AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2700 plastic surgery questions for Allexperts. His expertise is in cosmetic plastic surgery including breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts etc.
Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction."
Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), and the Dr. Keith Ablow Show. Videos of his appearances are available on YouTube (SEARCH FOR "DR. ENGLER"). His website is www.bodysculpture.com.
Experience Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, etc.
Education/Credentials Dr. Engler graduated from Yale University (undergraduate) and the College of Physicians and Surgeons of Columbia University (medical school). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York.
I had a body lift with belt lipectomy and muscle repair on March 27th. I had four drains placed during surgery. Two of them were pulled at three weeks. Now I'm over four weeks post op and still have two drains. I'm desperate to be free of these drains but my surgeon won't take them out until they are between 20 - 30 ccs. One is finally under 25 ccs for 48 hours. The other is still chugging along at 40-50 ccs per 24 hour period... four weeks later. The drainage fluctuates from yellow to red and back to yellow. I understand the yellow fluid is serous fluid and is a good sign once it has turned this color. However, I don't understand why it would turn back to red. The drainage amount has decreased from the day of surgery but for the past nearly 2 weeks it has remained at the 40 to 50 mark.
I'm concerned that things are not healing properly inside. The incision looks great. There's swelling but it's even and nothing out of the ordinary... no lumps or redness. I'm a bit more sore on the right side, the side of the high producing drain. I'm taking it very easy and resting a lot. What could be causing this drain to continue on the way it does? Is there anything I can do to help it slow down?
Thank you,
Heather
ANSWER: from Dr. Alan Engler
www.bodysculpture.com
Hi Heather,
I'm sorry that the pace of your recovery is going as quickly as, I'm sure, everyone would like.
Your surgeon is doing the right thing. You cannot remove drains until the drainage is low enough (less than 30 cc's in 24 hours is the generally accepted benchmark though, in all fairness, little is written in stone). You may still be draining because there was a little bleeding that persisted postoperatively, and as the blood liquefies (which is part of the normal healing process) it turns the fluid red for a while.
The only other question is whether the type of drain you have - presumably a closed-system like a Blake or Jackson-Pratt - is the best thing at this stage. I have become a fan of using two different types of drains for body contouring procedures: both active drains (like Blake) and a passive drain such as a Penrose. This is a simple rubber tube that allows fluid to drip out onto a pad on a more or less constant basis. It may be a good idea to try to insert one or more of those now.
Again and as always, I'm a little uncomfortable trying to direct your care online and without being able to examine or see you and, more to the point, while you are under the care of an obviously cautious surgeon.
I don't know of anything you can do to speed up the process; it's something that you just have to wait out. And the only issue at all is whether there's some sort of additional drainage that can be effected at this point.
I hope that this helps, and good luck,
Dr. Alan Engler
www.bodysculpture.com
---------- FOLLOW-UP ----------
QUESTION: Thank you for your response! I appreciate it.
There's been no change since I last wrote to you. I'll be 5 weeks post-op tomorrow. I have two drains still in. One is still under 25 cc's. The other has remained steady between 40 and 55 cc's for about the past ten days. I don't see any change whether I am sedentary or going about my life or even getting back to the gym (light excercise) a couple of days ago. I also have had very little swelling through these five weeks of recovery. Only occasionally in the evenings.
I read somewhere that even the drain itself can contribute to drainage amount. Is that true? I occasionally have serous fluid leak from the hole in my mons. Not a lot but enough to where I have to wear a thin maxi pad across my drain holes.
My surgeon says he's going to have to pull them despite the numbers. Probably today or tomorrow because of infection risk. Tell me that doesn't mean an automatic sentence to a seroma. In your experience have you had patients drains pulled even though they produced higher than desirable cc's and not develop seromas?
Answer Hi Heather,
As I indicated, I feel that there is a certain value to the use of a passive drain. Personally, I don't like pulling drains that are still putting out 40-55 cc's day at this point, particularly if there appears to be additional fluid coming out around the drain. The drainage may not go to zero, and the drain probably causes SOME fluid, but it's a question of degree.
Again, there are no absolutes and it's hard for me to say anything substantive via this forum, but I would favor removing the drains you have and resinserting two passive drains (which can be done under local anesthesia, and brought out through or near one of your existing incisions.
