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Dr. Rodriguez discusses Plastic Surgery, Medicine, and Stem Cell Research

Tummy Tucks: How to reduce swelling and eliminate fluid collections (seromas)

Tummy Tuck techniques influence blood supply disruption and post operative swelling

Tummy Tuck techniques influence blood supply disruption and post operative swelling

I have been looking at Tummy Tuck forums, just to get an idea of how patients perceive the whole experience of surgery of the abdomen, or  abdominoplasty. Two things struck me.

The first one was the large number of patients who complain of swelling, both immediately after surgery, and weeks after.
The second is that a lot of patients are still getting fluid collections that have to be drained with a needle, sometimes repeatedly.

I think a lot has to do with the type of technique the surgeon uses for the tummy tuck procedure. In my opinion the Lockwood technique of Tummy Tuck offer superior results to my patients.

I think post operative tummy tuck swelling and seromas (fluid pockets) are largely preventable by:

  • surgeon’s choice of abdominoplasty technique: Standard vs. Lockwood
  • post operative compression

In today’s post I would like to discuss the three types of techniques used in the abdominoplasty procedure.  The standard Abdominoplasty Techniques and the Lockwood techniques are illustrated in the above diagram.   They are the two most common types of tummy tuck techniques used. The pink sections of the diagrams show the amount of tissue that is dissected or elevated for the procedure.


The standard abdominoplasty(tummy tuck) surgical technique is taught in most Plastic Surgery Residency programs. Therefore, this is the procedure that most plastic surgeons perform. This technique gets the job accomplished, but the large area of dissection does disrupt the blood supply, which can lead to fluid build up and seromas.

The diagram above illustrates how the standard abdominoplasty operation lifts the abdominal skin from the pubis all the way to the rib margins, the excess skin is cut, usually at the level of the belly button, and the remaining upper abdominal skin is stretched down to the level of the pubic mound. Since such a large area of skin is being dissected, this results in a large area with blood supply disruption. The area with blood supply disruption is represented on the left by the pink shaded area WITH red x’s. You can see that a large area does have blood blow disruption. The problem with the standard technique is that it cuts off the blood supply coming up from the muscles to the abdominal skin. Secondly, the space that was created by the separation of skin flap from muscle is now an empty space where fluid can build up. This is why drains are so important with this technique– they suck the fluid out as it builds up allowing the skin and muscle layers to stick together again.


The Lockwood technique separates much less tissue and is less disruptive to blood supply. From the belly button to the breast bone it only separates a narrow tunnel. This leaves most of the abdominal skin tethered to the muscle and its blood supply. Thus, you have more blood supply in the general area which is a good thing. The area with blood flow disruption is much smaller in the Lockwood technique compared to the Standard technique.

The fact that the skin stays tethered means that there is less chance for fluid accumulations. The fact that the skin has better blood supply has a lot of positive implications. For example, I can liposuction a lot more before worrying about interfering with blood supply. Secondly, the wound itself heals better because of the better blood flow. Similarly if there are other existing scars in the abdomen, such as an old gall bladder scar, this technique is less likely to interrupt the blood supply. Finally, the increased blood flow allows for more compression so that I can tighten the area better (without fear of interfering with blood flow). Thus, I get a much better aesthetic result in my Tummy Tucks with the Lockwood technique.

The Lockwood technique places much of the wound tightening on a deep layer of tissue called Scarpa’s fascia. Other techniques, such as the standard technique use more tension near the incision area which can causes thick scarring. Since the wound tightness is diverted away from the skin with the Lockwood technique, there is less chance of thick scarring. Likewise, since the Scarpa’s fascia is better anchored to the deeper tissues, there is less chance of the scar settling upwards towards the belly button.

In the early years of my practice I used the standard abdominoplasty technique and patients would sometimes get thicker scarring postoperatively which would necessitate steroid injections and crèmes to reduce the scars. Now that I use only the Lockwood technique, I see patients at 4 months for photographs and I never get requests for scar fading creams.


