Learning About Liposuction In The Ankles And Calves
If you have recently lost a large amount of weight
, you may have found that there are still areas which are very hard to tone. With extra skin and extra fat around the ankles and calves, it can be hard to hide those and still wear shorts and skirts in the summer.
If this is the case, you may want to consider liposuction or lipoplasty. Lipoplasty of the lower extremities has become increasingly popular in the last 2 decades.
Although it was once considered a procedure that was fraught with complications and unsatisfactory results, improvements in technique are addressing these concerns. Emphasis on an aesthetic lower extremity has now replaced previous experiences with liposuction, in which legs became thinner but remained tubular and lacked curves.
Liposuction can now reduce the bulky look of the calves and result in slimmer, tapering lower legs. As early as 1964, doctors treated the ankle using small incisions strategically placed about the ankle and contoured the area using sharp curettage.
Illouz popularized liposuction as opposed to curettage in 1977. He recommended suctioning the deep layer of fat in areas with a defined superficial and deep layer.
These areas were typically the outer and inner thighs. In 1982, Teimourian and Fisher reported a case using both sharp curette and suction for the ankle.
Mladick began to suction the upper calf in selected patients in 1983. Further advances in 1985 and 1987 were the introduction of cross-tunneling and the accelerator-tip cannula, respectively.
He then reported his first case of circumferential liposuction of the lower legs in 1990. In 1994, Gasperoni and Salgarello, using small cannulae and incisions, popularized superficial liposuction 1-2 mm below the skin.
Over the last several years, Rohrich discussed using internal ultrasound-assisted liposuction for the upper one half of the lower leg. Liposuction of the lower extremity from thigh to ankle is an important adjunct to many plastic surgeons' practice.
Having succeeded in reducing particular bulges in the thigh, lower extremity surgery has now advanced to providing a curvy lower extremity with techniques of circumferential and superficial surgery. Patients who are considering this procedure must be examined to see if fat removal of the calves and ankles can adequately address their concerns.
Larger lower extremities can be secondary to hypertrophy of muscle tissue, in which case liposuction would be of little benefit. In selecting a patient for liposuction of the calves and ankles, legs are classified as circumferential or localized heavy legs.
In the circumferential type, specific fat distributions are not well-defined and the leg, as a whole, is considered fat. Areas in exception to this are between the perimalleolar regions and over the Achilles tendon distally, rarely having significant fat deposits.
In the localized type, the lower calves and ankles tend to have definite bulges over the lower lateral fibular, medial tibial, and ankle regions. Excess over the transition between the gastrocnemius muscles and the inferior leg can lead to a tubular-appearing leg.
The pinch test can be used to assess deposits. This is performed with patients standing on a stool flat-footed and then standing on their toes.
The pinch test can also be carried out with the leg rested horizontally on a chair and the knee bent 90 degrees while the patient stands on the other leg. The minimum pinch test result should be 2 cm in the calves and 1 cm in the ankles.
The ideal patient is in good health, is aged 20-30 years, and has good skin tone. If the patient is older than 50 years and has good skin tone, he or she is a suitable candidate.
When performing liposuction of the lower extremity, understanding the anatomy of the specific areas and the differences in fat layers is important. Traditionally, both deep and superficial layers are found throughout many areas of the body.
However, a deep layer is not present from the mid portion of the anterior and posterior thigh, in the calves, and in the ankles. When considering layers of fat, the subdermal layer is approximately 1-2 mm below the skin.
The intermediate or superficial layer is 0.5-1 cm below the skin, and the deep layer is approximately 1-2 cm below the skin. Understanding these layers and the anatomy of the lower extremity helps determine whether superficial or deep liposuction can be performed and helps predict the expected results.
If you think you are a candidate for this surgery, talk to your doctor right away. Do your research and see if it is something that might work for you.
by: Terry Daniels
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