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

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.

An illustration showing the different Tummy Tuck techniques.
Standard Tummy Tuck vs Lockwood Tummy Tuck

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 plastic surgeon uses for the Tummy tuck procedure. In my opinion, the Lockwood technique offers superior results for my tummy tuck patients.

I think postoperative Tummy tuck swelling and seromas (fluid pockets) are largely preventable by:

  1. The surgeon’s choice of abdominoplasty technique
  2. Post-operative compression

In today’s post I would like to discuss the three types of techniques used in the Abdominoplasty procedure. Surgical technique influences blood supply disruption and post-operative swelling, so let’s take a look a closer look.

The standard Abdominoplasty techniques and the Lockwood techniques are illustrated in the diagram here. They are the two most common types of Tummy tuck techniques used. The pink sections of the diagram shows the amount of tissue that is dissected or elevated for the procedure.

Standard abdominoplasty technique

The standard abdominoplasty surgical technique (or standard tummy tuck) 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.

Lockwood abdominoplasty technique

The Lockwood abdominoplasty surgical technique (or Lockwood tummy tuck) 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 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. And 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 gallbladder scar, this technique is less likely to interrupt the blood supply. And 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 by using the Lockwood surgical 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 result in 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.

Pascal, or drainless Tummy tuck technique

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.

My favorite Tummy tuck technique is the Lockwood 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.

Wondering if a Tummy tuck is right for you?

Contact Us to schedule your in-office or virtual consultation for just $30 (which gets applied to your surgery when you book). Or just give us a call at 410-494-8100! Note: Virtual consults can also be used to get second opinions.

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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25 thoughts on “Tummy tucks: How to reduce swelling and eliminate fluid collections (seromas)”

  • Jamie says:

    8 years ago i came across a belly button technique that i could of sworn was in your blog and I can no longer find. I clearly remember reading all about the Lockwood technique as well. The special belly button technique my surgeon used on me and I have been trying to find instructions again.
  • Jodie Narayan says:

    I had tummy tuck in December. My belly button is still dark color and red bump around it. And my tummy at the bottom is still swollen
    • Dr. Ricardo L Rodriguez says:

      Jodie: You need to take these concerns to your Doctor. Do not stop insisting that you need an answer to your questions. Do not stop until you think your surgeon has been forthcoming. If you do not feel satisfied, get a second opinion from a doctor that can see you and examine you so he can give you a meaningful answer. I cannot give you a realistic answer based on an online statement, but a surgeon examining you in person will.
  • JAMIE says:

    In 2010 I found a post about a special belly button that I had told my plastic surgeon about and I could have sworn It was your technique. I can’t seem to find this anywhere. Am I wrong?
    • Dr. Ricardo L Rodriguez says:

      Jamie: I don't know if you can find it published somewhere. It is not my technique, I learned it when I was in France from a Brazilian surgeon. I never see it done here, what i see most is that ugly circle that looks like a doughnut. Perhaps you meant this blog post
  • Twanna Washington says:

    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
    • Dr. Ricardo L Rodriguez says:

      Twanna: 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.
    • Dr. Ricardo L Rodriguez says:

      Sheila: 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.
  • maria says:

    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.
    • Dr. Ricardo L Rodriguez says:

      Maria: 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.
  • Adia says:

    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 :-)
    • Dr. Ricardo L Rodriguez says:

      Adia: 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.
    • Dr. Ricardo L Rodriguez says:

      Cream: I have been using the lockwood procedure since the year 2000. I have not looked back since I started using it.
  • Sandy says:

    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.
    • Dr. Ricardo L Rodriguez says:

      Sandy: 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!
  • cream says:

    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.
    • Dr. Ricardo L Rodriguez says:

      Cream: 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.
  • Robyn says:

    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.
    • Dr. Ricardo L Rodriguez says:

      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.
  • Lanette says:

    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.. ~Lanette~