Liposuction Surgery : Calves and Ankles

This is one of the more challenging areas when performing liposuction as the surgeon must shape the whole lower leg, essentially all the way around from the knee to the ankle, to achieve a well-shaped contour. Many less-experienced surgeons avoid this area. Like other areas, I feel that where one places the incision points are crucial to a great result. The only way I have found it was possible to be consistently complete without jabbing the skin from underneath was to place two upper incision points toward the posterior lateral, knee and two lower incision points toward the lateral ankle.

To consistently achieve an outstanding result with liposculpture, the surgeon needs perfect judgment and meticulous technique. As with any cosmetic surgery, liposculpture surgery is extremely  dependent on the experience and skills of the particular surgeon as any mistake in technique can adversely affect a perfect result.

I do not believe in a team approach or having multiple people performing my surgery. I have always and will always take full responsibility for every aspect of your surgery to ensure the best possible result. I am the only person I trust to perform all aspects of your surgery, from placing the local aesthesia to the entire contouring and sculpting procedure. Liposculpture surgery is the only major cosmetic surgery I perform. I also believe in quality service over quantity and purposefully limit the number of surgeries I perform
each week.

Q. Please forgive the length of this query, but I want to be sure you understand the nature of my situation so that you can answer my question(s) honestly.

My album, should you like to get a visual understanding, is at:
http://www.makemeheal.com/pictures/view … bumid=4932

I am not very pleased with my results. Essentially, I feel my PS was too conservative. Yes, this is better than too aggressive, however, I am frustrated, too, since revisions = more time away from my extreme athleticism.

Could I lose a bit of weight? Yes. However, I have Poly Cycstic Ovarian Syndrome, and because of my extreme athletics (racing bicycle, triathlons, XC ski marathons, etc.), I can not take the metformin; I get hypoglycemic and I have issues when exercising. Ergo, I have tried many diets, and few have worked. I am doing the Weight Watchers Core plan at the moment; we’ll see what happens. And yet, when I explained what I do, the counselor at Weight Watchers sort of gave me this look like “and why do you want to/why should you need to lose weight?” My BMI is borderline for “overweight,” yet my musculature is pretty profound. Honestly, I do not know what to believe…

This may seem irrelevant, however, the musculature is the crux of the matter:

My PS has said that results for me will be limited for two main reasons:

1) I have thick skin, so I will be prone to “rolls”. This I understand, and heard from ALL the surgeons I consulted with. Ok, I “get” it. A TT would give me more “flat” results. And, yes, I have a bit of a swayback, so I will always look a little “protruded.” However…

2) Because I have a thicker musculature underlying my abdominal region, my results will be limited. I have more “oomph” there, for lack of better term, so how “flat” I look will be very limited. AND, since I have so much muscle, she has to be careful about how much fat comes out. I quote: “I can not remove it all for safety reasons.”

So, my main question comes in to number 2: A) Without having seen me in person, have you heard/run into patients like me, with “thicker abdomen region”—meaning, is this really a factor in results, and B) How much is too much??!? The first time around, she removed about 1400 ccs. Where should she draw the line? What should I expect her to remove this second time around?

Will I ever be perfectly flat? No, not likely, and I am ok with that. However, am I being unrealistic in expecting to be relatively flat…at least, when I stand up? It would be nice to look down and be able to see almost ALL my pubic bone! Please help!! And again, I apologize for the tedious length of my question.

A. I appreciate you going into quite a bit of detail. Yes, it is very difficult to evaluate this on paper. Many times, even in person, there are many things to review to really come to a conclusion as to the best way is to approach these issues.

1. Dimple irregularities are caused by suctioning too much fat too close to the surface of the skin. Waviness, rippling, dimples or depressions may occur. How much fat to remove for a smooth finish is a difficult judgment call and should only be performed by an experienced liposuction expert.

2. Not proportioned. Many times a doctor not experienced in the art form of Liposuction will take too much fat from one area and put the entire body out of proportion. This is a difficult problem to correct and should be considered prior to surgery. Liposuction should be used for proportioning the body not as a fat removal procedure.

3. Loose Skin. Good skin tone with small amounts of fat removed usually results in good outcomes. However, if your skin tone is not good or you have lots of stretch marks in the area where fat is removed, problems can occur. The skin on different parts of the body also behaves differently and needs to be approached on an individual basis. The experience of your doctor in this area is crucial.

4. Fat returns in different areas. This is actually a problem caused by taking out too much fat in the wrong areas. If the doctor throws the patient’s body out of proportion by sculpting too much fat it will appear as though the fat has returned in different areas. Proportioning is vital to a successful outcome.

5. Noticeable Scars. There will be scars no matter what doctor performs the procedure. The key to successful liposuction is to place the incisions in areas that will be less noticeable, such as the natural folds of the skin. The size of the incision is also an important factor.

