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Archive for the ‘liposuction’ Category

Case Study – Knobby Knee Liposuction

Saturday, October 14th, 2017

 

Background: Excess fat collections can occur all over the body. Some may occur from excess calories (e.g., abdomen) while others occur as part of one’s development. (e.g.,

arms) But regardless of its source, most fatty areas can be successfully treated by liposuction for contour improvement.

Liposuction of the lower extremities is the second most common area requested for treatment after the abdominal/waistline area. This is almost exclusively a female request and historically consisted of the inner and outer thighs. But as liposuction has become more advanced, contour reduction and shaping has extended to the knees down to the ankles. It is no surprise that successful lower extremity liposuction shaping works just as below below the knees as it does above it.

The knees may be a small body area but they have an important aesthetic role in the lower extremities. Being situated midway between the upper and lower leg, they provide an aesthetic breakpoint in the leg. Their inner and outer contours provide a break in the linear line of the leg. A slight outward curve of the knee provides an appealing curvature as long as it is not too prominent. When fatty collections of the inner knee become excessive, they are known as knobby knees.

Case Study: This 42 year-old female wanted to reshape her ‘knobby knees’. Even though she was not overweight she always had  prominent inner knees which stuck out.

Under general anesthesia, she had power-assisted liposuction (PAl) using a 3mm cannula performed on the inner knee. Fat removal extended upward into the inner thigh and into the concavity of the area between the knee and the upper calf muscle for optimal contouring. A total of 200cc of aspirate was removed in each inner knee.

The Inner knees is often overlooked or forgotten as a liposuction treatment area. In reality it is one of the most successful body areas to treat with liposuction because there is little chance of creating a contour deformity and there is also little risk of loose skin afterwards. Conversely the biggest aesthetic risk is under resection leaving too much fat and an inadequate reduction.

Highlights:

  1. The inner knees is a small but effective body area to treat wth liposuction.
  2. An aggressive liposuction approach to treating knee lipodystrophy is needed to make a visible difference.
  3. The area above the knee  as well as below above the calf muscle is need to create shape to the inner knee contour.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Facial Reshaping Surgery with Chin Augmentation and Facial Fat Removal

Friday, September 15th, 2017

 

Background: The round face is often characterized by soft tissues excesses and bony deficiencies. It takes a combination of both tissue issues to create a round or convex facial shape. Very often the lower jaw/chin is short or deficient and the lack of a bony projection is the linchpin to this type of facial shape. While such a facial shape may be adorable as an infant or young child, it is often not perceived so in adulthood.

When the chin is short, the debate is often between that of an implant or a sliding genioplasty. There are advantages and disadvantages to either chin augmentation method. But the round or fuller face usually has a fuller submental fad pad and attached neck muscles that are relatively short. Moving the chin forward in the round face has the advantage of stretching out the attached neck muscles and improving the shape of the neck even if liposuction or a submentoplasty are still going to be performed.

The other component of the round face is excessive fat. While removing facial fat alone rarely changes one’s facial shape entirely, it still has a valuable role in facial reshaping surgery. Facial fat removal maximally consists of addressing the three main compartments of the buccal space, perioral mound/jowls and that in the neck..

Case Study: This young female had a very round face and short chin. She had an orthodontically corrected Class II occlusal relationship.

Under general anesthesia she had a 10mm sliding genioplasty advancement combined with buccal lipectomies, perioral and neck liposuction for an overall facial reshaping effort.

Her after surgery results showed a dramatic change in her facial shape with a better defined chin and jawline and much thinner looking face.

The combination of bony augmentation and fat reduction can produce a diametric facial effect which leads to a significant change in one’s facial shape.

Highlights:

  1. Significant facial reshaping often requires a combination of bony augmentation and fat reduction.
  2. A sliding geniopslasty helps the fuller neck by stretching out attached neck muscles.
  3. The combination of buccal lipectomies and personal and neck liposuction are the most fat reduction that can be done in the round face.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Severe Double Chin Correction

Friday, August 25th, 2017

 

Background: The lower face is perceived by the shape and projection of the chin and the cervicomental angle. A fairly well defined neck angle and a discernible chin are positive facial features regardless of age, gender or ethnicity. This speaks to the popularity of such plastic surgery procedures like chin augmentation and neck liposuction which strive to achieve these individual facial improvements.

