Care For Liposuction Patients Need Improvement – a closer look at WHY

Persistent inflammation, prolonged edema, and excessive bruising are the most bothersome and most common undesirable aftereffect of liposuction. The goal of post-surgical care is to optimize patient recovery by minimizing edema and bruising, and ultimately reducing patient discomfort and dissatisfaction. An ideal method prevents problems before they occur, and to a large extent, these problems can be mitigated following the universal standard of care regimen using compression and elevation. However, this traditional regimen could benefit from minor, yet valuable, improvements.

Acute posttraumatic hemorrhage, inflammation, and an osmotic pressure gradient are causes of acute post-liposuction edema. While cold application itself may have little effect on initial hemorrhage, immediate treatment using short cycles of cold therapy plays a helpful role in the control of inflammation and swelling formation by reducing cell metabolism, thereby decreasing metabolic activity and limiting the amount of secondary hypoxic injury.¹The subsequent vasoconstriction from cold application decreases the permeability of the postcapillary venules, and the reduced blood flow decreases the intravascular pressure. Both events discourage fluids from escaping into the tissues, limiting post- injury fluid collection. ² Furthermore, clinical studies have substantiated that in cold application, the amount of arteriole vasoconstriction is greater than that for venules.³ The surface area of the venules relative to the arterioles increases the area for reabsorption and aids in limiting the formation of edema.⁴ Cooling the treated areas during the first 3-5 days while draining may prohibit persistent inflammation and prolonged edema formation.

The trauma from tumescent liposuction allows plasma proteins to leak out of injured capillaries and into the subcutaneous wound space. Incubating residual blood-tinged tumescent fluid at body temperature increases the osmolality of wound fluid over time. This exacerbates post-liposuction edema. Osmotic amplification by incubation occurs by exposing the serum proteins to temperature-dependent proteolysis, escalating osmolality by effectively multiplying the number of solute particles within the wound space. The application of cold to the operated areas reduces the subcutaneous wound temperature, consequentially reducing post-liposuction edema by reducing would fluid osmolality.

Cold Therapy with Compression

Due to improved contact and increased tissue density, cold compression increases the depth of temperature reduction achieved by the application of cold to the body surface.^5-9 Both the rate and magnitude of tissue cooling are increased by combined therapy, as compared to the effect of cold application without compression.¹⁰ A greater magnitude of compression is associated with a shorter amount of time for a given level of tissue temperature reduction.¹¹ Ideally, cold compression must be applied evenly without the need to manually apply static pressure or keep the cold pack in place.

Compression

External compression from postoperative high-compression garments counteract the effects of intravascular hydrostatic pressure. However, if the compression garment is too tight due to excessive swelling, or to techniques when two garments are worn at the same time, the delicate lymphatic capillaries will become squeezed and cause the lumen to collapse, thereby effectively blocking lymphatic drainage and further impeding lymph flow. The one-way lymphatic capillary valves allow a degree of lymphatic pumping when an external force such as movement, arterial pulsations, or external massage compresses capillaries intermittently. The rate of lymphatic flow may be assisted by applying compression intermittently in addition to a well fitting garment to stimulate the lymphatic pump mechanism. Although static compression is an effective therapy for edema reduction, intermittent compression optimizes lymphatic drainage.^12,13 Traditional application of continuous external compression by high-compression garments may be counterproductive. Instead, compression garments in conjunction with intermittent compression applied using an external accessory, such as an adjustable compression belt, may accelerate recovery in the first 4-6 days by generating peripheral contractions that assist in the drainage of exudates.

In many cases, a liposuction patient benefits from supplementing a compression garment with an external compression belt. A compression belt will distribute the compressive force of an elastic garment over the treated area in a smooth, uniform fashion. By uniformly compressing the dermal interstitial collagen, the interstices between the dermal collagen bundles are narrowed, preventing red blood cells from moving toward the skin surface where it appears as a bruise.

Conclusion

Although the tumescent technique has become the worldwide standard of care for lipoplasty, many surgeons and nurses continue to use antiquated post-lipoplasty and abdominoplasty care techniques that were used before the invention of the tumescent. There is evidence that the inflammatory response in injured soft tissue is modified in a manner that promotes healing through the combined application of cold therapy and compression. The therapeutic effect of cold therapy is enhanced by the use of static external compression, minimizing the barriers to wound healing, while intermittent compression optimizes lymphatic drainage. A compression belt used with a compression garment reduces bruising by uniformly distributing the compression of elastic garments. With open drainage and bimodal compression being newer techniques that accelerate recovery, the post-surgical standard of care regimen may be augmented and further improved by cold compression therapy, and intermittent compression using an external accessory.

Traditional garments are relatively difficult to get into, or remove without assistance. It is especially challenging for someone who has just had liposuction and is sore, swollen and unable to easily bend over and wiggle into a tight garment. Along with the application and replacement of bulky absorbent pads, managing post-operative processes can be troublesome. LipoBelt is a single device that allows a patient to be mobile while applying reusable cold compression over large areas at once, add intermittent compression, and evenly distribute compressive force. Learn more about the LipoBelt’s post-operative & liposuction care, or if you would like to offer LipoBelt as an option to your patients, click here to request for a Wholesale representative to contact you.

It is the goal of every practice to promote optimal healing, so as to minimize time consuming follow up visits, especially if these visits serve only to provide comfort and information. With proper and an updated post-operative care regimen, the most bothersome discomforts of liposuction sequelae can be addressed and mitigated, greatly improving the patient’s post-surgical experience, and overall procedure outlook.