This is a far safer technique, with no deaths or major complications reported in the hundreds of thousands of patients over the many years that have had the procedure done.  Fat is removed with far less bleeding, leading to superior results, less bruising and faster healing. Patients are able to walk immediately after the procedure and typically return to work in two days.  All liposuction surgeries by Dr. Amron are performed in a state-of-the-art fully accredited surgery center.

Q. Can lipo be used to give a little more definition to one’s waist?

A. Absolutely. Liposuction can absolutely give a sculpted look to the waistline. On my website I discuss how I approach each area of the body. When I do the abdomen, I do it in one of two ways. Either I do the central abdomen in people that store fat centrally but yet have a good waistline laterally, or I do a person circumventuraly all the way around. There is a huge advantage in terms of doing patients purely under local anesthesia called pure tumescent liposuction. As the patient is conscience and can move in exacting positions to be able to contour areas precisely. I rarely do cases under general anesthesia and find it very difficult to achieve optimal positioning and even in my hands, it can sometimes compromise the type of result I would get under local anesthesia. So in this case I would have to say that there are great advantages, especially with the waistline, in terms of doing it under local anesthesia. When I do the waistline I have the patient sequentially move all the way around as I am doing the procedure to contour the area. It is important not to poke or jab the muscle or skin, and I feel this can only really be obtained with a conscience patient being able to assume specific positions. Very commonly, I do the abdomen and waistline, and the flank and thigh area at the same time and it is safe. The safer upper limit generally depends on the amount of local anesthesia that is used, but typically when two or three areas are done this can be done safely at one time.

Dr. Amron

Q. i have posted pics on the ‘should i get surgery’ section and i was wondering your opinion whether i could just get away with lipo and not a tummy tuck? I am still young and have not had children and i do want them in the future, this puts me off the tummy tuck and also the scar does. But i dont know what the results could be with just large liposuction? i do have quite good skin as when i breath in there is not much there if you know what i mean. What would you suggest and your thoughts on the results i could possible get, i was thinking of tummesant lipo. thank you :roll:

A. There is an area on my Web site where I discuss liposuction and pregnancy - either before or after pregnancy - and the role of a tummy tuck procedure at expertliposuction.com. But it does appear from your photographs that you have quite a bit of fullness in the upper and lower abdominal area, the waistline and the flank and hip area. I strongly feel that based on your photographs that liposuction that is well done is absolutely the best initial approach. If this is done properly and completely, it looks as if there is very little need for a secondary abdominoplasty procedure that can always be considered after the liposuction. It is better to do it this way anyway as you can be more complete with your liposuction and it is safer when they are done in separate procedures. But, once again, in your case it looks like well done liposuction is the way to go. On my Web site, there is also a section called Area by Area where I discuss how to approach the abdomen. It does appear that you are somebody that I would do circumventrically all the way around to bring in the whole waist area and to give a more contoured waistline. With regard to what specific technique that is used, personally I feel that tumescent liposuction offers many advantages in terms of safety, recovery and results and that is because it allows optimal positioning throughout the entire procedure of your patient which I feel is crucial in terms of meticulous sculpting.

Dr. Amron

Q. I’m a 34 year old male who underwent liposuction about 6 years ago and I haven’t been the same ever since. I really didn’t need it but was bulging around the waist area and the Doctor I went to said he could give me a six pack. Well instead I received massive discoloration and irregularity (lumps). I have been going to a dermatologist in Beverly Hills who has been working on me for the last past year by doing fat repositioning but it seems that he is only making it worse. When he fixes one area, it messes up another. The problem is he numbs me with some sort of solution that makes that area swell which makes it difficult to see what needs to be done. At this point he is only going off of memory and what he thought he saw before numbing that area. I told him this but he still chooses to do it this way instead of just giving me a pain pill so he can see the area correctly. He also tried using mesotherapy on some of the bumps and it collapsed the skin and now those areas are really red (discolored) and need to be corrected perhaps with laser treatments. Is there anything I can do? Living with this is just absolutely horrible! Below is a link of my current state however it’s hard to see all the lumps in the photo’s but believe me, I look like cottage cheese…

Thank you in advance for your help Doctor.

A. From what I can see in the photographs, it looks like there is quite a bit of models pink and purplish discoloration under your skin, with possibly some areas adjacent to this with some lumpy fat tissue. When liposuction is overly aggressively done in an area, a condition called Erythema Ab Liporaspiration, which can result forming this modeled discoloration. Although with time it can improve to some degree, typically it does tend to be long lasting and possibly permanent. It is a difficult condition to treat with regards to the discoloration of the skin. I have tried, when I have seen this in other patients, I have tried lasers such as the V-Beam laser, which typically will improve discoloration with limited success. With regard to the irregularities, this would fall under the category of what I would call revision liposuction, which is approximately 40 percent of my practice. What I would recommend is to possibly get other opinions in terms of how to approach your results. I am in the Beverly Hills area and would strongly encourage you to come in and take advantage of another opinion. About one-third of the patients that I see come from all over the country and many times, other areas of the world. In your case you happen to live in Los Angeles and it would be easy for you. So, that is my recommendation.

