Legs, Thighs & Ankles
Designer dresses and skirts define societal expectations of the perfect legs, 
knees, and ankles. For many women, this body part is the most critical and important area on their body. Unfortunately for many, the distribution and proportion of fat on the lower extremities for many men and woman is genetically predetermined. Despite aggressive exercise and weight reduction, a disproportionate and unpleasant distribution of fat remains. This is why so many clients want Smartlipo™ on their thighs (inner and outer) and knees.
LEG FAT IS SUPERFICIAL
It is important for the patient to be aware the fat on the legs and ankles is primary superficial fat. There are no deep compartments of fat on the leg and ankles. Thus liposuction of the legs and lower extremities is performed superficially because of the increased risk of injury to the subdermal vascular plexus. Therefore, patient expectations must be reasonable as this area represents the most challenging body part for the surgeon.
AREAS OF HAZARDS-OUTER THIGHS
When we look at our hips and legs, we see bulges and areas of fat we believe can be easily removed with liposuction. But don’t be fooled about the perceived ease of surgery. This is because there are pitfalls in performing liposuction in these areas. When you have your surgical consultation be sure to ask the surgeon if they are aware of the hazards of doing liposuction in this area. They should know that although this area looks simple to perform liposuction on, if they are not aware of positional distortions, then you may have a bad aesthetic result of the buttocks and outer hips.
There are two (2) types of position distortions of fat on the thigh. One type is a focal fat bulge caused by the underlying part of the bone, called the Trochanteric Tubercle. This type of distortion is called a “trochanteric pseudobulge.” The second distortion occurs from stretching the subcutaneous fat, referred to as “topological lipowarp.” Although these are technical issues, these two types of distortions are important because intraopertively the surgeon can become overly aggressive and cause excessive fat removal causing a “Lipotrop.” A Lipotrop is a cosmetically undesirable depression of the lateral thigh a result of excessive liposuction of the pseudobulge.
To avoid a Lipotrop, we use the Klein Thigh Midline™ wedge-shaped surgical positioning pillow. This special cushioning device helps reduce the pseudobulge and decrease the risks of excessive liposuction causing a trochanteric fatty depression. If our patients who are seen for a complimentary consult ultimately decide to obtain lateral thigh liposuction from another surgeon, we want you to make sure your surgeon tells you how they plan on reducing the risks of a Trochanteric Lipotrop.
Another area of concern is behind the knee (popliteal fossa). This area contains important nerves and blood vessels that are vulnerable to injury by a liposuction cannula. Liposuction in this area should never be attempted.
OPEN-DRAINAGE TECHNIQUE
Our office believes open drainage after liposuction with several tiny "adits" (1mm to 1.5 mm holes in the skin) on the lower extremities allows for better outcomes and patient satisfaction. Adits or open incisions allow drainage of the blood-tinged tumescent anesthetic solution. Open drainage techniques reduce swelling and bruising after this type of surgery.
WALKING IS ENCOURAGED
We encourage patients to walk immediately after surgery and during the first few days after surgery. Walking encourages drainage and reduces swelling. Early ambulation and exercise after surgery also reduces the risks of blood clots and pulmonary embolus.
EXCESSIVE LIPOSUCTION OF LEGS AND ANKLES
It would be a mistake to attempt to remove most of the fat from the legs, knees and ankles. Overly aggressive liposuction of the legs risks increase injury to blood vessels. An attempt to remove all fat will yield some areas where the skin is directly adherent to the muscle. This would give an aesthetic bad result and physiologically compromise that body part to trauma and injury. The goal of liposuction of the legs or ankles therefore, should be an aesthetically pleasing and natural looking result. Fat melting in these difficult areas with Smartlipo™ makes the best sense to achieve your aesthetic goals while reducing intraoperative injury.
SIDE EFFECTS, COMPLICATIONS, AND ALTERNATIVE APPROACHES
As with any surgery, a surgeon or patient can’t predict what may happen during or after surgery. Rare problems that can occur are insertion site scarring, keloids, post inflammatory hyperpigmentation of insertion scars, nodularity, skin irregularities, waviness of skin, localized tenderness, hyperesthesia, poor skin retraction, hematomas, seromas, and localized and systemic infection. After liposuction of the legs or ankles, persistent swelling of the ankles and feet can be an annoying problem without the use of the technique of "open-drainage". With open-drainage (incisions are not closed at time of surgery) postoperative swelling is minimal and usually resolves within a few days.
he distribution and proportion of localized fat on female legs and ankles is genetically predetermined. Many women find that even with aggressive exercise and weight reduction that they have a disproportionate and unpleasant distribution of fat on their legs.
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