Post-lipo after care (after liposuction, vaser, BBL, cellfina and other cosmetic surgery)

All you need to know about liposuction, cellulite surgery and related procedures, and post-lipo aftercare

After liposuction and cellulite surgical procedures (normal lipo, liposculpture, vaser, smart lipo/laser lipo, bodytite, cellulaze, cellutite, profound RF) the skin is often left with either fibrosis (hard scar tissue lumps, hardened skin and adhesions), pigmentation due to bruising, unremoved fat lumps, skin looseness (saggy skin) or a combination of the above. Cellulite is typically also increased. Liposuction DOES NOT remove cellulite and nobody tells you that, while cellulite surgery quite often makes the situation worse, replacing cellulite with loose skin, fibrosis or a combination of both.

Brazilian butt lift/BBL, may not leave behind skin looseness, due to the addition of fat that stretches the skin, but does not do anything for cellulite, plus it can leave you with fibrosis and water retention. Fat may also “travel”, diminish or, if in the wrong place, may simply look, well, out of place.

By definition, two other surgical cellulite procedures, cellfina and subcision, leave you with loose skin. This is because they undercut the collagen fibres that keep your skin in place. Again by definition, cellfina and subcision cannot remove all cellulite - only the major cellulite bumps (with cellfina, up to 8 are allowed, while the body has hundreds smaller and larger cellulite “bumps”). And like all cosmetic surgery they may give you fibrosis (lumps), pigmentation due to bruising and inflammation and sometimes worse cellulite than before.

After all those types of cosmetic surgery, treatment is almost always needed, first for the removal of the fibrotic hard lumps and then for skin tightening, reduction of unremoved fat lumps and cellulite.

At LipoTherapeia we have specialised for the last 15 years in post-lipo treatments and offer the strongest skin tightening and cellulite treatments available.

If you are reading this page chances are that you already have had surgery so you cannot prevent any wrong decisions, such as having liposuction for cellulite; or believing that ultrasound-assisted lipo will tighten your skin long-term (it doesn’t it scar tissues it, which passes as skin tightening, temporarily); or believing that subcision cellulite surgery removes all cellulite.

Below you can read an extensive analysis of post liposuction aftercare and what you can do yourself to improve the appearance of the operated areas, from recovering from bruising and swelling to tightening your skin and removing cellulite.

Life after liposuction: what surgeons don’t tell you

Post-liposuction rescue guide

Liposuction and related procedures often leave you with looser skin and more prominent cellulite

Liposuction is useful but also problematic. It is sometimes the only method to remove large amounts of stubborn fat from one specific area or without diet and exercise.

However, liposuction and all its variant procedures (vaser, smart lipo, bodytite, cellfina, cellulaze, cellutite, subcision, profound RF) almost always leave behind either saggy skin, hard lumps, residual fat lumps or a combination of the above, and may make cellulite more prominent.

It is in the nature of liposuction

This is an unavoidable result of removing fat tissue from underneath the skin. By removing the fat, the excess, stretched skin that used to cover the excess fat tissue appears as loose and saggy.

Skin contracts very slowly on it's own and in most cases it never regains its pre-overweight shape and tone after the removal of fat by surgery.

If you had tight skin to begin with, you may not notice such a big difference. If you already had loose skin and then had "lipo", then skin will look very loose and saggy.

 

Radiofrequency, ultrasound or laser-assisted liposuction does not tighten skin, it "scar-tissues" it

Bodytite, vaser and smart lipo procedures (i.e. "mini-liposuction" with a smaller cannula equipped with a radiofrequency, ultrasound or laser tip, respectively) claim to tighten up skin after the removal (smaller amounts) of fat.

However, this skin hardening effect is not true skin tightening. Skin tightening refers to collagen contraction and also more collagen and elastin produced by a higher number of collagen cells (fibroblasts), i.e. tissue with an actual functional role in the body. Because this is real, alive collagen tissue, it remains on your body long-term.

On the other hand, the skin hardening produced by those types of energy-tip assisted liposuction is nothing more than deliberate scar tissue (fibrosis), formed by literally burning the skin from the inside and sticking it to the underlying tissues (coagulation). Because this is scar tissue, i.e. dead, non-functional collagen, it is quite short-lived (does not live for more than a year). These technologies do not solve the problem of loose skin after liposuction, as they cause "scar tissue-ing", not real, functional skin tightening.

