Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘knee liposuction’

Case Study – Knee and Calf Liposuction

Saturday, May 23rd, 2015


Background: Liposuction is performed over many areas of the body, most commonly in the trunk region. (abdomen, chest and flanks) Its success is largely dependent on how well the overlying skin can retract after the underlying fat is removed. There are numerous types of liposuction that claim superior results if used. But the key to liposuction success is proper patient selection and the skill of the practitioner using the liposuction device.

Liposuction is also be performed in the extremities (arms and legs) although with less frequency than that of the trunk.  The principles by which liposuction works in the extremities is the same as anywhere else. But the legs pose unique challenges for good liposuction results. Skin retraction is often not as good due to the circumferential nature of the tissues and prolonged edema may result from increased venous pressures below the knees with delayed lymphatic outflow. Longer recovery times and prolonged use of compression garments is essential to get good skin retraction around the reduced fat areas.

Some women are afflicted with thicker lower legs, which they may refer to as ‘tree trunks’. This description is somewhat applicable as it refers to a lower leg that has no shape and is more of a straight line from the knees down to the ankles. The knees are thick, often with an inner bulge and the underlying calfs have no discernible shape. This is often a source of embarrassment and may even prevent them from wearing anything other than pants to hide them.

Case Study: This 33 year-old female had always had thick and unshapely legs. They did not match the rest of her body and made her look ‘fat’. She never wore shorts and did not really like warm weather because of her clothing limitations. Liposuction was offered to her as the only treatment option with the understanding it could give her lower legs more shape although not necessarily make them a lot smaller.

Knee and Calf Liposuction result front viewKnee and Calf Liposuction result back viewUnder general anesthesia, liposuction was performed on her inner knees and circumferentially on her entire calfs. Particular emphasis was focused on creating a superior and inferior concavity on the inner aspect of her calfs. A total of 1,750ccs was aspirated. She wore compression garments after surgery for six weeks.

Her three month postoperative results showed more shapely lower legs. The inner knees had less of a bulge, a medial infrapatellar indentation was evident as was a lower calf  contour that turned inward towards the ankles.

Case Highlights:

1) Liposuction of the knees and calfs can help create lower legs that are more shapely and look less like ‘tree trunks’.

2) Liposuction of the lower legs is about creating a more shapely outline than overall size reduction.

3) Liposuction of the lower legs takes up to three months after surgery for all swelling to finally subside and see the final shape.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Liposuction of the Knees

Saturday, August 18th, 2012


Background:  As liposuction has evolved over the past thirty years, it has undergone numerous developments most of them technological. But besides improvements in how effectively fat can be extracted, the use of liposuction has been applied to every conceivable body part from the neck down to the ankles. The development and use of small cannulas has enabled liposuction to be used in even the smallest fat collections. Smaller fat extractions have been termed liposculpture, implying subtle reshaping rather than just large volume reduction.

The legs are a frequent site of liposuction surgery. While many women do not like the appearance of their legs and often wished they were smaller overall, circumferential leg reduction by liposuction is not a practical or highly successful approach. Most leg liposuction is about changing its silhouette with reduction of the outer thighs (saddle bags), inner thighs and knees. Fat reduction is these areas can make the leg more shapely, although not always thinner or smaller.

The knee makes a valuable contribution to the shape or outline of the inner leg. Ideally, the line of the inner leg makes a small break or bulge as it crosses the knee. It then turns inward below the knee to separate it from the outward convexity of the upper part of the calf muscle. If a line is drawn from the upper inner thigh down to the bulge of the inner calf muscle, the size of the knee should not pass beyond that line. Large fat collections of the knee make it bulge outward and obscure the shape of the patella over the central knee.

Case Study: This 40 year-old female was undergoing multiple body contouring procedures including breast augmentation and a tummy tuck. But she never liked the shape of her legs, being embarrassed by her ‘knobby’ and unsightly knees. She did not want to wear any dresses or shorts that exposed her knees. In addition to the other procedures, she opted for liposuction of her knees and inner thighs to get a more shapely appearance.

Under general anesthesia, the knees and inner thighs were infiltrated with a Hunstad solution. The other body procedures were completed first, giving the solution plenty of time for maximal vasoconstriction. From a small incision in a popliteal skin crease in the inner knee, a 3mm cannula was used to remove over 75ccs from both inner knee areas. Focus was made to create a deeper indentation below the knee above the calf muscle. Medial patellar fat was also extracted. The inner thigh was then liposuctioned from different incisions above the knee.

After liposuction, the knees were dressed with reston foam and ace wraps. The foam was removed the next day but the ace wrapping continued for two weeks after surgery. The knees had persistent swelling and stiffness which took six weeks to go away completely. The change in the shape of the knees was visible , giving them a more shapely appearance between the inner thigh and the calfs.

While the knee is a small area, liposuction can very effectively and quickly make for a dramatic change. It needs to be done aggressively, removing fat and working the cannula right up to the underside of the skin to get a good result. Fat removal should also be done above the inner knee in the patellar area and downward below the knee to create a more shapely inner knee profile.

