Daniel J. Gould, MD, PhD
Board-Certified Plastic Surgeon | Beverly Hills, CA
Fellowship-Trained in Aesthetic Surgery | MD-PhD in Bioengineering
Author of 170+ peer-reviewed publications | 800+ national presentations

Introduction: Redefining Recovery in Abdominoplasty

Traditional abdominoplasty has long been associated with significant postoperative pain, limited mobility, and the need for surgical drains to manage fluid accumulation. These standard recovery elements have been a barrier to patient satisfaction, increased complication risks, and prolonged downtime.

Through years of clinical refinement, academic research, and hands-on aesthetic surgical experience, I’ve developed a comprehensive recovery optimization strategy—centered around Exparel, a long-acting liposomal bupivacaine formulation—paired with progressive tension sutures and drainless closure techniques.

This combination, which I term the “Drainless, Painless Tummy Tuck Protocol,” significantly reduces narcotic consumption, eliminates the need for drains, and supports faster, safer healing. I’ve implemented this in over 50 consecutive cases with a remarkable safety and satisfaction profile.

“Pain control is not just about comfort—it’s about reducing inflammation, enabling early ambulation, and avoiding the complications that come with immobility and opioid dependence.”

Surgeon Education Hub: Optimizing Recovery with Exparel in the Drainless, Painless Tummy Tuck Beverly Hills

What Is Exparel?

Exparel (liposomal bupivacaine) is an FDA-approved, non-opioid local anesthetic indicated for single-dose infiltration to produce postsurgical analgesia. Encapsulated in a multivesicular liposome delivery system, Exparel provides sustained release of bupivacaine over 72 hours, targeting the immediate postoperative window when pain is most intense. Key pharmacological features:

Extended pain relief duration (up to 72 hours)
Reduced need for opioid rescue medication
Can be safely combined with other pain control agents (as part of a multimodal regimen)

Clinical Evidence: Supporting the Use of Exparel in Abdominoplasty

In our peer-reviewed publication:

“Drainless Abdominoplasty With Long-Acting Local Anesthetic and Progressive Tension Sutures: A Safe and Comfortable Technique With High Patient Satisfaction”

(Aesthetic Surgery Journal Open Forum, 2022)

Full Article on PubMed Central

The Gould Protocol: Step-by-Step Surgical Integration

Preoperative Patient Optimization

Thorough counseling on expectations for a narcotic-sparing recovery
Begin multimodal regimen with acetaminophen and gabapentin the night before surgery
Optional: scopolamine patch and celecoxib for additional comfort and inflammation control

Intraoperative Strategy

A. Exparel Infiltration

Dosage: Up to 266 mg (20 mL of Exparel diluted with saline to 60–80 mL total volume)
Technique: Fan or grid infiltration across:

Rectus sheath fascia
Sub-Scarpa’s fat plane
Lateral abdominal walls
Iliac crest and lower flank junctions

Timing: Administer during fascial closure before final subcuticular closure

Additional Reading

Pro Tip: Use a long spinal needle for deeper layers to distribute Exparel evenly across tension-prone zones. This helps maximize its regional analgesic effect.

B. Progressive Tension Sutures (PTS)

Placed in a layered fashion using 2-0 or 3-0 Vicryl
Distribute tension across the abdomen to minimize shear forces
Eliminate dead space → no drains required

C. Incision Closure

Quill or barbed sutures can be used for aesthetic, tension-free closure
Reinforce low incision line for added durability under stress

Postoperative Management: Multimodal Analgesia Without Narcotics

Day 0–3 (Postoperative Days 1–3):

Exparel provides sustained pain control
Scheduled acetaminophen (650 mg q6h)
Ibuprofen (400–600 mg q8h) or Celecoxib (200 mg BID)
Ice packs or external compression as tolerated

Opioids: Only as rescue medication (5 mg oxycodone prn)

Result: >85% of patients do not require opioids beyond day 1

Advantages of Exparel-Based Protocols

Benefit	Impact
Faster Mobilization	Patients walk the same day
Reduced Infection Risk	Early ambulation, less narcotic-induced ileus
Lower Opioid Usage	Fewer refills, less constipation
No Drains	Better comfort, reduced wound care burden
Improved Lymphatic Flow	Less seroma formation
Higher Patient Satisfaction	Boosts word-of-mouth and online reviews

Watch the Technique: Step-by-Step Video Tutorial

Learn how to perform this protocol from incision to closure:

This walkthrough includes intraoperative strategy, Exparel administration, progressive tension suturing, and closure technique with commentary and pearls.

Pearls & Pitfalls for Surgeons

Pearls

Pre-dilute Exparel for smoother infiltration and broader coverage
Combine with TAP blocks or spinal if doing larger cases
Communicate clearly that Exparel is non-narcotic to align patient expectations
Use layered closure to support longer analgesia distribution

Pitfalls

A. Exparel Infiltration

Avoid mixing Exparel with lidocaine directly—use in separate syringes if needed
Don’t exceed max dose (266 mg)
Don’t underestimate pre-op education; patients who expect to recover with fewer opioids tend to use fewer opioids

The Science of Why It Works

Exparel works by sustained sodium channel blockade, interrupting pain transmission at the surgical site. When injected near nerve-rich fascial planes, it creates a diffuse regional field block that:

Reduces central sensitization
Inhibits inflammatory cascades
Supports more complete early healing

When combined with anti-inflammatory agents and mechanical tension reduction (via PTS), you create an ideal biological and mechanical healing environment.

For Surgeons: Implementation & Practice Benefits

Whether you’re a solo practitioner or working within a group aesthetic practice, adding Exparel-based recovery to your abdominoplasty protocols offers:

Market differentiation: Branded painless recovery = higher value perception
Streamlined follow-up: Fewer calls, fewer drain issues, less narcotic management
Improved reviews and referrals: Patients love a smooth, pain-light recovery
Better outcomes: Less inflammation = better scar and contour

Surgeon Education Hub: Optimizing Recovery with Exparel in the Drainless, Painless Tummy Tuck