FAQ: Elastic Compression Garments
1. Why are elastic compression garments worn after liposuction?
In the early days of liposuction, before the tumescent technique had been invented, elastic compression garments (specially designed girdles) were intended 1) to reduce bleeding immediately after surgery and 2) to reduce swelling the time that the body is healing. Tumescent liposuction has eliminated surgical bleeding. (See About Tumescent Liposuction).
With the tumescent technique, there is always a certain amount of blood-tinged
anesthetic solution which remains beneath the skin where the fat has been suctioned.
This blood-tinged fluid causes bruising and the post-operative swelling known
as "osmotic-edema". With tumescent liposuction, the function of the compression
garment depends on the whether or not the surgeon closes incisions with stitches.
With the modern "open-drainage" technique for post-liposuction care, the tiny
incisions/adits are allowed to remain open (not closed with stitches), and
the reason for using compression garments (need only be worn for a few days)
is to encourage the rapid drainage of the residual blood-tinged tumescent anesthetic
solution from beneath the skin. With "closed-drainage", the reason for using
compression garments (which must be worn for several weeks) is to force the
absorption of the blood-tinged anesthetic solution into the body's blood vessels.
2. What type of garment must be worn after surgery?
Most surgeons require that patients wear an elastic compression garment for
a certain length of time after liposuction. Such garments are intended to provide
continuous postoperative compression to areas treated by liposuction. Some
garments are constructed from Lycra type cloth. Other garments are made from
elastic cloth typical to that used for girdles. The garments are usually crotchless
so that the patient can urinate and defecate without having to remove the garment.
3. How long must I wear a girdle (elastic compression garment) after surgery?
The length of time that a patient must wear an elastic compression garment depends on the type of aftercare technique preferred by the surgeon. If the surgeon closes the incisions with stitches then patients are typically instructed to wear a garment for 2 to 6 weeks. If the surgeon places stitches in the skin incisions, then the blood-tinged tumescent solution remains trapped beneath the skin causing prolonged bruising, swelling, and tenderness, which in turn requires the patient to wear an elastic compression garment for an extended length of time.
With the open drainage technique (skin incisions/adits are not closed with
stitches) for post-liposuction care, an elastic compression garment is typically
worn for an average of only 3 to 6 days. With "open-drainage" patients must
wear compression garments for 24 hours beyond the time when all drainage has
stopped. For example after tumescent liposuction of the outer thighs, if all
drainage stops after 3 days, then the garments must be worn for 4 days.
4. How does the "open-drainage" reduce time a compression garment must be
worn?
After tumescent liposuction there is always some residual blood-tinged tumescent
local anesthetic solution that remains under the skin within the treated areas.
If this blood-tinged fluid is allowed to remain under the skin, it increases
the degree of bruising, swelling and tenderness. By using "open-drainage" with
good compression, most of this fluid is "squeezed out" within the first 24
hours after surgery, and healing is more rapid. When surgeons close the incisions
with stitches, then the blood-tinged tumescent fluid is trapped under the skin,
and can cause prolonged inflammation, swelling and the formation of seromas.
5. Can the blood-tinged drainage be prevented from staining clothing, and furniture?
Yes, the large volume of blood tinged drainage is readily controlled by placing super-absorbent pads (sterile HK Pads, available from HK Surgical, Inc.) directly on the skin over open liposuction incisions, and then applying elastic compression garment(s) over the pads.
6. How does "bimodal compression" accelerate healing after liposuction?
"Bimodal compression" describes a technique that uses two degrees of compression
after liposuction. Initially, a high degree of compression is used to accelerate
the drainage of blood-tinged tumescent anesthetic solution from open incision
sites (incision not closed with sutures). Next, the degree of compression is
reduced after all drainage has ceased, in order to avoid excessive compression.
If there is too much compression after all drainage has ceased, the lymphatic
vessels are squeezed shut and prevented from absorbing the remaining blood-tinged
tumescent fluid. Bimodal compression is easily achieved by initially using
two compression garments, one on top of the other, which provide additive compression.
After all drainage has ceased, wearing only one garment provides enough compression
to reduce the risk of seroma formation, but avoids the risk of preventing the
absorption of residual fluid by lymphatic capillaries.
7. What are the risks of using of elastic compression garments after liposuction?
Too much compression can prolong swelling and edema. Excessive compression after all drainage has ceased, can impair the normal function of lymphatic capillaries which is to absorb residual tumescent fluid and inflammatory exudate from the tissues of the liposuction site.
Too little compression will permit the accumulation of fluid within the tunnels created by the liposuction cannula within targeted fat.
8. Does Reston foam reduce bruising when applied to a patient after liposuction?
Although Reston foam does reduce bruising after liposuction, its dangers far
outweigh its benefits. Reston foam consists of a 3/8 inch thick sheet of sponge-like
plastic foam pad with adhesive applied to one side. The intended use of Reston
foam is to prevent bedsores by applying the adhesive-backed foam to the bed
sheet beneath a patient's heels or buttocks.
A bruise occurs when red blood cells leak out of blood vessels and move toward
the skin surface. The application of Reston foam directly onto skin beneath
a compression garment, tightly compresses the skin's collagen fibers and prevents
bruising by impairing the outward percolation of red blood cells from the liposuction
wound toward the surface of the skin.
Reston foam applied directly to skin can compress capillary blood vessels. This impairs oxygen delivery to the skin, and can cause blistering and ulceration of the skin. Several patients have died from infection (necrotizing fasciitis) associated with the use of Reston foam after liposuction.
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