Should a Doctor Leave the Incisions Open After Tumescent or Smartlipo?

I always close my liposuction incisions, and most if not all board certified plastic surgeons I know do the same.
For some reason, it seems as if many non-plastic surgeons that do liposuction tend to leave the incisions open, placing bulky dressings to soak up the fluid. They make exactly the arguments you made in your question, namely that by leaving the incisions open the swelling goes away faster. They probably also would argue that the incisions are just as good.
In my experience, leaving the incisions open leads to soppy wet and gross dressings, and an even bigger mess on your bedsheets than when the incisions are closed. There is pain medicine in that tumescent solution, and I think patients benefit from having it stay inside of them. The amount of fluid we give patients is carefully calculated in liposuction, and there is no way to account for the exactness of the fluid resuscitation if you don't know how much is going to leak out. And since your body absorbs that fluid anyhow in just a few days, I don't see how it could reduce swelling beyond those few days.
Finally, and it may only matter to me because I am a board certified plastic surgeon, I think the incisions look much better when they are closed nicely with a fine stitch. It's not just that the line is thinner, but many of the incisions I have seen that were left open tend to indent.
But no doubt there are good and thoughtful surgeons who leave them open. This is just my opinion. But it is a far less important issue than choosing the best surgeon you can. Be sure your surgeon is certified by the American Board of Plastic Surgery: the only ABMS board recognized to credential plastic surgeons.

Most Board Certified Plastic Surgeons close liposuction incisions regardless of the type of liposuction used (Smart Lipo, Ultrasonic liposuction, conventional or PAL - power assisted liposuction. In my more than 2 decades of practice and trying each of these devices, I have not found any prolonged recovery by closing incisions. On the contrary I feel that I have prevented the mess and hassle to the patient.

Dear ymiller,    I personally prefer to close my liposuction incisions. I believe they will heal and ultimately look much better than if left open. The issue with swelling is not really an issue in my opinion. There is little fluid that remains after liposuction is performed and what does remain is slowly absorbed by your body over 24-48 hours. Since we keep pads and compression garments on for 5-7 days, the swelling is minimal. Leaving the incisions open leads to wet and messy garments, sheets and furniture. Most board certified plastic surgeons that I know, close all their incisions as well. Good luck.

 

 

I think that most board certified plastic surgeons will close the incisions after liposuction. Closing the incision nicely with sutures will approximate the skin better and lead to a better scar. If the incision is left open, the scar may be wider and indented. The swelling that occurs after liposuction is normal and the fluid will be absorbed by your body with time. More of the fluid may leak out of the incisions if they are left open, but not enough to make much of a difference.

It is really a matter of persona preference and how these incisions were created. I sometimes do liposuction thru 14 gauge needle sticks, I will leave these open, but if incisions are created with a blade , I will close them.

Hello,

I close the incisions but surgeons have differing opinions on this. The arguments for leaving them open are drainage and swelling reduction related. The arguments for closing them center upon better looking scars.

Best Regards,

John Di Saia MD

Although some doctors do leave the incisions open after a liposuction, in our experience, we find that the patient benefits from a smaller scar if we close the incision. However, we inform all our patients that they should expect a small amount of drainage from these incisions for the first 2 to 3 days after liposuction.
 

Every surgeon is different. I prefer to close my incisions to seal an open wound and hopefully minmize the risk of infection. Some like to keep them open to allow them to drain. 

To close the small incisions of liposuction or not is a personal choice of the surgeon, when open they permit drainage of fluid. They heal well, at most they need scar revision if needed under local anesthesia
Keeping them open is a little messy with all the fluid draining through. But less seroma.
Some surgeons even out soft rubber drains to help with drainage.
It is not a big issue.

I use an extremely small (2 mm), round device to create the opening.  I leave it open.  It helps when patients are allowed to have some drainage after surgery.  These tiny openings heal by themselves virtually to the point of invisibility.