Legs and Ankles
Leg Fat is Different
The distribution and proportion of localized fat on female legs and ankles is genetically predetermined. Women who have a disproportionate and displeasing distribution of fat on their legs often find that this fat is resistant to diet and exercise.
Leg Fat is Superficial
The fat on the legs and ankles is composed mainly of relatively superficial fat. There are no deep compartments of fat on the leg and ankles. Consequently, liposuction of the legs is necessarily done rather superficially and has an increased risk of injury to the subdermal vascular plexus. Because of the effects of gravity, the veins in the legs and ankles are especially susceptible to the long-term effects of vascular injury.
Danger Zone
The area behind the knee (popliteal fossa) contains important nerves and blood vessels that are vulnerable to injury by a liposuction cannula. Liposuction in this area should never be attempted.
Care After Liposuction of the Legs
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 with stitches) postoperative swelling is minimal and resolves within a few days.
Open-Drainage
Open drainage after liposuction requires that the surgeon make several tiny “adits” (1mm to 1.5 mm round holes in the skin) on the lower leg and ankles. Adits encourage complete drainage of residual blood-tinged tumescent anesthetic solution, which in turn dramatically reduces swelling and bruising. Absorbent pads, placed over the adits and held in place by elastic compression bandages, will catch the drainage. This open-drainage technique can eliminate the problem of persistent swelling and bruising.
Walking is Helpful
Patients should be encouraged to walk during the first few days following surgery. Walking will encourage drainage and minimize swelling. Bed rest and leg elevation are not necessary if the surgeon utilizes the technique of “open drainage”.
Excessive Liposuction of Legs and Ankles
It would be a mistake to attempt to remove every last bit of fat from the legs and ankles. Overly aggressive liposuction of the legs risks injury to blood vessels. An attempt to remove all the fat will yield some areas where the skin is directly adherent to the muscle, and other areas where there are thin collections of fat. In this situation, if the patient subsequently gains weight, areas with residual fat will increase in size, and areas without fat will not change. The overall effect will be an accentuation of any irregularities producing an increasing lumpiness and bumpiness. The goal of liposuction of the legs or ankles should be an aesthetically pleasing and natural looking result. Excessive liposuction should be avoided.