constrict leading to less bleeding in that area during liposuction. More aggressive liposuction does tend to have more bleeding since the goal is to remove almost all the excess fat in that area. With a BBL surgery the liposuction tends to be more aggressive. Some people just bruise easier than others.

Bruising is the breakdown of hemoglobin from red blood cells that leak out during surgery when patients bleed. Hemoglobin breaks down to various components including pigmented components called Biliverdin and Bilirubin. These pigmented components are what you actually see when you observe bruising after surgery or an injury. In fair skinned people the bruising becomes much more obvious because of its pigmented dark nature.

If patients do not bleed during surgery they will have no bruising.

It’s therefore possible to have injury with no bruising and bruising with no surrounding tissue injury. Bruising is only the breakdown of red blood cells.

Those who bruise significantly from Liposuction or fat transfer procedures bled more during surgery.

The primary way surgeons minimize bleeding and has bruising during liposuction is to properly use tumescent solution. The solution needs to be injected adequately in adequate amounts to get the maximum affect.
Tumescent solution is basically intravenous IV fluid typically normal saline with added lidocaine, epinephrine and sometimes sodium bicarbonate.

Of these components it’s the epinephrine that controls bleeding.

Epinephrine or adrenaline causes intense vasoconstriction which decreases and almost stops the blood flow through the tissues while we’re working.

My best analogy for this is turning off the water before you do plumbing.

Constricted blood vessels are less likely to be injured and when they are the amount of blood that seeps through before a blood clot forms is far less.

For tumescent solution to be most effective it needs to be injected in appropriate amounts in all areas being treated and the surgeon needs to give the solution 15 minutes to work before starting Liposuction.

Some surgeons use tumescent solution concentrations proposed by Dr. Jeffrey Klein often called Klein solution which includes 500 mg of lidocaine per liter of tumescent solution.

The amount of tumescent solution depends on what areas being treated and how much lidocaine the surgeon feels it safe and appropriate for the patient.

Each surgeon has the freedom to make their own concoction and one can easily decrease or increase the amount of lidocaine and or epinephrine as needed.

I typically go up to a maximum of 50 mg of lidocaine per kilogram patient weight when doing body contouring. This is a fairly high dose of lidocaine and it’s not always necessary but sometimes is when treating many areas or treating large patients. Often the total dose of lidocaine used per patient weight is closer to 30 or 40 mg per kilogram.

During liposuction patients typically begin bleeding more towards the end of the procedure. This may be simply the cumulative trauma of the cannula going back-and-forth so many times or it may also be related to blood vessels being more exposed as more fat is removed.

Using larger cannulas also increases bleeding to some extent.

Personally I find using PAL or power assisted Liposuction to create less bleeding and hence bruising compared to manual Liposuction.

The biggest variable when it comes to bruising and recovery is the appropriate use of tumescent solution.

Personally I perform body contouring with my patients awake using local anesthesia in the form of tumescent solution with mild sedation. I’ve been doing body contouring this way for over 10 years and to date I have done more than 7000 Liposuction procedures. I specialize exclusively a liposuction and fat transfer procedures only and do not perform any of the other plastic surgery procedures.

A BBL case for me may include spending 30 or 40 minutes injecting tumescent solution. My best guess is surgeons using general anesthesia in the operating room will spend 15 minutes usually less for this part of the procedure. Operating rooms and anesthesiologist are expensive often costing $1000 per hour and sometimes more.
Without the cost of a formal operating room and anesthesiologist I have the luxury to take my time for the procedure which can take up to 4-6 hours to do quality work with attention to detail.
In my case the patient is awake and in order to not feel pain the numbing with tumescent solution has to be slow down to some degree. Because the patient is awake they must also be completely numb in every area that’s being treated. If not the procedure will be painful. Tumescent solution was really initially intended for awake Liposuction which is how Dr. Klein does his procedures avoiding general anesthesia.

With general anesthesia lidocaine isn’t really necessary but it’s the advent of epinephrine that makes tumescent solution especially in regards to minimizing bruising.

Surgeons who don’t spend the time and effort to properly infiltrate tumescent solution during general anesthesia liposuction including a BBL will have significant more bruising on their patients after surgery. This can potentially also lead to unnecessary excess blood loss.

In the early days of Liposuction before tumescent solution was created it was not unusual for patients to bleed significantly from Liposuction to the point of requiring blood transfusions. Today is exceedingly rare that anyone bleeds to the point of being hemodynamically unstable or requiring blood after liposuction or fat transfer procedures.

Patients certainly appreciate not being bruised. In rare cases excessive amounts of blood in tissues can lead to hemosiderin deposits or permanent skin pigmentation problems.

It’s probably not necessary to discuss technical details like exact amounts of tumescent solution used during consultations but this is a basic rundown on bruising, bleeding that causes it and ways we prevent this from happening during the BBL procedure.

One last point that’s worth mentioning.

The BBL procedure has been tainted with a single complication called fat embolism that has caused patients to fear this procedure.

Fat embolism’s happen if the surgeon accidentally inject fat into a larger vein during the fat transfer part of a BBL.

It’s still a fairly rare occurrence but as described as happening in one out of 3000 cases. The consequence of a fat embolism is often severe and can be fatal.

Personally I believe that using high volumes of tumescent solution in the recipient fat transfer area significantly decreases the chance a fat embolism because of the vasoconstrictive properties of epinephrine. Epinephrine protects blood vessels from being injured through construction and in this way the proper use of tumescent solution makes the BBL procedure much much safer.

I’ve never had a fat embolism in my career and hope to finish my career not ever seen this complication.

We don’t have scientific evidence that injecting sufficient tumescent solution in the buttocks decreases the chance of fat embolism but clinically this seems like a no brainer to me.

Avoiding grafting fat into the gluteus muscle is the main recommendation by the American society of plastic surgeons as well as using blunt large 5 mm cannulas. I think most plastic surgeons are taking that advice but fat transfer is generally a blind procedure and the surgeon is using intuition in regards to where they are injecting. Eliminating the gluteus muscle as a source of host tissue for fat transfer also significantly diminishes final results.

With general anesthesia Tumescent solution becomes less important and fat transfer typically doesn’t cause much bleeding compared to Liposuction.

Taking the extra time to properly inject tumescent solution in all areas especially fat recipient areas is in my opinion one of the greatest safety measures we can do to protect our patients.

Best,

Mats Hagstrom MD