There is another technique called the Pascal, or Drainless Tummy Tuck technique where the abdominal skin flap is sutured in quilt like fashion to the abdominal wall to prevent accumulations pockets. While it may be effective in preventing fluid accumulations, it does nothing to improve the blood supply of the abdominal flap, which I feel is so important for the reasons listed above. Thus, I do not use this technique.


The Lockwood technique is a great option for preventing fluid accumulations (seromas), like the Pascal technique, but it accomplishes so much more because of the improved blood supply to the skin flap.

Posted in Body

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  • wrote
    January 8, 2016 at 2:52 pm

    Normal skin is always shedding off. When you have a deep belly button as often happens after a tummy tuck those shed dead cells stay trapped in there. Bacteria then can settle in the belly button because it is dark and humid and create a bad smell.
    Simply use a q-Tip daily soaked with water or hydrogen peroxide and clean out the inside of your belly button. The problem will go away right away, but you will need to keep washing the belly button 2-3 times a week to prevent it from happening again.

  • wrote
    December 2, 2015 at 3:59 pm

    i had an tummy tuck last year in may and now im starting to have some discharge out of my belly button and yes it wasnt an very nice smell i dont knw what to do my doctor who did my procedure in no longer there can you help me

  • wrote
    September 4, 2012 at 9:35 pm

    I have done a few Lockwood procedures on patients with lap band procedures. You just have to be careful with the dissection, and it’s not a problem because the port is made by design to be easily palpated.
    Give Kelly a call at kelly@cosmeticsurg.net, she’d love to help out.

  • wrote
    August 24, 2012 at 3:18 pm

    Can the lockwood procedures be done on Lap band patients? Or would the port be an issue?

  • wrote
    August 11, 2011 at 8:16 pm

    It costs the same. And it’s better.
    Contact Kelly, she can let you know more details and put you in contact with patients who have had it.

  • wrote
    August 1, 2011 at 8:39 am

    hi, that was a great deal of important information that u shared. I’d like to know if the lockwood system is more expensive or not.

  • wrote
    March 10, 2011 at 11:08 pm

    It is really hard for me to give any kind of input without knowing the technical details of how the surgeon did his procedure.
    Even if I saw pictures at this stage it would be unreliable advice as I myself tell my own patients that full results are not seen for at least 3-4 months.
    My advice to you is to be patient and communicate fully your concerns in luxury of detail to your surgeon. Do not leave his office until you feel you have been given a full explanation. Above all, rely on your doctor patient relationship at this early stage. He is in the most knowledgeable position because he knows what he did, how he did it, and what his expectations are.

  • wrote
    March 9, 2011 at 11:11 am

    I just got a tummy tuck almost 3weeks ago and I am freaking out about my results. First off, Im still not walking completely straight. Second, There is lilttle to no space between my belly button and pubic area. My pubic area appears to be higher is looks like a mound (I assume its swollen?). I know for a fact that there is suppose to be a space between the 2. I go see my PS again next week and I am going to address him about this. He did my sister’s tummy tuck a week after mine and she has a space between her BB and pubic area. I know the PS and his team kept stressing to me that “he made you really tight” that is all good and everything but now my results are not what it should be. I wanted to know what your input is on all of this and if when the swelling goes down will the pubic area appear “normal” again and when the incision starts healing does the scar drop? PLEASE get back to me thank you. P.S. I am going to try to post a pic :-)

  • wrote
    November 7, 2010 at 10:15 am

    You can call Kelly at 410 494-8100 for pricing information.
    For implant sizing it is best to try them on at the doctors office. You may like the implants to be wider on your chest, or more compact and with enhance cleavage. Look at this blogpost for more info.
    As for the Tummy Tuck, the use of the lockwood procedure both reduces the need for drains and minimizes the scar.
    Call us, we’d love to hear from you!