This "scar tissue-ing" inadvertently leads to difficulty with movement, pain and discomfort for a few weeks or months, until all tissue adhesions are broken down.

Fibrosis after lipo

You do not need to have ultrasound, radiofrequency or laser with your liposuction to get fibrosis / scar tissue (Hard lumps). It comes with the territory. Every surgery causes some degree of scar tissue, and liposuction, being by its nature a harsh technique, will cause a lot of fibrosis.

Imagine someone scraping inside your body to detach your fat from its attachments on the tissues above and beneath it. Depending on the surgeon’s technique, the hardness of your tissues and your propensity to develop scar tissue, you may have minimal fibrosis or a lot of it.

This fibrosis manifests itself as palpable, quite often visible scar tissue hard lumps that may remain visible and palpable for two years or more; and as adhesions, i.e. hardened skin which adheres to the tissues underneath, inhibits movement and causes pain with movement.

Very strong massage can help with adhesion and fibrosis removal after lipo, but several sessions are needed (typically 10-20 are needed for good results, yet most people have 5-6). The problem in this case is that no-one tells patients about fibrosis after lipo, so patients don’t budget for post-lipo fibrosis treatments and simply neglect them. Unfortunately, for many people with liposuction is not as cheap as it initially seemed.

As a result, the vast majority of clients I see at the clinic who have previously undergone lipo, have scar tissue in the operated areas even years after the op: you can see it, you can feel it and you can touch it.

(Loads of examples on all of the above at realself.com.)

 

Residual fat pockets after lipo

Furthermore, quite often small pockets of fat that are not removed by the surgeon remain on the body after liposuction. In some cases the surgeon leaves quite a lot of residual fat to avoid the appearance of excessive loose skin. This is a compromise between removing all the fat with the skin looking very saggy and removing some of the fat and keep skin relatively firm (which later usually grows again if you overeat/do not exercise)

In some cases the surgeon agrees to do a "touch up" and remove those fat pockets, but this is not always possible, especially if you had your liposuction procedure abroad, if you are very sensitive after surgery or if you already have a lot of scar tissue from surgery. Moreover, residual fat removal touch-ups are not always successful.

(Loads of examples on all of the above at realself.com.)

Cellulite becomes more evident after lipo

Finally, due to the excess, saggy skin after lipo, cellulite always becomes more evident after lipo. Liposuction does not make cellulite worse per se, but it makes it look worse, due to the removal of the underlying fat and the appearance of loose skin.

Liposuction can never remove cellulite

At this point it is important to clarify that, contrary to popular belief, liposuction and mini-liposuction procedures such as "smart lipo", "bodytite" and "vaser" by definition CANNOT remove cellulite.

This is because cellulite is fat INSIDE the skin itself (hypodermal fat), while liposuction removes fat UNDER the skin (subcutaneous fat). Because cellulite is an inherent part of the skin structure it can not be surgically removed without removing the skin itself.

If anyone promises you cellulite reduction with liposuction, vaser, smart lipo or bodytite, they are simply lying to you.

 

Surgical cellulite removal is even more problematic

There are two groups of surgical techniques for cellulite, and all are problematic, as you will see below.

Even if you manage to effectively remove cellulite with them, you will need post-surgery treatments to reduce either swelling, scar tissue, pigmentation or skin looseness.

In fact, the cost for those post-surgery treatments can easily be the same as the cost of surgery itself.

After cellfina or subcision cellulite surgery you really need skin tightening

There are two surgical techniques for cellulite removal that work by removing the collagen fibres (scientifically called retinaculae, quite often erroneously called septae) that anchor skin to deeper tissues: subcision and cellfina. These collagen anchors, together with the enlarged fat globules and water retention, cause the cellulite mattress appearance.

However, those anchoring collagen fibres are there for a reason: to keep skin attached to underlying tissues and maintain skin firmness. By undercutting those anchoring fibres with subcision or cellfina, you replace one evil with another, i.e. you replace cellulite with jelly-like skin looseness / flabbiness. This can actually look worse than cellulite, especially on women with looser skin. Only very firm skin will genuinely benefit from this procedure (same as liposuction).

