Liposuction Seroma

 Seroma formation after liposuction

Liposuction is a procedure in which your board-certified cosmetic plastic surgeon can remove specific unwanted areas of fat from your body.

Here are is a blog post about liposuction, swelling and seroma:

https://tavmd.com/2013/03/17/lymphatic-drainage-after-cosmetic-surgery/

Arm liposuction photo

Complications of liposuction

As with any cosmetic surgery procedure, there are a number of complications that can occur after liposuction. Some lipo complications include:

  • infection
  • bleeding
  • uneven contour
  • loss of skin
  • liposuction seroma formation

 

Liposuction Seroma

Seroma is the name given to an accumulation of serum, or lymph, under the skin. Essentially, it is what causes the initial swelling in an area of the skin after an injury. In this case, it’s just that the swelling does not go away and continues to get larger, forming a seroma!

 

Seroma formation

After skin is injured by any form of trauma, a bump or a cut, blood vessels in the area become more permeable. This allows white blood cells and other blood protein factors necessary for the skin to heal to go out of blood vessels  and lymphatics and surround tissue cells to help in the repair process.

This fluid mixture is called lymph, and its accumulation is called a seroma.

In fact, there is a constant flow of lymph in and out of blood vessels, which is picked up by the lymphatics and taken back into blood circulation through specific points on the left side of the neck for the head and the groin for each side of the body.

Injury merely means there is more fluid going into the tissues than can be absorbed, leading to its accumulation as swelling or seroma.

With time, this fluid is absorbed back into the blood vessels once healing has occurred.

If the fluid cannot be absorbed fast enough after surgery because the vessels carrying lymph (lymphatics) have been cut, a seroma will form.

 

Seroma after liposuction

A main cause of seroma formation after liposuction is damage to the lymphatics by liposuction cannulas ( this is worse with laser and ultrasound injury) . The normal tissue response to injury also occurs, and more lymph and fluid pours into areas where lipo has been performed, causing swelling.

 

What to do with seroma

Once a seroma has formed, the fluid needs to be removed so the skin can stick back down. Seroma can either:

  • drain spontaneously
  • be resorbed spontaneously
  • be drained surgically

 

Spontaneous drainage

Spontaneous drainage is usually messy but is also efficient and typically occurs when a seroma is least expected. The skin over the seroma may not feel like it’s holding the clear yellow to brown liquid. It may just feel firm. Once spontaneous seroma drainage occurs, I tell my plastic surgery patients to encourage the drainage by expressing the fluid out. Keeping the area clean with hydrogen peroxide is also important.

Infection is a rare but possible complication of seroma, and both the patient and the plastic surgeon need to keep an eye out for it and treat it if it becomes apparent.

 

Resorption

Spontaneous resorption is a common occurrence for small seromas and probably occurs in all cosmetic plastic surgery procedures without the cosmetic patient or plastic surgeon even knowing about it.  One does not know about it, and so nothing needs to be done!

 

Surgical drainage of seroma

When the cosmetic plastic surgeon feels an accumulation of fluid under the skin, it is usually drained with a needle and syringe. In rare cases, drainage using a drain that stays in for a week or so may be necessary.

 

Compression after seroma

Wearing  compression garments for at least two weeks and, later on,  massage, will help move the fluid out of skin areas. The skin needs time to stick down to the underlying muscles and have a chance for the lymphatic vessels to heal together. During this healing phase, it is important to prevent shear forces on the skin, and exercise is not recommended.

So, when a seroma develops, get the fluid out, watch for signs of infection, wear a compression bandage and don’t exercise until the skin has adhered to the underlying tissue.

 

Morad Tavallali, M.D., FACS