Liposuction can be performed on several parts of the body, anywhere there is fatty tissue located just under the skin. It is even possible to sculpt multiple areas during the same procedure, for example, two, three, and more rarely four. It is very important to know how to coordinate these different sites during the same procedure. This is where an experienced liposculptor can be very valuable. But why limit yourself and not do the entire body in one session, you might ask? It would be done once and for all, you might think!
It is important to repeat for educational purposes that anesthesia must be taken into account in this kind of decision. Xylocaine, this local anesthetic that dentists also use, becomes toxic beyond a certain limit. Therefore, in this specific case, we cannot exceed 50 to 60 mg of this substance per kilogram of body weight. Sometimes a single site, for example, a very large abdomen, may require the entire amount of xylocaine allowed for a procedure.
Also, it must be considered that liposuction is a trauma to the body. This trauma must be minimized, dosed in a way that allows the body to heal and recover safely. By way of comparison, you know that a body burned on 20% of its surface is not in danger, whereas it would be quite different for a burn on 60% of the surface. The same applies to liposuction if we want it to be safe.
The surgeon combines their experience and judgment to make wise decisions for the benefit of their patient, by aspirating a quantity of fat equivalent to 4% or 6% of the total body weight over an area of 20% to 25%.
Let’s now list the parts of the body: the chin, breasts (men and women), arms, abdomen, back, flanks, buttocks, thighs, knees, and calves. Here is an overview of the possible procedures for each of these areas. In the following chapters, we will expand further on the possibilities offered by liposuction, with photos and drawings to support.
Chin Liposuction
It is very common for people to accumulate fat in the chin, face, and cheeks as they age. Some people have a very strong hereditary tendency to develop an unsightly accumulation in this area. Fortunately, liposuction can be very useful in correcting this type of problem. Any fat located in these areas can give the impression that the person has too much skin, but in general, the skin reacts very well to liposuction. However, if the person is older and their skin is very stretched, a neck lift (facelift) may be necessary.
If there is one area of the body where liposuction sometimes seems like a miracle, it is often the chin. Some people, who practically had no chin, in the sense that they had a straight line from the chin to the base of the neck, were amazed when comparing before and after photos. It is incredible to see the rejuvenation that liposuction can bring to these people. Another advantage of chin liposuction is the return to work after one or two days of recovery. For example, liposuction is performed on a Friday, and by Monday, it is possible to return to work.
First, the fatty double chin. I characterize it by a very palpable roll, a thick fold when pinching the skin under the chin. This case will respond well to liposuction;
There is also the cutaneous double chin, which is a pure sign of aging, in the sense that the skin has descended and stretched. Moreover, when pinching the skin, the cutaneous fold is very thin. Liposuction is not recommended here.
After liposuction, the skin will no longer form a straight line between the chin and the base of the neck but will form a more pleasant angle to look at, and more youthful in appearance.
Arm Liposuction
Some people accumulate excess fat in the arms, especially on the back side. This can be seen, among others, in people who have lost and regained weight several times in their lives. Some people carry this unfortunate heredity with them.
Liposuction of Fat Rolls
Fat rolls anywhere on the body can be liposculpted very well. A preferred location for these rolls is on each side of the bra, accentuated and highlighted by it. I almost always do this when I work on the trunk, that is, the abdomen, hips, and part of the back.
Similarly, on the front part of the leg, just below the knees, there is often an unfortunate roll that responds very well to liposuction.
Some women (I have never seen it in men) have a bump at the back base of the neck, commonly called a “buffalo hump.” This fatty bump responds well to the liposuction cannula and gives very beautiful results.
Abdominal Liposuction
The abdomen is the most popular site for liposuction. Especially since this area interests both sexes.
For many people, heredity and many other factors cause fat to accumulate very easily in this area. Fortunately, liposuction can be of great help, even in older people, as everyone agrees that quality of life is poisoned by this problem. I have even seen a pathetic case where I had to perform the procedure in two phases, two months apart, removing 4 liters of fat each time. It is very important to remember here that liposuction cannot correct muscles that have lost tone. It is also crucial, during the consultation, to make a good diagnosis and, above all, to explain to patients the ins and outs of the procedure. The surgeon’s honesty always has its place in liposuction, as elsewhere, if not more so in this important decision. A patient will always be grateful to you for telling them everything before rather than after.
