Will Stitching Incision Site After Tumescent Lipo Hinder Drainage and Prolong Swelling?

Open Incisions vs Closed for Liposuction is highly variable based on surgeon's preference and either way way in good hands you get a satisfactory result. I differ however in some of the recommendations below. 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. The ultimate scar has a better chance of being smaller if sutured based on my more than a quarter of century of performing liposuction and having used both techniques.

                  In
the vast majority of patients we suture the liposuction entry sites.  This doesn’t appear to impact swelling
or seroma formation in the post-operative period.  In theory, closing these wounds should minimize scarring,
but scarring doesn’t seem to be an issue when wounds are left open.

                  The
major advantage of this approach is decreased drainage from the wound.  When wounds are left open, constant
drainage occurs with bloody fluid which constantly stains the patient’s
compression garments.  When wounds
are sutured this fluid is resorbed by the body.  In our experience, we’ve not seen problems when wounds are
closed following tumescent liposuction and it appears to simplify after care.

Slightly loose stitching of the access incisions is really the preferred way to go.  This technique provides the advantages of both worlds - drainage can still proceed but the wounds heal more reliably and more invisibly. 

I don't suture the small incisions after liposuction is finished, and here's why:


once the lipo is done the fluid has served its purpose--so let's get rid of it

the fluid will drain onto dressings and be removed from the body faster than absorption

trapping the fluid also traps blood and increases the appearance of bruising

there's less of a feeling of swelling if the fluid drains rather than slowly absorbing

any skin bacteria that may have been dragged into the tissue won't be trapped there

the incisions are very small and heal without the track marks suturing may cause


Dr. Jeffrey Klein, the dermatologist who invented tumescent anesthesia liposuction, proved the benefit of open incisions rather than sutured incisions. He did lipo on hips and thighs and sutured one side and left the other to drain without sutures and the evidence was clear that the open drainage side healed much faster and the patients were more comfortable. After performing more than 5500 tumescent liposuction procedures without sutures, I don't see the need for them.

Thank you for the question. There is really no hard rule as to close or not to close the liposuction incision. Most liposuction incision are too small to require suturing. When larger cannulas are used, I close the incision site. But,  ultimately its up to your surgeon to make that decision. The outcome of the surgery depends on how its done and not on the closure of the incision. You need to see before and after photos of your surgeon and base your decision in part on that. Many patients are concerned about the incisions before liposuction; after surgery, it is not a concern. I wish you all the best 

I close my liposuction incisions all the time. Some people will leave them open. I am mainly concerned with infection with an open wound. The fluid left inside will sometimes drain but will mostly be absorbed.

Dear danielle7,

There were a number of reasons why plastic surgeons frequently left the incision sites open with tumescent anesthesia and liposuction in the past and not so much today.  With "true" tumescent anesthesia, the volume of fluid being injected is around a 3 to 1 ration of what is being planned for removal.  So if the surgeon estimates that there is going be a liter of fat out, they injected 3 liters in.  Today, most surgeons use the "super wet" technique which instills much less tumescent fluid in and therefore has less need for drainage and decreased risk of seroma formation. Some still will use the term "tumescent" even though they really are using the other technique-which makes it confusing for the patient.  Even though the incisions are very small, many plastic surgeons using the super wet technique will close the incisions though I do know some who do not and still get very nice results.

This is a great subject to discuss with your plastic surgeon who can help address your concerns.  Best of luck with your surgery.

The incidence if seroma after liposuction is low but can happen with or without suturing the incisions. In very largr liposuction may be a drain will help

In my experience, closure of liposuction Incisions will not be associated with increased postoperative adverse effects.

I have always closed the incisions on my liposuction patients.

There are different "camps" regarding closure vs. non-closure of the liposuction incisions, perhaps based on training and surgeon preference/experience/technique.

The tumescent solution is evenly distributed throughout the subcutaneous adipose (fatty) layer, and suction is used, so there are no pools of fluid remaining and the body lymphatic system and circulatory system will resorb the tumescent fluid that remains even if the incision is closed.

The truth is, the incisions close even if left open---the incisions are small and they close on their own in 24 to 48 hours.  The best way to "drain" the area, if drainage were surgically required, is with the actual placement of small siliconized drains through the liposuction entry/access incisions.  Very few surgeons, if any, use drains after liposuction, and if they do, I am certain each surgeon has his/her reasons to do so.  I never use drains after a pure liposuction procedure, but I will use them if the liposuction (I use Smartlipo-laser-assisted liposuction) procedure is combined with a skin flap and skin excision procedure, such as abdominoplasty and rhytidectomy (face/neck lift).

 

I perform Cellulaze, laser minimally-invasive, single procedure for the anatomical treatment of cellulite, and in these cases, I do leave the access incisions open to drain, as in this procedure the tumescent fluid is put under the skin in the space between the skin (dermis) and fat.  I do not want the tumescent fluid to "pool" under the skin, so the incisions are left open in the lower parts of the treatment areas, so that drainage is encouraged by gravity.  Another fact is that ---suction is not any part of the Cellulaze procedure, so the fluid is not aspirated at the end of the procedure.  The fluid is massaged out of the access incisions at the end of the Cellulaze procedure and the incisions are left open and the areas are padded to "accept" the drainage, which may continue for 1 to 2 days.

It is important to understand why certain aspects of an operation are done, so these explanations will be useful to help patients know why in some cases, the incisions are left open and in other surgical situations, the incisions are closed, or even drains are utilized.

It is rationale, clinical and scientific reasoning ----and knowledge is power---so patients can feel confident that with understanding --comes confidence in the surgical procedure.

Chrsitine Petti, M.D., F.A.C.S.

In most cases, I suture liposuction incisions and have not found an increases problem with swelling or seroma formation.  If a seroma does form, the suture can be easily removed and the incision drained.  Placing the suture can make managing your incisions easier in limiting the need for changing wet dressings.  Best wishes.