Dr. Amron

Q. Long story short—I have several deformity issues from liposuction I had done in 1999 when I was in my mid teens. I am now 22 and the deformities are obvious and embarrassing. The majority of the work was done on my inner/outer thighs and on my buttocks. My left side (saddlebag area) is uneven with slightly more fat, but this is not the main problem. I have a large dent on my right thigh below my buttocks. There are two collapsed areas on both sides of my buttocks that give it a flat, unshapely appearance. The whole region is saggy, lumpy, and stretched. I am slim, workout daily for 3 hours, lifts weights, and I eat a restricted diet—nothing has helped this area. My workouts have “lifted” my butt but the collapsed areas have become worse and more noticeable. What is the probability that this can be fixed or improved? This situation has left me depressed and hopeless. The bottom half of my body does not look like the body of a 22 year old. Maybe you could recommend a surgeon or procedure.

Your help is greatly appreciated

A. It appears that your issues after liposuction fall into three areas. One is asymmetry, two a dent, and three a collapsing of the buttocks. The first two issues are easier to correct, but I am sure it is the last issue that is most concerning to you. An asymmetry such as the left side being larger in your saddlebag region is quite easy to improve by bringing down that left side more in line with the right side. The indentation can be treated with fat transfer and typically there is a permanent take of most or all material which greatly improves the dent. If there is also some fullness around the dent, that can also be brought down to improve the contours so the dent is less noticeable. Unfortunately, the most difficult thing to greatly improve is if there is collapse of the buttock. Typically this occurs from liposuction that is done underneath the buttock in the banana roll area in too aggressive a fashion, loosening the connective tissue that supports the buttock. If the area is very large in terms of collapse, it is very difficult to treat. If it is a small area of collapse, it is possible that some fat transfer can be done to build up some roundness in the lower buttock area. Alternatively, you might want to consult with a plastic surgeon who does do butt lifts to see whether or not you are a candidate. However, in my experience, this does tend to leave a scar in a superior area of the buttock. But if the collapse is bad enough, it might be something that you might want to look into and consider. I hope this helps to give you some guidance.

Dr. Amron

I believe that a great result and a happy patient begins with a proper complete consultation and evaluation by the surgeon. It is absolutely necessary to be seen prior to the surgery. I am the only person who determines if a patient is a good candidate for liposuction. Every patient must be evaluated by myself prior to surgery and understand what I feel the results will be. I examine every single patient from their neck to ankles to determine where they are genetically disproportionate and may benefit from liposuction. Liposculpture is a balancing procedure and unless comprehensive evaluation is performed by the surgeon a patient may be thrown permanently out of proportion. A discussion between myself and the patient must take place in order to be clear about every aspect of the procedure and the expected results. For out of town patients, photographs are evaluated only by myself and I only allow patients to travel to see me once I have determined they are a candidate. They must arrive at least one day prior to surgery where I re-evaluate and examine areas in person.

Regarding general anesthesia verses local anesthesia, basically you will have two camps in terms of opinions. I personally strongly feel that there are many advantages to local anesthesia. I have done many cases under general anesthesia over the years and find it to be a great disadvantage in terms of many areas. Personally, I don’t find that general anesthesia is much quicker because by the time you put the patient asleep and you do all the moving around that you are able to with general anesthesia, it tends to take at least as much time. I also strongly feel that it has nothing to do with how aggressive you are choosing to be. In many ways under local anesthesia, because the tumescent fluid is so good at reducing the bleeding, it allows me to be more aggressive in areas with less bleeding. There is a great benefit with regard to the bruising and swelling of local anesthesia because it prepares the area very well prior to doing the liposuction by hydro-dissecting, or breaking apart with fluid, fatty parts of the tissue as well as causing basal constriction. So you usually get much more of a pure fat removal. I do think it is much better to leave the incision sites open in almost all areas to drain that fluid and it tends to promote faster healing in all areas and I find that the sites heal up beautifully and are almost imperceptible if they are placed properly without suturing them up. So to summarize, I find that there are three advantages to local anesthesia over general anesthesia with regard to liposuction specifically. One is safety and if you do your research, you will find that general anesthesia liposuction has had a lot more complications approximately 1 in 5,000 mortality rate verses virtually no deaths under local anesthesia in more than 20 years. Number two, the recovery is faster. But the biggest advantage as far as I am concerned has to do with results and that is because liposuction is a very different type of surgery. It is a contouring and sculpting procedure and I personally and very particular in terms of exacting positioning the patients are in during the procedure. One thing I am careful to never do is poke or jab the skin and personally under general anesthesia because of improper positioning surgeons many times are poking the skin. This is one of the main causes of irregularities and indentations.