Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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On the day of surgery, the anesthesia team prepares the patient. For small areas, local anesthesia with oral sedation may be sufficient. However, for larger volumes or multiple areas, general anesthesia or deep sedation (twilight) is preferred for patient comfort and safety.
The anesthesiologist continuously monitors heart rate, blood pressure, and oxygen levels. The goal is to keep the patient stable and pain-free. Once the patient is sedated, the surgical team begins the sterilization and draping process.
The surgeon begins by making tiny incisions, typically 3 to 5 millimeters long. Through these access points, the tumescent solution is infused into the fat layer. This fluid contains lidocaine for numbing and epinephrine to constrict blood vessels.
The infiltration is done slowly and evenly. The volume of fluid injected is typically equal to or slightly greater than the estimated volume of fat to be removed. This creates the “tumescent” or swollen state that facilitates smooth fat removal.
Once the fluid has taken effect, the surgeon inserts the suction cannula. Using a back-and-forth motion, the surgeon breaks up the fat cells and suctions them out through a tube attached to a vacuum machine.
The surgeon carefully sculpts the area, removing fat from the deep layers first, then refining the superficial layers. They constantly check the contour by feeling the skin thickness (pinch test) to ensure evenness and prevent divots.
The procedure is not just about removal; it is about shaping. The surgeon works to blend the treated area with the surrounding tissue. For example, when treating the abdomen, they will feather the edges into the hips and ribs to avoid a “step off” or visible line.
Symmetry is checked repeatedly. If the patient is under general anesthesia, they may be rolled or repositioned to ensure equal treatment on both sides. The surgeon sculpts the body in three dimensions.
After the desired contour is achieved, the cannulas are removed. The small incisions are usually left open or closed with a single loose stitch. Leaving them open allows the residual tumescent fluid to drain, reducing swelling and bruising.
Absorbent pads are placed over the incision sites to catch the drainage. The patient is then placed into the compression garment while still on the operating table. This immediately applies pressure to the treated areas.
The patient is moved to the recovery room where they wake up from anesthesia. Nursing staff monitor vital signs and manage any immediate pain or nausea. The compression garment may feel tight, which is normal.
Because of the lidocaine in the tumescent fluid, patients often feel very little pain immediately after surgery. They are encouraged to drink fluids and, once stable, are discharged to the care of their escort.
The first day involves resting and managing the drainage. It is normal for a significant amount of blood-tinged fluid to leak from the incisions. This is the tumescent fluid leaving the body, not active bleeding.
Patients should change the absorbent pads frequently to keep the skin dry. They are instructed to move their legs and ankles to promote circulation, but should stay in bed or on the couch for the most part.
Pain usually peaks on the second or third day as the local anesthesia wears off. It is typically described as a deep ache or soreness, similar to the feeling after a very strenuous workout.
Surgeons prescribe oral pain medication for the first few days. Most patients transition to over-the-counter acetaminophen within a week. Anti-inflammatory drugs are avoided initially to reduce bleeding risk.
Swelling and bruising are inevitable. The treated areas will look puffy and may be discolored. Gravity causes swelling and bruising to migrate downward, so genitals or legs may appear swollen even if the abdomen was treated.
The swelling increases for the first few days before plateauing. The compression garment is the primary tool for controlling this edema. Keeping the body hydrated and avoiding salt helps minimize fluid retention.
Early mobilization is crucial to prevent blood clots. Patients are encouraged to take short, gentle walks around the house starting the day after surgery. However, strenuous exercise is strictly prohibited.
Patients can usually return to desk work within 3 to 7 days, depending on the extent of the surgery. Driving is permitted once the patient is off narcotic pain medication and can move comfortably.
Patients can typically shower 48 hours after surgery. The compression garment is removed, and water is allowed to run over the incisions. Scrubbing or soaking in a bath is avoided.
The garment must be worn 24 hours a day, except when showering, for the first few weeks. It supports the skin as it reattaches to the underlying muscle and prevents fluid pockets (seromas) from forming.
Patients are taught to look for signs of infection (fever, redness, foul odor) or hematoma (sudden, painful swelling). Numbness in the treated area is common and usually temporary.
Irregularities or lumps may be felt as the tissue heals. These are often areas of internal scarring or trapped fluid and usually resolve with massage and time. Follow-up appointments monitor these issues.
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The fluid is the tumescent solution that was injected before surgery, mixed with a small amount of blood. It is good that it is draining out; it reduces bruising and swelling. The drainage usually stops within 24 to 48 hours.
Typically, you will wear it 24/7 for the first 3 to 4 weeks, removing it only to shower. After that, your surgeon may advise wearing it for part of the day or during activity for another few weeks to ensure the skin retracts smoothly.
You can start light walking immediately. You can usually return to light cardio (like a stationary bike) at 2 weeks. Heavy lifting and high-impact activities should be avoided for 4 to 6 weeks to prevent swelling from returning.
This is due to swelling. The trauma of surgery causes fluid retention. It is entirely normal to look and feel bloated for the first few weeks. The actual results will not be visible until the swelling subsides.
Yes, many surgeons recommend lymphatic drainage massage starting a week or two after surgery. It helps move the fluid out of the tissues, reduces swelling, and can smooth out any hard lumps or irregularities under the skin.
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