Case Highlights:

1)  The knee is one of the smallest areas on the body to liposuction but can have a dramatic effect on the shape of the inner leg.

2) Liposuction of the knee is unique because it is the only area on the body that fat removal is done across a moveable joint.

3) Recovery from knee liposuction is prolonged with swelling and stiffness of the knees for up to six weeks after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

Uncommon But Effective Plastic Surgery Procedures

Monday, January 11th, 2010


Cankle Liposuction


Liposuction can be performed almost anywhere there is some thickness of subcutaneous fat. The thick leg, between the knee and the ankle, represents differing thicknesses of subcutaneous fat which yield an amorphous lower leg that has a straight line shape. Creating an improved shape comes by creating a thinner profile, or inward indentation, from the lower end of the calf down to just above the ankle bone. (particularly above the inside of the ankle) Discrete small-cannula liposuction can be safely done to reduce the appearance of a chubby ankle.

The key is to not overdo the liposuction area and focus on a limited treatment area that will make the most difference. Because of the elevated venous and lymphatic pressures, the ankle swelling after surgery is more prolonged than liposuction does in almost any other area of the body. But the results can be very visible later and a modest shape improvement is definitely achievable.

Earlobe Lift

Even though the earlobe is small, it is extremely visible. Its appearance can definitely create an impression as to one’s age. (much like one’s hands) An abnormal earlobe, like the ‘pixie earlobe’ deformity after a facelift, is particularly unflattering and a well-known sign of a ‘bad facelift.’


As we age, the earlobe for some people actually deflates losing some of its fat volume.  It may also get elongated, particularly in women, due to decades of ear ring wear. The deflated or stretched out earlobe can be rejuvenated. Injectable fillers are an easy and immediate fix to the wrinkled and delated earlobe. A few tenths of a cc of Juvaderm (or amost any filler) provides an instant plumping. Fillers in the earlobe seem to last longer than almost anywhere else in the face, perhaps due to its slow lymphatic clearance. This is a not uncommon request after someone has had a facelift. The floppy thin earlobe looks out of place after.


In the elongated earlobe, a simple earlobe lift can be done by removing a full-thickness wedge of tissue. Done under local anesthesia, a shorter and fuller earlobe is the result.


Dimpled Chin

Neuromuscular injections have found a low of uses but no matter where it is placed on the face it is for muscle weakening or paralysis of an area of hyperactivity. One of the uncommon but very effective uses for this treatment is in the softening of chin fasciculations. Some patients will experience excessive muscle activity of the mentalis muscle. This is a small but thick muscle that envelopes the bony chin with attachments into the overlying skin. When this muscle becomes stressed, through habit or from straining in a short chin, the chin skin will develop irregular dimples and assume an almost golfball shape. In the extreme, it can be quite noticeable and peculiar-looking.

Muscle weakening injections, like Botox and Dysport, can lessen these chin skin irregularities. While not permanent, repeat injections over time make allow for some expression re-education. 

Knee Liposuction

When looking at the legs, it is important to look at the entire legline particularly its inner aspect. The inside of the knee is one small area that can stick out and breakup a smooth transition from the inner thigh down to the calf. It is one of the most bothersome leg areas for many women. It is an easy area in which to do liposuction from a small incision located in the backside of the knee. A surprising amount of fat can be quickly removed and it is important to blend the fat removal down into the upper calf and upward into the knee and lower inner thigh so a smooth flow of the inner leg line is obtained.


It is uncommon to just do knee liposuction alone. It is almost always done as part of inner and outer thigh reshaping. One important patient consideration is that the knee will be sore for some time, often longer than any other liposuction area. Because the knee is a moveable joint, there is a lot of continuous motion across the area leading to prolonged swelling and discomfort. I advise my patient to wear an elastic athletic knee strap afterwards for several weeks. Not only does it stay on but the contiunous support helps reduce discomfort.


Neckline Botox

Even after a good facelift, low neck lines (necklace lines) may still be present. No form of  a necklift can produce  as much improvement way down in the neck below the adam’s apple as it does above it. These low horizontal lines across your neck are a telltale sign of aging. One of the only methods to treat it are Botox or Dysport injections.

While claimed to produce a bit of a neck lift, some go as far as calling it a “Nefertiti lift.”  While there are no other options to treat these neck lines, I have never been impressed that a true neck elongation actually occurs. But a slight softening effect can be seen and it is quick and easy to do.  Whether injections into this neck area is beneficial is ultimately based on whether one feels that the cost is worth its temporary effect.

Dr. Barry Eppley

Indianapolis, Indiana



Knee Reshaping with Liposuction

Saturday, July 25th, 2009

The knees serve as the articulation and midway point between the thighs and the calves. While in many ways knees are a bit of an oddly shaped structure, they are at a very visible location and can help make the determination as to whether some women choose to wear short skirts and shorts or not. Many women are unhappy with the appearance of their knees and that concern is largely focused on the appearance of their inner aspect or medial part of the knee.