Furthermore, both these techniques can only be practically applied on a few dozens of the larger collagen anchors that are found in the hypodermis and cause the large cellulite "bumps" (surgeons are allowed to remove up to 80 collagen anchors per surgery).

It is practically impossible to remove the hundreds of hypodermal or thousands of dermal cellulite lumps with these methods. So these techniques do half the job and you still need non-invasive cellulite reduction for the smaller bumps.

And of course, you also need skin tightening to correct the resulting skin laxity, which can easily cost as much as the surgery itself. So do your research and don't fall for the hype.

Subcision, profound RF cellfina can also lead to pigmentation due to bruising and also worse cellulite than before.

(Loads of examples on all of the above at realself.com.)

Burning the skin from the inside And then replacing cellulite with scar tissue. What could possibly go wrong?

The other two cellulite surgical procedures (cellulaze, cellutite), plus profound RF which is based on needles inserted into your hypodermis, attempt to burn (euphemistically, coagulate) the skin from inside, with a laser or a radiofrequency tipped cannula, respectively.

However, as with laser/radiofrequency/ultrasound assisted liposuction, the burned tissue that is produced is not functional collagen tissue, it is dead, hardened, fibrotic scar tissue.

This scar tissue is quite often excessive and may look much worse than the original cellulite it replaced, with pronounced hard bumps, much larger and much harder than those of cellulite. Again, this is not skin tightening, it is literally "scar tissue-ing". It offers little and the scar tissue bumps may prove impossible to remove and they can last for years after surgery.

(Loads of examples on all of the above at realself.com.)

What would I personally do?

For fat removal anywhere except the stomach area: knowing what I know after all these years and all the clients I have seen, if I needed to surgically remove fat, I would have normal liposuction or mini-lipo (without laser, radiofrequency or ultrasound tip) and then follow it up with a course of 6-12x treatments for skin tightening, residual fat removal and cellulite removal.

For excessive stomach fat with hanging skin I would pick the absolutely best surgeon and I would have a tummy tuck/abdominoplasty (don't do a tummy tuck on the cheap, you will regret it).

In addition to those, I would ideally have to also allow for 6-12 massage sessions for quick recovery and scar minimisation immediately after surgery and for the next eight weeks. This is before the skin tightening treatments, mentioned above.

(If you think that the only cost of the surgery is the surgery itself, think again...)

For cellulite, it's a no-brainer. I would not touch any of the four surgical cellulite removal methods with a bargepole and would instead have 6-12x sessions of strong radiofrequency, if possible combined with other technologies, such as ultrasound and non-injection mesotherapy with concentrated natural actives.

And practising what we preach, this is what we offer at LipoTherapeia.

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Why is liposuction aftercare needed?

As with all surgery, aftercare treatments are essential after all types of liposuction (after liposuction, liposculpture, abdominoplasty, vaser, smart lipo, bodytite, cellutite, cellfina, profound RF, cellutite, Brazilian butt lift/BBL and cellulaze), even if liposuction is performed by a very skilled surgeon. This is because pain and swelling always follow any intrusive procedure. The following side effects typically occur:

  • Loose skin

  • Excessive skin hardening

  • Scar tissue (fibrotic) lumps

  • Lumps of fat left unremoved

  • Skin adhesion onto the underlying tissue, which leads to movement restriction

  • Cellulite looks worse (cellulite is not removed by liposuction and cellulite surgery is quite often the wrong decision)

 

How to reduce swelling and hard lumps after liposuction with progressively stronger massage

The recommended treatments differ depending on the timeline after surgery. Here is a short list: 

  • Day 3-21: Focusing on pain, swelling and tissue healing. During the first 2-3 weeks, post-lipo aftercare treatments should initially be gentle and progressively become stronger and aim to minimise pain and swelling and prevent excessive scar tissue from forming. Mild lymphatic drainage massage by hand or with special electro-lymphatic drainage equipment is needed in the first couple of weeks after any liposuction surgery. A firmer massage - but not too strong - must be applied from the second or third week onwards.

