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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring
By Dr. Leon Forrester Tcheupdjian, M.D.
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Dr. Leon Forrester Tcheupdjian, M.D., respected scientific researcher, teacher innovator and surgeon. As the Medical Director / Chief Surgeon of a Chicago, Illinois Plastic Surgery Practice, Dr. Tcheupdjian has supervised and performed probably more liposuction procedures than any other American doctor.

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Chapter XIX

Liposuction of the Knees, Calves and Ankles

More women than men seem to be interested in having liposuction of the knees-probably because women tend to have fat deposits around the knee that give them a chubby appearance. When women patients describe the kind of ideal knees they hope to have after the surgery, their descriptions often match the contour of the leaner knee. They would like to have the knee cap and the front structures of the knee defined more sharply.

FAT DEPOSITS OF THE KNEE
There are three additional areas which are especially troublesome for fat deposits: the upper tibial aspect of the leg, the lower fibula aspect of the leg, and the calves. Let's look at each of them.



1. Upper portion of the knee; the medial or inner portion fat usually extends also to the back.

2. Pinch test illustrates amount of fat build up.



3. Ankle and tibial pad (or shin) fat.

4. The same patient, shown from the rear, with posterior knee fat, calf and ankle fat.


WHERE ADDITIONAL FAT DEPOSITS ARE FOUND
There are three sdditional areas which are especially troublesome for tfat deposits: the upper tibial aspect of the leg, the lower fibula aspect of the leg, and the calves. Let's look at each of them:

Upper Tibial Fatty Deposits
The upper tibial aspect of the leg is not as hard to find as it sounds. Your tibia is one of your two bones in your lower leg. It is the weight-bearing bone that extends between your ankle and your knee, and is on the inner side of your leg. The fat pad that bothers many patients is a large, fatty deposit on the upper front inside portion, just under the skin. Excess fat tends to settle there, giving the leg a most unattractive appearance.

Lower Fibula Area
A second fat deposit that many patients find troublesome occurs in the lower fibula area. This accumulation of fatty tissue seems to settle just above the ankle, on the front outer side of the leg, making it difficult or uncomfortable to wear boots for any length of time. In fact, I have had patients with this problem complain that they had a great deal of trouble finding boots that fit well.

The Calves
A third area that bothers patients a good deal is the calves, where fatty deposits are all too common. The back of the leg becomes thickened and unattractive, leading to the term Apiano legs. Often, these patients complain of tired legs.

 

1. Patient's knee pads before.



2. Same patient, after treatment..

3. Front view, after, shows improvement.

A PATIENT WITH PROBLEMS
Diane was a patient with unsightly legs, and sensitive enough so she tried to camouflage them by wearing pants most of the time. She had a condition that troubles many women: fatty deposits on the inner portion of the knees, which tended to give her a knock-kneed appearance. Since they were coupled with fatty deposits at the back of the knee, Diane was extremely unhappy.

When we talked at her initial consultation, she was embarrassed at showing what she considered her Adeformity. I was able to reassure her that by no means was she alone in having problems in this area, and that liposuction could benefit her greatly.



1. Front view of knees, before.

2. Front view, after treatment.

3. Back view, before treatment.



2. Same patient, after treatment..

3. Back view. after treatment.

After further medical tests and discussion, Diane decided to have the surgery to remove substantial amounts of fat from her knees. I made an incision only 1/8 inch long in the back of each of her knees, hiding it in a crease so it could barely be seen. In Diane's case, a second incision in each knee was not necessary. However, I have performed liposuction on patients who needed an additional tiny incision just above the kneecap in order to take out the fat at that point.

Liposuction removed a total of 500 cc of fat (approximately 18 oz.) from Diane's knees, and reshaped them so her kneecaps were not camouflaged or blanketed by fat. She was thrilled with the results, because her kneecaps were now sharply delineated.

LIPOSUCTION OF THE CALVES
At 42, Andrea knew she had a problem. It was the same problem she had been suffering with for nearly 20 years. Her large fatty calves were embarrassing. Andrea's fat bulges were located on the outer portion of her legs, just below the kneecap. Fortunately, liposuction surgery here can be very effective in removing fat cells. Through a tiny incision approximately 1/8 inches long, I removed a total of 800 cc of fat (approximately 27 oz.).



1. Tibial and ankle fat pads before treatment.

2. Calf and ankle fat before treatment.

3. Back view, before treatment.

 

3. During surgery, when one leg has been treated, the tape measure Indicates the difference in circum- ference: more than two Inches Oust before the doctor proceeds to complete the treatm ent on the second leg.).

Shortly after the post-surgical swelling had subsided in Andrea's calves (approximately two weeks), she told me during a follow-up visit how pleased she was with liposuction's results. I'm not embarrassed to wear skirts any more, she confided.

Frequently, experienced liposuction surgeons use a procedure called feathering, which gently, yet precisely, removes the fat and helps to make a smooth transition in the shape of the leg. I feel that best results are achieved when feathering is done, and that it is necessary to feather into the front and inner area of the thigh.

A third patient who was helped substantially by liposuction, Ellen, came into my office before surgery with some harsh words to say about herself. Piano legs was what she termed her lower extremities-and piano legs is what they actually looked like. Liposuction changed that forever for her.

During surgery, I removed a total of 1200 cc of fat (41 oz.) and she recovered well from the operation. Today, she is far more attractive than she was with unsightly, almost deformed, Apiano legs.