As I have already mentioned, a good diagnosis is essential when the abdominal muscles are weak. Indeed, very often the “beer belly” or other hard, large bellies are caused by fat located behind the muscle, where, of course, the liposculptor has no access.
In these cases where the fat hides behind the muscle, by force of circumstance, this muscle is always “bulging.” One could say in vulgar language that the muscle is “deflated,” a bit like a car tire inner tube that is too stretched. At that point, liposuction will not give a flat stomach, since the muscle was deformed before liposuction and will remain so after liposuction.
Some people come to the consultation with a considerable fatty apron, sometimes hiding the pubic area. How will the skin behave after the procedure?
Well, believe it or not, thanks to superficial liposuction invented by Gasparotti, the skin will rise. Obviously, it may not always rise completely, but there will certainly be a nice improvement. I have seen aprons of 7 to 8 inches or 20 cm in length disappear completely after liposuction, because it is important to understand that it is not the skin that makes the fat hang, but the fat that makes the skin hang, and if you remove this fat, the job is done.
In the past, a lipectomy (surgery of the fatty apron) was performed outright in these cases, but today, with the development of liposuction, I would say that it is almost always necessary to start with liposuction, and if the skin does not rise completely, it will be very easy with a minor procedure to remove this excess skin of one or two centimeters.
On this subject, Klein said at a liposuction congress: “Take a hundred patients scheduled for a lipectomy, transfer them to liposuction, and only five will need a skin lift.“
Liposuction is almost always a benign procedure compared to lipectomy, a heavy surgery that is almost always performed under general anesthesia.
If we were to talk about skin quality, I would say that the abdominal skin, especially below the navel, is of exceptional quality. Indeed, let’s not forget that this skin stretches with each pregnancy and retracts progressively after childbirth. You often see women who have had four or five children and still have a very firm stomach. Therefore, this abdominal distension is strictly due to the volume of fat, which, once treated by liposuction, will allow the skin to retract very well. Let us remember once again that it is the fat that made the skin descend, and not the other way around. Freeing the skin from this mass of fat will be a pleasant satisfaction to see it rise.
Sometimes patients do not have an excellent memory of their physique before liposuction. This young patient called my nurse to complain that five months after her liposuction she still had no visible results. My nurse told her to come back to see me for comparative photos.
Surgical scars are very often improved by liposuction. In fact, they constitute adhesions, and the liposuction cannula, passing under the scar, partially releases it and makes it much less visible.
Male Breast Liposuction
I often have consultations for this problem, which is called pseudo-gynecomastia in technical language. Some men, regardless of age, indeed have an excess of fat in the breast area that would make many women envious. In general, these men are extremely embarrassed by this disfigurement, which makes them say, “Doctor, if this continues, I will need a bra,” and which especially prevents them from baring their chest in public.
Well, gentlemen, you should know that these male breasts are well treated with liposuction, and excellent results are generally obtained. With what pleasure these men can put on a T-shirt after the procedure, and especially take it off afterward!
Thigh Liposuction
As we saw at the beginning of the volume, liposuction was invented precisely to solve the problems of saddlebags. In the past, a distinction was made between true and false saddlebags, not recommending the procedure in cases of false saddlebags. False saddlebags are due to ptosis of the gluteal muscles. To make the diagnosis, it is necessary to contract the gluteal muscles, and the false saddlebags disappear, at least partially. Now, this distinction is no longer made, and even an aspiration of 50 cc on each side can make an interesting difference for the patient.
True saddlebags, the most common, are a lump of fat located in the upper-lateral region of the thigh. This is obviously an excellent indication for liposuction. There are saddlebags where barely 50 cc to 100 cc of fat are removed, and others where up to 1000 cc of fat can be removed from each side. The results are excellent. Wearing jeans and bikinis after the procedure becomes a real pleasure for those who had been deprived of it for a long time.
Violin Deformity
After the abdomen, the second most common reason for consultation in liposuction is precisely this violin deformity. It combines three anomalies.
A depression between these two adiposities, or between these two bumps where there is very little fat, and which makes a kind of valley between two mountains; this is the iliac depression.
For women afflicted with this extremely common deformity, which is partly physiological, the procedure is very simple. We make our incisions, one or two depending on the case, in the valley between the two “fatty mountains.” We can therefore, through the same incision, treat the flank by aspirating upwards and the saddlebags by aspirating downwards. And the job is done… Here is a rewarding decision.
In the two weeks following the procedure, if the patient’s morphology allows it, what I have called the “Claudia Schiffer line” appears, which is a perfect line that starts at the hip and goes to the outer knee, without interruption.
