Posture After Liposuction — Even Skin Contraction Shapes the Result

In this article, I will explain how the skin contracts after liposuction and why the skin contracts evenly only when the compression garment is worn flat and good posture is maintained. I will then go through the areas where posture easily causes creases — the lower abdomen, the arms and breasts, the thighs, and the double chin — one by one, and show a revision case of a patient who developed a horizontal crease across the lower abdomen because of poor care after a previous surgery.

※ This is a simulated image. Actual results may vary from person to person.

As noted in our Venus Clinic pre- and post-operative care guide, for up to 2–3 weeks after surgery the treated area goes through a healing process in which it becomes firm and lumpy, and because the skin contracts during this process, the area becomes smaller without sagging. The process of the skin adhering to the underlying tissue continues for up to 2–3 months after surgery[3][4]. The shape in which the skin is held during these few weeks of firming and contraction determines the final shape.

The problem arises when the skin contracts "while folded." If the compression garment rolls up or bunches to one side and is worn wrinkled, or if a bent posture is held for a long time, the folded area of skin sets in that folded shape, and the excess skin gathers above and below it. Skin contraction then cannot occur evenly, so the contour may look unnatural, or in severe cases dents or bulges may form in the treated area. The postures to be especially careful about, by area, are as follows.

The area that needs the most care is the lower abdomen. If you sit in a chair for long periods after abdominal liposuction, your lower abdomen stays folded horizontally. If the skin contracts in this state, a horizontal crease forms and becomes a dent along the fold, while the skin above and below it gathers and bulges. In the end, instead of even skin, you get a body shape with a horizontal dented crease. If you work sitting down, stand up from time to time to straighten your back and walk, and when you sit, lean back so that your abdomen does not fold deeply. Klein's textbook also recommends light walking early on after abdominal liposuction rather than just lying in bed[6].

Left: sitting hunched for a long time with the lower abdomen folded · Right: standing upright

If the lower abdomen contracts unevenly during long periods of sitting like this, a horizontal depression can form from below the navel to the flanks, as if a swim ring were around the waist. In such cases, revision surgery refines the depressed area and the bulging areas above and below it to even out the lower abdomen. As an illustration, it looks like this.

Left: a horizontal depression across the lower abdomen · Right: an evenly refined lower abdomen after revision surgery

After arm liposuction or breast liposuction, many patients keep their arms pressed tightly against their bodies because the armpit area feels sore and awkward. However, if you keep your armpits pressed against your body, the excess armpit skin contracts while folded, forming deep creases, and in some cases adhesions may develop to the point that it is hard to raise the arms. It is better to keep a little space at the armpits and, within the range your pain allows, slowly raise your arms often.

Left: arms pressed tightly against the body · Right: arms raised with the armpits opened

After thigh liposuction, creases can sometimes form on the inner thigh just below the groin. This area folds easily if you sit for a long time with your legs pressed together, so please be careful. In addition, if you stand with your hips tucked forward, the buttocks rise and the existing crease below the buttocks becomes exposed and deeper, so that it can look like a double crease. The crease between the buttocks and thighs deepens or becomes shallower with muscle movement: when the hips are tucked forward, the buttocks and thighs fold and the crease deepens, and when you stand upright it becomes shallower[7]. Please make a habit of standing upright with your pelvis set straight, as in standing at attention.

Left: hips tucked forward · Right: standing upright with the pelvis set straight

Right after surgery, the subcutaneous tissue is heavy with swelling and not yet firmly attached to the underlying tissue, so it tends to slide downward with gravity. If the compression garment has slipped down or is loose below the buttocks at this time, the tissue at the lower buttocks contracts in a sagging position. The area may then settle into a sagging buttock shape, in which the lower edge of the buttocks covers the crease and the back of the thigh looks thick.

The diagram below shows this process as a cross-section of the skin, fat layer, and fascia. The treated area, heavy with swelling, tends to shift downward, and if it contracts in this state, the upper part becomes thin while sagging and bulging remain in the lower part. Conversely, when the compression garment supports the entire treated area from below and presses it evenly, the skin does not shift to one side but contracts evenly, adhering into a smooth line. This is why the result of liposuction is completed not only by "how much was reduced" but also by "how evenly the skin contracted."

Left: lower buttock tissue sagging and covering the crease · Right: supported from below with the crease visible

For this reason, after thigh liposuction you wear a compression garment that covers both the buttocks and the thighs[8]. When putting it on, pull it up from the thighs so that the garment supports the buttocks from below. After using the restroom or after getting up from sitting for a long time, check in a mirror that the garment has not slipped down and wrinkled below the buttocks, and pull it back up. Proper compression is important for preventing swelling and contour irregularities after surgery, but compressing the arms or legs too tightly can actually cause venous thrombosis, so you should wear a garment that fits your body[9].

After double chin liposuction, if you keep your head bowed for long periods while looking at your phone or a book, the skin under the chin and on the neck contracts while folded, and horizontal creases on the lower neck can form. Raise your phone to eye level, and check frequently that the face, chin, and neck compression garment is not lifting or rolling under the chin.

Left: head bowed for a long time · Right: phone held at eye level

The areas differ, but the principle is the same. An even result comes when the skin contracts while spread flat, without folding. Here is a summary of what we at Venus Clinic advise during the recovery period[3][4].

The patient below developed a horizontal dented crease across the lower abdomen after a previous abdominal liposuction and underwent abdominal revision surgery at Venus Clinic. All post-operative photos were taken 2 weeks after surgery. Swelling and bruising are still present at this stage, so these are not the final results.

In this revision, liposuction was performed on the abdomen together with the flanks and waist and the back above the bra line. The front, side, and back views are shown in order.

This is a case in which a horizontal dented crease formed across the lower abdomen after a previous surgery. In the pre-operative front photo, there is a deep crease across the lower abdomen, and the areas above and below it bulge, so the abdomen looks as if it were divided into upper and lower mounds. Because skin contraction did not occur evenly during care after the previous surgery, the abdomen took on this shape with a crease and bulges above and below it. In the post-operative photo after revision surgery at Venus Clinic, you can see that the horizontal dented crease is no longer visible and the lower abdomen has become flat.

From the side as well, the lower abdomen protruded forward before surgery, but after surgery the line running from below the ribs to the lower abdomen has been made flat. The yellowish discoloration visible on the skin is bruising that is fading around 2 weeks after surgery, and it disappears over time.

The back view shows the waist and the back above the bra line, which were treated at the same time. The rolls that had been folded on both sides of the waist and on the back before surgery have been reduced, and the line from the waist to the back has become smooth. We also advised this patient to wear the compression garment flat during recovery and to avoid sitting for long periods so that the lower abdomen would not fold.

After liposuction, the skin — loosened by the amount of fat removed — contracts over several weeks and settles into the new contour. During this time, wearing the compression garment flat and keeping a good posture in which the skin does not fold allows even skin contraction, so that a good cosmetic result can be expected. At Venus Clinic, we remove the fat that needs to be removed as thoroughly as possible and refine the contour so that it is smooth rather than uneven. To help that refined contour settle as it is, we also guide you on the compression garment suited to the treated area and on posture during recovery.

References: Precautions for Pre- and Post-Operative Care The Compression Garment That Completes Your Liposuction Result