Post-Bariatric Plastic Surgery – After the Procedure
Dr. Barry Eppley – Indianapolis Plastic Surgery

Body contouring surgery usually involves removing large segments of skin which are then closed by bringing the two sides together. What is not obvious is that the skin is closed over a 'space'. As the skin is more elastic or flexible than the deeper tissues (such as fat) that lie underneath, closure of the skin when large segments of tissue have been removed leaves an open area beneath. As the body abhors a space, it will fill it with fluid. Thus, the need for drains is an important part of the after surgery phase.

The reason fluid accumulates in this space under the skin is that wounded tissue weeps. Much like a brush burn that you had on your knee as a child, fluid comes leaking out from the wounded tissue. In the spaces left behind after big skin removals, a large surface area of wounded tissue lies underneath. This will weep fluid for weeks after surgery. Drains are inserted into these spaces to prevent fluid build-up. A soft tube is inserted under the skin through a small opening near the main incision. This drainage tube is then attached to a suction bulb which pulls fluid out by vacuum pressure. This is known as a closed suction drain. The drains are quite long, up to 18 inches in length. Usually one or more drains are used for surgical site depending on the procedure. (An arm lift needs one drain, a tummy tuck needs two drains, a body lift may need four drains) Some procedures such as breast surgery may not need a drain at all.

The removal of this fluid is of critical importance. While the body can absorb a certain amount of fluid, large amounts that occur after major body contouring surgery cannot be absorbed. If allowed to build up, it may be a source of infection but will also not allow the sides of the wound inside to heal together. Therefore, the drains keep most of the fluid out so that adequate internal wound healing can occur. The drains serve as a safety valve until the internal weeping stops.

How long does this internal seeping persist?.or more pertinently, how long will you have to have these drains? It varies by the area and type of surgery. For arm lifts 2 to 3 days, thigh lifts one week, tummy tucks seven to ten days, and body lifts as long as two weeks. Some plastic surgeons use the amount of fluid coming out as the measure of how long they stay. Generally, less than 25 to 30 ccs per day per drain means they may be able to be removed.

How long will it take me to recover? It is best to think of surgery recovery as three phases based on what you will experience during each specific phase. How you feel, what you can do, and what is happening with your surgical incisions make up each phase. When talking about body contouring surgery, we need to be specific as to what procedures we are talking about. For the sake of this discussion, I am referring to the procedures of circumferential body lift, thigh lifts, or a combination of other body procedures which may add up the size of a procedure such as a body lift.

The first phase of recovery from body contouring surgery is right after the operation. It is a phase of pain, dressings, drains, and more limited physical activity. Surprisingly, body contouring surgery is not acutely pain but has more of a dull discomfort and some stinging along the incisions. In my practice, I glue on tapes over the incisions so there is no care needed. One can shower after 48 hours and feel free to get the incisions and drains wet, it will not hurt them. You can do whatever you feel like doing but most patients will be fairly limited to sitting around and walking about the house. Phase one is obviously the most difficult, generally lasts from 7 to 10 days, and is what most patients envision it to be.

Phase two in body contouring surgery recovery is when the drains come out, the tapes are removed, and you are getting back to some normal activities of daily living, including driving and some out of the house events. You are still sore but no longer in any severe pain. Some external stitches are removed, if present, as well. This phase is from 10 to 21 days. You may return to work if your job is a sit down one with minimal strenuous activity. You are not ready to return to any physical activity, particularly any form of working out. Your incisions may start to turn redder by three weeks after surgery as they start to heal. The red color is normal.

Phase three is what I call the nuisance phase of recovery and it is between 3 and 8 weeks after surgery. During this phase, you are really recovering, feeling much better, and by the end of this phase are almost or are back to all of your presurgery activities. This is also the phase when small 'problems' will develop at your incisions which will surprise patients as they think they should be completely healed by now. This includes extrusions or reactions to dissolvable sutures, known as 'spitters', which the body is pushing out as they dissolve. It is also the time when seromas or fluid collections may occur after the drains have been removed. These are minor problems but are common delayed issues that will occur in most body contouring patients.

In summary, recovery from body contouring surgery takes longer than most patients think. Complete recovery, including the full healing of all incisions, can take up to two months. Patients should be aware and prepare accordingly for their work and lifestyle. Body contouring surgery is a big change.frequently with a big recovery as well.