  • Day 21-56: Focusing on cellulite removal and fibrosis after lipo. From the third week onwards treatment can become progressively more vigorous: strong lymphatic stimulation massage is preferred to the “fluffy” lymphatic drainage (MLD) variety used the first three weeks. In addition to reducing water retention, stronger massage also helps with the breakdown of scar tissue / hard lumps that typically form after lipo surgery and uncouple skin that is stuck on underlying tissue and increase range of movement. Pressotherapy for lymphatic drainage can also be used during these weeks (week 33 to week 8).

  • Day 56+: Breaking down leftover fat and cellulite and tightening up the skin. After about 8 weeks you can start having a strong radiofrequency / ultrasound / electro-mesotherapy treatment to effectively break down leftover fat and cellulite and tighten up the skin. This may also assist in the removal of fibrotic / scar tissue lumps due to the micro-massage action of ultrasound, due to the increase in metabolism on the tissue affected by both RF and ultrasound and due to the anti-fibrotic action of the natural active ingredients used for the electro mesotherapy component of the treatment. However, RF and ultrasound are not lump removal treatments per se.

(Please note that we do NOT offer scar tissue/fibrosis removal after liposuction anymore. It is very stressful, as patients feel desperate for quick improvement and it also requires a lot of sessions, which, after forking out thousands of pounds for the botched surgery, most people are unwilling to pay for. The result is pressuring the therapist to produce miracles in 3-6 sessions, when quite often 10 or 20 sessions are needed. Not a very rewarding job, especially when you are pressured to correct with £300 the complications of a £5,000 botched surgery. Thanks but no thanks.)

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A simple method to self-massage the fibrotic hard lumps after lipo

  1. First apply a little oil on the area. Not too much, not too little. The skin should not be slippery., neither dry. It should allow some “drag”, but not too much. Almond oils is ideal, but you can use anything, even olive oil. It does not need to cost £20 for 30ml. Contrary to the marketing blurb, expensive vegetable oil (e.g argan oil or anything overhyped) does not have magic properties and will not magically take away the hard lumps or the inflammation if it costs a fortune. If you wish, you may add 2 drops of essential oil (lemon, mint, eucalyptus etc) in 5ml of oil (that is roughly 2% - that’s enough). From time to time make sure you reapply a bit of oil to ensure a balance between slip and drag.

  2. Now start to massage with long, firm strokes. It doesn’t matter if they are upwards or downwards. We are not doing lymphatic drainage here, we break the lumps. In fact you DO need to massage on both directions to more efficiently break down the fibrotic lumps and the skin adhesions. Apply differing pressure, lighter and firmer.

  3. After a few minutes start kneading the hard lumps, as you would need dough. Again apply lighter and firmer pressure at times. Do that for several minutes and make sure you are just on or just below the pain threshold. If you overdo it your skin will be sore and potentially inflamed the next day.

  4. Now massage the scar tissue with your knuckles, again with varying pressure and again do not overdo it.

  5. Now you can add a bit more oil to make skin a more slippery and massage upwards with long, medium pressure strokes for a few minutes to drain any excess fluid.

  6. Again, please note that this is an anti-fibrotic massage and should be done with gradually increasing pressure from day 15 after lipo. Before that, you need a drainage massage, which can simply be step 5, with very light pressure in the first few days after lipo and gradually firmer pressure as the days go by. If you want a full-on lymphatic drainage massage, that cannot be taught in a few paragraphs and you need to go to an expert.

 

A good, multi-ingredient cellulite cream can be of help

A good anti-cellulite cream, i.e. a cream that contains anti-inflammatory, circulation/lymph drainage-enhancing and lipolytic ingredients, can also offer valuable help with recovery after liposuction, not just with cellulite.

Such a cream can be applied throughout the different stages of recovery. Cream application can start immediately after surgery, provided that contact with the portals (cannula insertion points) is avoided while the wounds are still open.

How to tighten skin and remove cellulite after lipo

The strongest possible technologies for skin tightening and cellulite removal are high-power, deep-acting radio frequency, high-power cavitation and electro mesotherapy (only if it utilises highly concentrations of actives, though), and for this reason this is what we offer at LipoTherapeia - get the facts below.

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