  • wrote
    October 20, 2010 at 3:46 am

    Hi there Dr. Rodriguez,
    How much it cost for a tummy tuck? Howmuch for breats implants? I am 105lbs 5’1. I want to go for 533cc. I am A cup or just nothing. I was C cup when I was pregnant or full C while breast feeding. Do you think I can go for D? I don’t have breast now because it shrunk. I also want tummytuck,but I am scared of the draining thing. Also, I don’tlike the thick scar. I agree with you that the procedure of the surgery play a big role when it comes to scarring.

  • wrote
    June 21, 2010 at 8:03 am

    I have been using the lockwood procedure since the year 2000. I have not looked back since I started using it.

  • wrote
    June 20, 2010 at 8:59 pm

    How long have you used the lockwood procedure?

  • wrote
    June 21, 2010 at 7:43 am

    Contact Kelly at kelly@cosmeticsurg.net.
    You may also call the office at 410 494-8100 and speak with Vanessa or Molly.
    I’m looking forward to meeting you!

  • wrote
    June 20, 2010 at 6:52 pm

    Will your office be open on Friday of this coming up week? I am from NC and will be passing through and wanted to see if I could schedule a consult with you.

  • wrote
    June 20, 2010 at 5:48 pm

    The Lockwood technique is a way of doing a full Tummy Tuck procedure. For a mini Tummy Tuck one only elevates the tissue between the pubis and the belly button. The two procedures have different indications. See this blogpost for a fuller explanation.
    For maximum healing and scar appearance, the most important things are operative technique and postoperative management. Post operative management has to do with the patient following instructions carefully, and the proper surgical garments. I think the role of creams and massage is secondary, and only necessary when something in operative technique or postoperative management has not gone as planned.

  • wrote
    June 20, 2010 at 1:06 am

    the lockwood technique sounds better and safer, but what if not all patients require this technique, for instance in a mini tummy tuck? You said you now exclusively use this technique in all your tummy tucks. Did you mean all of your full tummy tucks? also what are some of the post operative care pocedures that you stress for maximum healing and scar appearance, for instance garments, creams, messages etc.

  • wrote
    August 19, 2009 at 12:42 pm

    I get a lot of questions from patients about the immediate post op recovery period. Since I cannot examine a patient online, and I do not know what was done surgically, it is not appropriate for me to give advice.
    I really recommend to you that you go see the surgeon again, and be very insistent about your concerns. Do not leave the office until you feel like all your concerns have been addressed.
    It helps both you and him if you write all your questions down before the meeting.

  • wrote
    August 17, 2009 at 9:42 pm

    I had a tummy tuck (I believe the Pascal method),an embilical hernia repair and some abdominal liposuction about 6 1/2 weeks ago. I have developed a pocket with fluid buildup that isn’t going away and seems to be getting worse. My doctor drained it twice about 3 weeks ago. I am starting to panic because the last thing I want is another surgery. I also seem to be swelling more. My doctor said I don’t need to wear the binder anymore so now I am wearing Spanx which seems to be tighter. Is there anything I can do to get the fluid to absorb? My doctor said it is O.K. to do normal activity so I am.

  • wrote
    August 4, 2009 at 10:51 pm

    Sorry to hear about your problem, hope your surgeon took care of it!

  • wrote
    August 4, 2009 at 4:17 pm

    i had a tummy tuck 7-08-09 (by another surgeon), almost a monthy ago. last nite i noticed a lil leakage on my bandage. This morning i was getting ready to get in the shower and noticed leakage started coming out of the bandage, it was a lil yellowish orangish. i noticed in that are in front of my belly was a lil more swollen. now that the bit of leakage came out and stopped now that it went down some, and is not leaking with any pressure or movement. Could it possibly be done leaking and oit was leakage build up from the drains coming out?? my doctor app. is today at 4pm. so hopefully it was just that lil bit, cause im kinda scared to get a needle in my stomach..


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