OBJECTIVE The purpose of this study was to prospectively investigate coagulation during suction-assisted lipoplasty (SAL) and to compare it to other plastic surgery where no SAL was used, with the aid of a computerised thromboelastograph coagulation analyser (TEG). METHODS A prospective cohort study enrolled 50 pure SAL patients and 50 patients presenting for other aesthetic plastic surgery operations, without the need of liposuction. TEG evaluates in real time the competency of the blood clot in samples that are studied under a low shear environment resembling venous flow. Six thromboelastographic measurements were performed in each patient: one preoperative, two intraoperative at the middle and end of the surgery and three postoperative at 60, 90 minutes and 24 hours. All the patients also had standard pre- and postoperative coagulation studies. RESULTS R (time of clot to form) and K (time or speed the clot takes to be firm) were shorter in the SAL group vs control (P<0.001). Angle (growth and stranding process of fibrin) and MA (dynamic properties of the platelets and the final strength and elasticity of the fibrin clot) were greater in SAL vs control (P<0.001). None of the cases had pre- or postoperative coagulation study abnormalities. CONCLUSIONS TEG analysis demonstrates that SAL patients have decreased initial clotting time, decreased time to full clot formation, increased pro-coagulability state, and increased clot rigidity. The clot lysis time was not different between the studied groups.