A well known lower facial aesthetic deformity is the double chin. This does not occur because one really has two chins, it just looks like one does. The real chin is usually horizontally short but creates the upper part of the double chin. The second ‘chin’ is a fat and skin roll in the upper neck that sits below the bony chin. It is more recessed than the bony chin and thus creates a double roll in profile, like a set of stairs, into the lower neck. The double chin often appears as part of an overall facial lipodystrophy in its more severe form.

Case Study: This 25 year-old female had a rounder fuller face and a double chin in profile. The chin was horizontally short due to a more recessed lower jaw and a high mandibular plane angle. She also had a hyperactive mentalis muscle due to the short chin.

Under general anesthesia, a 10mm sliding genioplasty was performed from an intraoral approach to improve her chin projection and stretch out the submental area. Submental/neck liposuction and buccal lipectomies were also done to help deround her face as well,.

Her result shows the dramatic change that can occur from the diametric movements of increased shin projection and decreasing the cervicomental angle.While both tissue movements are concurrently helpful, the biggest influence is from the sliding genioplasty.

As the chin bone is brought forward it carries with it the genioglossus and geniohyoid muscle. This creates a tissue stretch in the upper neck and helps elevate the ‘second chin’ of the double chin. This is an effect that is not created by the placement of a chin implant on the bone. Which is why in cases of severe double chin cortrection the sliding genipoplasty is the preferred approach to implants even though it is far less initially appealing to do so.

Highlights:

  1. The double chin is always associated with a short lower jaw projection and a thicker fatty neck.
  2. ]The diametric movements of stretching out the chin and pulling back on the neck creates the best double chin correction.
  3. The best chin augmentation for the severe double chin is a sliding genioplasty as the bone movement lengthen the neck muscles as well.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Large Buffalo Hump Reduction

Thursday, August 3rd, 2017

 

Background: The buffalo hump is a descriptive term that universally applies to a discrete collection of fat on the back of the neck. Looking at the American bison it is easy to see why it has its name with the massive shoulders of the animal being amongst its most distinct features. But unlike the bison, the human buffalo hump is not muscle but fat.

The dorsocervical collection of fat in humans both unusual and distinct for two reasons. First, it is not a typical location for fat to deposit as it is not known for being a metabolic depot site. It may reflect the congenital location of brown fat which is known to be present in newborns but diminishes with age. Secondly what activates the enlargement of the dorsocervical fat pad is not precisely known. Certain medications and illnesses are associated with its development but it can also occur in people who do have these drug or disease associations.

Case Study: This 22 year-old male presented for treatment for his large buffalo hump deformity. He was a large adult man (almost 300lbs) but he did not have any of the associated triggers for its development. It caused him neck pain and restricted his neck extension. He was also socially embarrassed by it.

Under general anesthesia and in the prone position,  a three-hole liposuction approach was used. Using power-assisted liposuction with baskets as well as smooth round-tipped cannulas the very dense fibrofatty tissue was aggressively treated with an aspirate volume of just under one liter. (900ccs)

His immediate result during surgery showed the degree of improvement which largely made the back of his neck flat again. Unfortunately there are no good methods of after surgery compression for the back of his neck so he will have considerable swelling which will take more than a month to return to this intreoperative result.

The traditional method of buffalo hump reduction was open excision. Due to its very dense fibrofatty tissue it was felt that liposuction could not get an adequate reduction. And if one was using traditional ‘elbow-driven’ liposuction this would still hold true. But today’s many power-driven liposuction technologies make it possible to reduce denser and more fibrous fatty areas like the buffalo hump. While not every case has such dense fibrous fat many buffalo humps do.

