Boston Cosmetic
Boston Cosmetic

















Boston Cosmetic


We at Boston Cosmetic Specialists, specialize in a post operative recovery therapy that is extremely effective for our clients who have recently had featured-lymphatic-drainage-massageliposuction.  We see our clients daily for the first 7-10 days immediately after their liposuction and begin the process of healing that is required for them to get back to their daily activities. After a series of treatments, clients report reduction of swelling, ease of movement and allows our clients to advance through the stages of their compression garments quickly.

After liposuction, there are two components that cause the swelling, the pocketing of fluid between the layers of tissue opened mechanically with liposuction cannula as well as edema or swelling of the tissue layers due to post-traumatic inflammation both of which cause discomfort to the patient. The pockets of fluid that require drainage for proper healing consist of seroma or tissue fluid which is due to the extensive damage to the superficial lymphatic system that results in the pooling and production of excess fluid in the healing process as well as a large volume of blood-tinged tumescent anesthetic solution remaining trapped under the skin both of which slow postoperative recovery.  Management of both causes of fluid, the pockets of fluid between layers of tissue as well as the fluid or swelling within the tissue layers,  require external treatment and specific manipulation to aid in drainage of the pooled fluid and the reduction of post-inflammatory tissue edema.

Traditional post-operative care methods

Much of the bad press given to liposuction procedures comes from the painful recovery attributed to old-fashioned post-operative care.

Traditional after-care methods include:

  • Closing the incision
  • High compression elastic garments
  • Prolonged inactivity and discomfort
  • High percentage of revision and touch-up procedures to correct undesirable fibrosis

These traditional methods usually protracted the amount of pain, swelling, and overall discomfort following surgery by keeping the excess fluid inside the body.

Bimodal dressing

Instead of the prolonged high compression elastic garments, the patient is advanced through bimodal dressings much faster after the active drainage is significantly slowed. These help ensure that proper drainage of the blood-tinged tumescent fluid occurs without hindering the recovery of the fragile lymphatic channels which will remove the tissue fluid or edema and drain it back into the vascular system. There are two stages:

  • A high degree of compression is maintained as long as drainage occurs, plus an additional 24-72 hours.
  • After significant drainage slows, second stage, mild, uniform compression is used and is typically continued long-term for patient comfort

Open drainage

Open drainage leaves the incisions, called adits, open after surgery, allowing the excess fluid to escape. This minimizes the swelling and bruising that used to occur with the old methods.

Full drainage after Hi Def liposculpture procedure takes approximately seven to ten days to complete, with a follow up visit to ensure that the incisions do not close prematurely. Because the solution contains anesthesia in it, the first day or two may not be as painful as subsequent days, but the pain is usually controlled with prescription or over the counter medication.

Massage and Ultrasound

Beginning immediately after surgery, we begin a series 5-7 weekly massage and ultrasound treatments which are given in-house. These treatments facilitate the healing process by helping drain the pockets of fluid and reduce swelling and by increasing the blood supply.

Possible complications

Even with the new post-operative care techniques, you may experience the following after the tumescent liposuction:

  • Swelling
  • Bruising
  • Pain
  • Infection

In order to minimize these risks it is important to find an experienced cosmetic surgeon, such as Dr. ishoo who practices the latest post-operative care with liposuction techniques.

Since the incisions are open and the lymphatics are temporarily disrupted, our massage technique is not technically a lymphatic drainage massage, which is in fact contra-indicated in immediate post-operative liposuction as it may increase inflammation and edema. CARES was developed as a specialized and individualized treatment plan for each client that includes external drainage of the pockets of fluid initially, later progressing to lymphatic recovery manipulations to reduce deep tissue edema using not only specialized massage techniques, but also ultrasound and sequential compression devices as well as diet recommendations, activities and tools for clients to utilize at home in between treatments that will aid in and speed the recovery of their healing process and prevent irregularities and undesirable fibrosis leading to visible deformity.  Often clients who are within days of their liposuction surgery are in an intense amount of pain, swelling and bruising. The highly specialized CARES protocol will speed the recovery time from lipocontouring and liposculpture and will get clients back to their normal work and personal routines.

Traditional After-Liposuction Care Methods 

Traditional After-Liposuction Care Methods rely on 1) the closure of incisions with sutures and 2) the prolonged use of high compression elastic garments for two weeks or more. Most liposuction surgeons would agree that these traditional methods of caring for patients after liposuction leave much room for improvement. The common undesirable characteristics of the healing phase after liposuction include protracted swelling, bruising, tenderness, as well as time-consuming post-operative follow-up visits with the surgeon.

Minimizing Swelling, Bruising, & Tenderness

Swelling, bruising, tenderness are the result of 1) persistent blood-tinged tumescent anesthetic solution and tissue fluid including contents of ruptured fat cells and serum rich in inflammatory products trapped under the skin and between deep tissue layers after liposuction (also referred to as Seroma), and 2) injury to subcutaneous lymphatic capillaries caused by the liposuction procedure. Lymphatic capillaries are small vessels that drain fluid away from injured body tissues. Temporary injury to lymphatic capillaries as a result of liposuction cannot be avoided. However the persistence of large pockets of fluid trapped under the skin and the tissue cavities can be prevented. Older techniques for post-liposuction care do not facilitate rapid drainage of seroma and in fact, hinder timely recovery of the lymphatic vessels by maintaining high compression. The newer technique known as “open drainage” diminishes the swelling and speeds recovery after tumescent liposuction, especially when combined with LASER lipo-lysis or Vaser lipo-emulsification which create a deep tissue burn and result in seroma containing high levels of inflammatory products. Such retained seroma is highly irritating to the surrounding tissue which aggravate the exisiting edema, inflammation and discomfort leading to prolonged, uncomfortable recovery as well as lumpy irregularities and unpredictable fibrosis and deformity.

Swelling occurs after liposuction during the healing process. There will always be some swelling after surgery, but taking the right steps will greatly reduce the amount of swelling, discomfort and irregularity you will have. Contact Boston Cosmetic Specialists for more information regarding our CARES protocol for optimal post-liposuction recovery.