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6 Lower- Limbs
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Fig. 6.52 Pre- and postoperative lipodystrophy
lateral thighs
109
Fig. 6.53 Pre- and postoperative lipodystrophy
lateral thighs
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Fig. 6.54 Pre- and postoperative lipodystrophy
lateral thighs
K. Bhangoo
Fig. 6.55 Markings for anterior thigh
The skin in the medial aspect of the thigh lacks elasticity
and does not have good skin tone. Because of this lack of
elasticity, extreme care should be exercised in doing liposuction in this area. Care should be taken not to remove too much
fat as this can result in the so-called “golf bag” deformity.
In some cases the procedure can be staged to allow for
skin contraction between the procedures. The patient should
be warned that only limited improvement can be obtained
and that excessive removal of fat would result in skin redundancy which will require surgical resection by doing a thigh
lift (Figs.6.59, 6.60, and 6.61).
5. Circumferential Thigh Liposuction
Circumferential thigh liposuction involves treating the
lateral, anterior, and medial thighs as well as posterior
thighs. This will necessitate ipping the patient to a prone
position to treat the posterior thighs (Figs.6.62a, b, 6.63,
and 6.64a, b pre- and post-operative).
Figures 6.62a, b, 6.63, and 6.64a, b show pre- and post-
operative GLUTEAL.
6. Region and Posterior Thigh Area
Some patients have an absence of infragluteal fold
and have a so-called “banana roll” deformity. For this,
the patient has to be placed in a prone position. An incision is made on the medial aspect of the proposed infragluteal fold. Suction- assisted lipectomy can be performed
using a 4mm cannula. Accentuation of the infragluteal
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Fig. 6.56 Pre- and postoperative anterior thighs
111
Fig. 6.57 Pre- and postoperative anterior thighs
fold will result in a more aesthetic contour of the buttock
area. As an exception to the rule, the holes of the cannula
can be supercial and under the skin to accentuate the
infragluteal crease. Care should be taken to avoid excessive liposuction as this can result in ptosis of the gluteal
area. At the end of the procedure, some surgeons prefer
to leave the incisions open to allow for drainage.
However, the author prefers to compress the areas prior
to closing the incisions in two layers using an absorbable
suture for the subcuticular layer and 5.0 catgut sutures
for surface closure. These are covered with steri-strips
and waterproof Tegaderm dressings. This will allow the
patient to shower after 2 or 3days (Figs.6.65, 6.66, 6.67,
and 6.68).
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Fig. 6.58 Pre- and postoperative anterior thighs
K. Bhangoo
Fig. 6.59 Lipodystrophy
medial thighs
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Fig. 6.60 Pre- and postoperative medial thighs
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Fig. 6.61 Pre- and postoperative medial thighs
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K. Bhangoo
a
Fig. 6.62 (a, b) Markings for circumferential thigh liposuction
Fig. 6.63 Pre- and post-
operative circumferential
thigh liposuction
b
7. Medial Knee Area
The medial knees can be approached through an inci-
sion in the postero-medial aspect below the knee. Through
this incision, and using a 4mm cannula, lipodystrophy of
the medial knees is addressed. Fat is usually soft and
readily aspirated. Liposuction of the medial knees is very
gratifying and enhances the overall result of the lower
extremity liposuction (Fig.6.69a, b).
8. Lipodystrophy of the Calf Area
Some patients will request correction of lipodystrophy
of the calf. This usually requires circumferential liposuction. It can be performed through the same incision as used
for the knees in the postero-medial aspect of the calf.
Sometimes another incision on the lateral aspect is
required. Extreme care should be exercised in doing liposuction of the calf because this area is unforgiving.
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115
a
Fig. 6.64 (a, b) Pre- and post-operative circumferential thigh liposuction
b
Irregularities and puckering can result and can be a disturbing post-operative complication and very difcult to
correct. Furthermore, these areas can result in seromas and
hematomas, and prolonged hyperpigmentation. Prolonged
post-operative compression is required (Fig.6.70).
Fig. 6.65 Banana rolls
9. Ankles
Some patients have heavy ankles, and this can be
addressed through an incision over the lateral and medial
aspect, taking care to keep the incisions away from the
neurovascular bundles. The procedure should be performed with small cannulas, usually 2–3 mm diameter
cannulas with holes on one side only. Extreme caution
should be exercised in treating the ankle because this area
is very unforgiving and prone to complications such as
puckering, irregularities, and skin necrosis (Fig.6.71).
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Fig. 6.66 Banana rolls preand post-operative
K. Bhangoo
Fig. 6.67 Gluteal liposuction
to create infragluteal crease
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Fig. 6.68 Gluteal contouring
pre- and post-operative
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a
Fig. 6.69 (a, b) Lipodystrophy medial knees
b
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Fig. 6.70 Liposuction calves
pre- and post-operative
K. Bhangoo
Fig. 6.71 Liposuction ankles
6.13 Post-Operative Care
Immediately post-operatively, properly tting elastic garments are applied. The length of the garment will depend on
the treatment areas (Fig.6.72). For the hips and thigh areas,
a garment extending from below the knee to the lower abdomen is used. When the knees are also aspirated, a longer
garment extending from just above the ankle to the lower
abdomen should be used. It is important to ensure that the
garment should be properly tted because tight garments
can lead to femoral vein compression and deep vein thrombosis. TED stockings should also be applied post-operatively [34].
There is usually little pain following liposuction because
the procedure is conned to the subcutaneous layer without
injury to the underlying structures such as muscles. It is usually easily controlled by over the counter analgesics, such as
paracetamol, acetomorphine, and ibuprofen.
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