Highlights:

  1. The buffalo hump deformity is an abnormal development of fat in the dorsocervical fad pad.
  2. It is a often a dense fibrofatty tissue that requires a mechanized or energy-driven liposuction method for removal.
  3. An open excision of the buffalo hump can usually be avoided.

Dr. Barry Eppley

Indianapolis, Indiana

Increased Penile Show with Pubic Liposuction

Monday, June 19th, 2017

 

While undesirable fat collections can occur anywhere in the body, even small amounts in the wrong place can have undesired effects on adjacent body structures. Such is the case with pubic mound lipodystrophies. The buried penis, also known as the hidden or concealed penis, is when some or all of the length of the penis is obscured by the size of the pubic fat pad. This creates the impression of a short or deficient penis even though its true length may be actually normal.

In the April 2017 issue of the journal Aesthetic Plastic Surgery, an article was published entitled ‘Infrapubic Liposuction for Penile Length Augmentation in Patients with Infrapubic Adiposities’. In this clinical study ten (10) patients were treated by liposuction. All were under age 40 with two-thirds (6 out of 10) having various degrees of obesity. The volume of fat aspirate averaged around 500ccs. (range of 325cc to 850cc) The increase in flaccid penile length three months after surgery was 1.1cm. (14%) Patient satisfaction was very satisfied (30%), satisfied (50%) and no change or dissatisfied. (20%) No correlation was found between the obesity of the patient and their satisfaction with the outcome of the suprapubic mound reduction.

The use of ljposuction in the treatment of the full or fatty pubic mound is much more common in children and teens in conjunction with actual penile lengthening in the treatment of the buried penis. These young patients may or may not be normal weight for their height. Treatment of the buried penis in adults is usually associated, more times than not, with some degree of being overweight. It is therefore logical that reduction of the height of the suprapubic mound would improve penile show. This does not mean that the actual penis gets longer, just that more of its natural length is revealed.

This clinical study supports what other such studies have shown…that liposuction reduction of the pubic mound adds up to 1cm or more of penile exposure. It is important that men realize that this is 1 cm and not 1 inch of penile reveal. Mound size reduction is helpful but is not a true penile lengthening procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Abdominal and Waistline Power-Assisted Liposuction

Tuesday, June 6th, 2017

 

Background: Fat removal by liposuction remains the most common body contouring surgery, particularly if one looks at body surface areas treated. Having been around for over 35 years liposuction has undergone many technologic advancements. The vast majority of these improvements have been in the equipment needed to perform it from cannula design to the devices used to free and remove the fat.

While liposuction has been historically powered by ‘elbow grease’, manually moving the cannula back and forth, this is the least efficient and most laborious technique for performing it. Many energy-based devices have been developed to make the fat particulation part of the process more efficient and effective. Using energies of focused light (laser), ultrasonic waves and high flow water, various manufacturers have put forth their machines for commercial use. Understandably all claim their superiority for improved liposuction results.

One low tech but popular liposuction technology is that of a power-assisted method. What this means, and is unique amongst all liposuction technologies, is that the tip of the cannula moves back and forth thousands of time a minute using ana electric motor. This is a miniature form of manually moving the cannula back and forth but being done by a machine. This creates much more action at the end of the cannula that could ever be done manually and spares fatigue on the operator as well.

Case Study: This 39 year-old female wanted to reduce some fullness across her abdomen and around her waistline into her back. (flanks) She was at a good weight but was un able to shed this fat layer.

Under general anesthesia and using a tumescent infiltration fluid, a 4mm cannula was used on a power-assisted device. A total of 2,150cc of fat aspirate was obtained from the entire abdomen and waistline. At six weeks after surgery she had a complete recovery and  the treated areas showed substantial contour improvement.

Power-asssisted liposuction is one of the many contemporary liposuction technologies. It offers more efficient cannular fat extraction with less surgeon fatigue than traditional liposuction. These features are attractive to patients as well as less surgeon fatigue means greater sustained intraoperative efforts…which is often the key to good liposuction results regardless of the technology used.