Total Thigh Liposuction
For patients who really have large thighs, we can liposculpt the entire thigh, that is, the front, the outside, and the inside. The back of the thigh is less suitable for liposuction, among other reasons for technical and pathophysiological reasons.
Total thigh liposuction is a long procedure and requires a lot of experience on the part of the liposculptor. Indeed, it concerns almost the entire thigh, and the left and right must, of course, be identical. It is very important to be able to have the patient stand up after the procedure to appreciate the result and make immediate adjustments in case of asymmetry. If we were working under general anesthesia, this verification would be impossible, and the results uncertain.
Subgluteal Banana Liposuction
When talking about the thighs, it is important to mention the “subgluteal banana.” This is the small horizontal roll, shaped like a banana, you guessed it, located just below the buttock. Not easy to make disappear, but it can greatly improve. When the subgluteal banana is very hard, it is because it serves as a support for the buttock, and treating it too radically could make the buttock descend. An experienced surgeon will not make this mistake.
Inner Thigh Roll Liposuction
On the inside of the thigh, just below the pubic area, some women have an accumulation of fat, very unsightly, and even harmful at the functional level, because when they walk, friction occurs that can sometimes injure them, especially during the hot season. Some men may also present this problem. Liposuction gives excellent results here, even with poor-quality skin. However, one must be very careful when the patient is approaching sixty, as the skin may redrape unpredictably.
Calf and Ankle Liposuction
These anatomical sites respond well to liposuction. The drawback, not very serious, is that the results take longer to perceive after the procedure. While the flanks or saddlebags are very satisfying after a few weeks (I even dare to say that I performed liposuction on a nude dancer who was able to perform two weeks after her surgery), the calves may take several months to heal well.
Large ankles, large calves, as well as large knees, give the appearance of “post-like” legs. Magnificent results can be obtained in this case.
Knee Liposuction
The knees can accumulate fat in two places; on the inside and on the front, just above the kneecap, which some call the “knee palette.” These two cases can be corrected very well by liposuction. In some cases, there is so much fat inside the knee that patients tell us that their knees rub, which causes great discomfort. And also, to tell the truth, a fatty knee is not very attractive. Some people who thought their knees were large because they had large bones are very surprised to see magnificent results after liposuction.
Buttock Liposuction
Some people tend to accumulate fat in the buttocks, especially as they age. In others, where nature has been very generous with fat, they have buttocks that distress them, especially when wearing pants. They can rest assured, liposuction gives excellent results in this area. Sometimes, buttock liposuction becomes necessary after thigh liposuction. At that point, the buttocks appear more “projected” now that the thighs are slimmer.
Often the volume of the buttocks is very suitable, but their pitted appearance displeases patients. A special cannula, the Toledo, allows cutting the adhesions responsible for this pitted appearance.
Trunk Liposuction
A procedure that is often performed and consists of liposculpting the entire thorax, except the breasts, that is, the abdomen, flanks, hips, and a large part of the back, gives extraordinary results. I have sometimes seen a reduction of several inches or centimeters in waist circumference. The joy of these patients when they come for their postoperative visit is beautiful to see.
Extreme Cases
Sometimes, people present significant fatty deformities that go beyond the aesthetic domain. You are their last hope. You must use your judgment, explain the possible result well, and do your best. Each of these cases has allowed improving the patient’s quality of life… far beyond what the observer may think, because living with abnormal masses often constitutes a daily questioning.
Fat rolls anywhere on the body can be liposculpted very well. A preferred location for these rolls is on each side of the bra, accentuated and highlighted by it. I almost always do this when I work on the trunk, that is, the abdomen, hips, and part of the back.
For women afflicted with this extremely common deformity, which is partly physiological, the procedure is very simple. We make our incisions, one or two depending on the case, in the valley between the two “fatty mountains.” We can therefore, through the same incision, treat the flank by aspirating upwards and the saddlebags by aspirating downwards. And the job is done… Here is a rewarding decision.
Total thigh liposuction is a long procedure and requires a lot of experience on the part of the liposculptor. Indeed, it concerns almost the entire thigh, and the left and right must, of course, be identical. It is very important to be able to have the patient stand up after the procedure to appreciate the result and make immediate adjustments in case of asymmetry. If we were working under general anesthesia, this verification would be impossible, and the results uncertain.
Buttock Liposuction