OTHER TREATMENT FOR CIRCULATION PROBLEMS
Ellen was lucky. She was one of a large number of patients who benefit from the liposuction procedure. In some individuals, however, part of their swollen calves or generally fatty appearance of the legs is due to circulation problems. Other tests and treatments are appropriate for these patients.



1. Above, the crucial points of fat accumulation on the human body, indicated by the rear.

Like all my patients who have liposuction of knees, calves, or ankle areas, Diane was asked to keep her legs elevated for two to three days following surgery, to help minimize swelling. While I encouraged her to walk to the bathroom, and to move around her apartment as she needed to, I nevertheless wanted her to spend considerable time resting, with a pillow or two under her ankles to raise them up.

Diane's legs were taped following surgery, and she kept the tape on for about a week after the operation. Sometimes patients are also asked to wear support hose such as T.E.D. stockings (similar to that used for varicose veins) after liposuction-over the tape, of course-but in Diane's case, her healing progressed so well and her general condition was good enough so that it was not necessary.

During the first week after surgery, as with all my patients, I advised Diane not to take a shower or bath. Following that I instructed her to shower or bath. Following that I instructed her to shower and peel the tape off in the shower.

These instructions should be followed in all cases of liposuction of the knees, calves, or ankles, unless your own surgeon has given you specific, different instructions.

Diane had swelling and bruises after surgery. This was to be expected, and was a normal result of the trauma of the operation. At slightly over two weeks post-operatively, the swelling was at its greatest. Since I had explained to Diane that this would happen, she was not concerned or worried. I continued to check her at regular intervals, however, and would have removed bandages or tape promptly if there had been any sign they were too tight. By two months after the operation, nearly all swelling had gone down. Diane now had the legs she had been hoping for, ever since she heard about liposuction. Above, the crucial points of fat accumulation on the human body, indicated from the rear.

MASSAGE
Unless your surgeon gives you other specific instructions, you will want to begin gentle massage after liposuction. Stroke your legs, one at a time, with gentle pressure. Move your hands in a direction from the ankle towards the knee. You will find this exercise easier to do if you use both hands on each leg. Repeat on the other leg. Massage should last from two to three minutes on each leg. Repeat the massage five times a day.

EXERCISE
Unless you have received different instructions from your surgeon, you can begin exercising at home one week after liposuction. Both men and women can do these exercises.

Home/Exercises
I have indicated the exercises for the left leg. Naturally, you will repeat them using the right leg.

1. Raising the calves. Fut a thick book or a block of wood on the floor, approximately a foot behind the base of a sturdy chair. Stand on the book, and grasp the chair back firmly. Keep your heels on the floor, but put your toes on the book.

Raise the heel of your left leg off the floor as far as you can comfortably go. Eventually, with practice, you should be able to be on tiptoe. You can bend your right knee, for balance. Hold the position for a few seconds. Then lower your you left heel down to the floor.

When you begin this exercise, do it 10 times on one leg before switching to the other leg. Ten repetitions equal one set. Do one set three times a day.

As soon as you comfortably can, work up to 15 times on each leg, for one set. Do one set three times a day. Two weeks after the surgery, you can add the following exercise at home:

2. Calf raises, with dumbbell. Hold a dumbbell in the right hand while you exercise your left leg. Your left hand will be holding the back of a chair. Your feet in the starting position will have your heels on the floor and your toes on a thick book you have placed behind the chair.

As before, lift your left leg until you are on tiptoe, hold the position for a few seconds, and return to starting position, with your heels on the floor.

Try this exercise two ways:

-Toes pointed out, with heels pointed in -Toes pointed in, with heels pointed out Move slowly, so your calves can stretch to their fullest. Now, switch hands on the dumbbell, holding it in your left hand. Your right hand will hold the back of the chair lightly while you exercise your left leg. When you first start this exercise, do ten times for each leg. This equals one set. Do one set three times a day.

As soon as you comfortably can, work up to doing fifteen times for each leg, to equal one set. Do one set three times a day.

Exercises for Health Club/Gym
Two weeks after surgery, unless you have received different instructions from your surgeon, you may go to the health club or gym. Both men and women can do these exercises.

1. Hold dumbbells while you do the calf raise you practiced at home (#l). Ten repetitions equal one set. Do two sets.

2. Many health clubs have a calf press machine. If you are not sure which machine it is, read directions or ask the fitness instructor.

If the machine is such that you are standing, stand at the machine in such a manner that your hands are gripping the front bar, with the backs of your hands facing you. The padded weight of the machine will rest on your shoulders. Usually this machine has a block of wood or footstand so that your heels can be on the floor, while you stand on tiptoe.

Some machines require you to be seated. Your fitness instructor at your health club can help you use their particular machine properly.

Lift your heels up off the floor, stretching your calf muscles gently, but firmly. Hold the position a few seconds. Then lower your heels to the floor.

Do this exercise with the machine 10 times for one set. Gradually work up to four sets per health club visit.
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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring - By Dr. Leon Forrester Tcheupdjian, M.D.
ISBN 0-9621284-1-4 | Library of Congress registration #: 2-414-199
copyright © 1988-2006 Dr. Leon Forrester Tcheupdjian M.D.
Published by Dr. Leon Forrester Tcheupdjian M.D. 875 Rush Street Chicago, IL 60611


All rights reserved. No part of this book may be reproduced in any medium whatsoever, including photocopy or other electronic medium, without the express written permission of Dr. Leon Forrester Tcheupdjian M.D..