Highlights:

  1. Liposuction remains the single best method for fat removal in the trunk.
  2. Many different technologies exist for performing liposuction, the ideal method remains to be determined.
  1. Power-assisted liposuction (PAL) is an effective liposuction method that uses an oscillating tip to reduce operator fatigue and improve efficiency.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Large Cankle Liposuction

Wednesday, March 8th, 2017

 

Background: Undesirable fat collections around the body, medically known as lipodystrophy, are usually caused by excess calories and results from their storage. But in some people and in certain locations of the body, fatty collections are more congenital in origin and are aggravated by weight gain. Even at a patient’s ideal weight these fat collections persist.

One such congenital lipodystophic condition is that of cankles. This urban term refers to the shape of the leg that is virtually the same from the knees down to the ankles. It occurs because there is a thicker than normal subcutaneous fat layer between the calfs and the ankles. This creates a uniform leg thickness below the knees with no defined or curvilinear leg shape. Whether it occurs in an overall larger leg or in a much smaller leg, the appearance of cankles is unmistakeable.

Case Study: This 36 year-old female presented for cankle liposuction. Despite her fairly short stature, she has a large body frame. She has lost a lot of weight but the thickness of her lower leg did not change. She was unable to wear boots and had to wear pants that were too big at the waist to get her lower legs to fit into them.

Under general  anesthesia and using a tumescent technique, her calfs and ankles ere treated with small cannula liposuction. Different entrance sites were done behind and below the knees as well as on the inside and outside of the ankles. Each lower leg had about 1,500cc per side.

Large Cankle Liposuction result front view Dr Barry Eppley IndianapolisLarge Cankle Liposuction back view Dr Barry Eppley IndianapolisIt took several months until most of her swelling resolved and almost 4 months until her legs felt completely soft and supple again. Her results show substantial size reduction and  the semblence of some better leg shape. She was now able to wear boots which she could not do before the procedure.

Cankle liposuction can be a very effective procedure for lower let reshaping even in extremely large lower legs. The amount of circumferential skin limits as to how much size reduction can be achieved.

Highlights:

1) Large collections of fat in the lower extremities is a congenital condition that not be reduced in size by diet or exercise.

2) Cankles refers to a consistent thickness from below the knee right down to the feet.

3) Large volume liposuction of the lower extremities would be considered any amount over 1,000cc per leg.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – The Liposuction Necklift

Monday, February 27th, 2017

 

Background: Aging of the neck is associated with numerous well known changes. The neck droops down as excess skin and fat develop in the center and sides of the neck. The underlying platysma muscle separates and allow the deeper neck tissues to come spilling out. All together a neck wattle or turkey neck is the result.

One of the major components of most neck wattles is fat. While removal of fat can be done by liposuction will that create an adequate ‘necklift’ or neck contouring effort. This is highly age-dependent. At younger ages the lack of  skin redundancy and its good elasticity allows for the neck skin to tighten and lift up. But at older ages neck skin excess and diminished skin elasticity make it more uncertain as to what the neck skin will do.

Case Study: This 57 year-old female was bothered by the shape of her neck. She had a reasonably thick fat layer but her skin was thin with numerous wrinkles in it. If possible she wanted to avoid any major surgery and was willing to see how much improvement liposuction alone could achieve.

Under general anesthesia (she was having other procedures as well) her entire neek was treated with small cannula power-assisted liposuction removing 26cc of fat.

Older Neck Liposuction results side view Dr Barry Eppley IndianapolisCA Neck Liposuction result front viewLiposuction can be a very effective for neck contouring method in the properly selected patient. Usually older patients are less than ideal for just liposuction because of their skin excess and diminished skin quality. But for the patient who wants to limit the extent of the surgery and are willing to accept that the outcome may be suboptimal, neck liposuction can serve as a test to determine if a lower facelift is really needed.

Highlights:

1) A sagging and full neck is a common development as one ages.

2) In the older neck liposuction alone will provide improvement but depends on what the overlying skin will do.

3) Neck liposuction is not a substitute for a lower facelift (necklift) but can be used as a ‘test’ to ultimately determine if one is needed.

Dr. Barry Eppley

Indianapolis, Indiana

OR Snapshots – Abdominal and Flank Liposuction

Sunday, February 26th, 2017

 

Liposuction is one of the most recognizable plastic surgery procedures and is the most commonly done body contouring operation. While there have been many innovations in liposuction devices and techniques over the past forty years since its U.S. introduction in the early 1980s, all such variations can produce effective fat reduction results when performed technically well.

Abdominal and Flank Liposuction one treated side only Dr Barry Eppley IndianapolisThe most common body area treated by liposuction remains the abdomen and waistline. Since this is a central depot area of excess fat accumulation it offers the most reliable and significant area for suctioned fat removal. Performed in the supine position, all of the abdomen and the flanks (love handles) can be treated. The technique of treating one full side first allows both an appreciation of the preoperative body contours but a reductive target for symmetry.

Larger Volume Body Liposuction aspirate Dr Barry Eppley IndianapolisThe safe amount of fat to remove in a single session of suction aspiration has been an issue of discussion. It is generally accepted that five (5) liters of liposuction aspirate is the maximum amount that can be removed without causing significant physiologic changes to the patient after surgery. While this is not an absolute number due to differences in patient’s body surface areas and weight, it provides guidance for what is an elective aesthetic operation. Such volumes of liposuction fat removal, however, is rarely an issue in abodminal and flank liposuction.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Double Chin Correction

Tuesday, February 21st, 2017

 

Background: The shape of the chin has a major effect on facial appearance. Since the chin is a projecting facial structure, it highly influences the shape of the face and how defined the neck can look. The shorter the chin becomes the more convex the facial profile becomes and the neck looks increasingly ‘lost’.

A common aesthetic facial concern is that of the Double Chin. This is really an urban term that is a misnomer. It is not really a double chin per se, it is really a chin deficiency or lack of enough chin projection. When combined with even a small amount of excess neck fat, which occurs right under the chin (submental fat), the profile will show two humps or mounds. They may look like two projecting chins but the lower ‘chin’ ir excessive neck fat.

The treatment of the double chin is a classic diametric surgery. Each ‘chin’ change must be in opposite directions to create the best facial profile change. The upper ‘chin’ must be moved forward and requires some type of bony procedure. (implant vs sliding genioplasty) The lower ‘chin’ requires soft tissue reduction using liposuction fat removal. Together the entire lower face is improved as it becomes more ‘pulled out’ and defined.

Case Study: This 45 year-old female was bothered by the increasing size of her double chin as she aged. She has always had a shorter chin but as she had gotten older the ‘double chin’ appeared.

Under general anesthesia an initial small submental incision was made through which the neck was treated by liposuction removing about 12ccs of fat. The submental incision was extended to 1.5 cms and a 7mm thick curvilinear silicone chin implant was placed in a subperiosteal pocket on the bottom of the anterior chin bone. (the implant had no extended side wings)

Double Chin Correction result side view Dr Barry Eppley IndianapolisDouble Chin Correction result front view Dr Barry Eppley IndianapolisHer eight week postoperative result show elimination of the double chin and a much improved facial profile. Between the chin augmentation and the liposuction, it really takes at least six weeks after surgery to see the full benefits of the double chin correction procedures. Depending upon the degree of horizontal (and even vertical) chin deficiency, the chin deficiency may be better done using a sliding genioplasty for a more 3D chin augmentation effect. It also can have a more positive neck reshaping effect as it pulls the underlying neck muscles (roof of the neck) forward and up.

Highlights:

1) The double chin deformity is a combination of excess fat fullness under the chin and insufficient horizontal chin projection.

2) The combination of submental/neck liposuction and chin augmentation effectively treats the double chin deformity.

3) Whether the chin augmentation is best done by a chin implant or sliding genioplasty depends on the degree of horizontal chin deficiency.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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