The size and shape of the knee is usually consistent with the rest of the leg. A full inner knee is typically part of bigger legs….but not always. In my Indianapolis plastic surgery practice, I certainly have seen numerous women who have relatively thin legs but have an inner knee bulge which is unsightly and inconsistent with the rest of their legs.

The inner aspect of the knees should not stick out beyond a straight line down the inner aspect of one’s thighs. It should also curve in or indent right below the knee cap to provide a break before curving out again into the calf. This provides some shape or curvature to the knee which is more aesthetically pleasing.

Liposuction provides a simple and ideal way to help sculpt the knee area. Unsightly knee bulges can be quickly and effectively reduced as it is a small area and one can be aggressive with the amount of fat removal. It would be nearly impossible to over reduce or remove too much fat from the inner side of the knee because the prominence of the knee joint prevents too much of an indentation to occur. The goal is to remove as much fat as possible. While all forms of liposuction will work, I currently prefer Smartlipo becasue patients have less pain afterwards which is the most significant part of their recovery. ( it is sore for some time because you are suctioning across an area which must constantly bend and flex)

The finesse part of knee liposuction is what is done above and below the inner knee area. Remember that the goal is to produce an appealing inner leg line which curves and undulates as it goes around the knee. Therefore, one must taper the amount of fat removed upward so there is a smooth transition from the lower end of the inner thigh into the knee area. As previously noted, fat must be removed as well from the top part of the inside of the upper calf area so that this line curves inward right below the knee before it curves out for the convexity of the upper calf area.

After liposuction, the knee will be sore for a while and it is very helpful to keep it wrapped for several weeks. This helps reduce the amount of swelling that will develop and it will provide support for the near constant motion across this area. It takes about 6 weeks to see the full results from the procedure so one has to be patient as is typical for all lower extremity liposuction.

Dr. Barry Eppley

Indianapolis, Indiana

Different Approaches to Thigh and Lower Leg Liposuction

Sunday, January 25th, 2009

Liposuction is commonly performed on the legs, particularly in the thighs. While this most frequently performed plastic surgery procedure works, I occasionally see patients who are attempting something that is beyond what can be achieved with this fat removal technique. Specifically, taking a thick or heavy leg and making it thinner.  It is often believed that liposuction performed circumferentially, or 360 degrees, can substantially reduce the size of the thighs or calves.

 When one considers lower extremity liposuction, two fundamental approaches exist depending on the problem. Spot or unit reduction or a circumferential liposuction technique can be used. While both liposuction techniques are practiced (circumferential less so), the outcomes and risks between the two are different.

Most liposuction of the legs is done to create a better shape, not necessarily to make it measurably smaller. This is the spot or unit reduction approach. Treating the outer and inner thighs, inside of the knees, and the upper inner and lower calf all work to provide a more curvy leg shape, particularly down the inside of the leg. Actual circumferential measurements may not change that much but the shape is visible better. Reducing these selective ‘spots’ or leg units has less risk of irregularities after because the straight liposuction cannula approaches these areas in a more direct vertical direction.

Circumferential liposuction is theoretically appealing but is not only more time-consuming to perform but is associated with a much higher risk of irregularities and more prolonged swelling and bruising. As the fat layer of the leg wraps around circumferentially (which is a curved surface) and the liposuction cannula is a straight rod, it is easy to how uneven fat removal would occur. Cutting across a curved surface in a straight line makes for uneven removal.  This does not mean that good and careful surgical technique can not compensate for these geometric differences but suffice it to say it is difficult, particularly when the patient is laying down flat on an operating room table as opposed to standing vertically during the procedure. (which is impossible in an asleep patient)

I have yet to be impressed that circumferential liposuction, which does accomplish some measureable circumferential reduction, can really achieve what the thick-legged patient wants.  You just can’t take a thick leg and make it thin. Therefore, I caution patients to think more about specific area of reductions of the legs and look for shape change. The patient seeking circumferential leg size reduction often endures a lot of soreness and swelling to be improved but often disappointed in the final results.

Dr. Barry Eppley

Indianapolis, Indiana

Liposuction of the Knees – Helping to Reshape the Legs

Sunday, July 20th, 2008

While liposuction can be performed on almost any body area below the neck, little mention is ever made of fat removal from the knee. Yet, in my practice, I regularly perform knee liposuction particularly when the inner thighs are being treated. Most female patients can benefit from knee liposuction if it is done judiciously and in consideration of the line and flow of the inner thigh down into the calf area. Knee liposuction can produce very rewarding results that can make patients more comfortable in shorts and above the knee dresses and skirts.
The knee sits at an important esthetic juncture between the thigh and the calfs. The most important esthetic line is in the inner aspect in which a straight or mildly curving line should run from the inner thighs down to the top of the calf before it bows out again. If the inner knee fat bulges outward, it disrupts this esthetic line giving one the appearance of knobby or chunky knees.While the top and outer aspect of the knee also makes up the knee unit, little can be successfully done with those areas compared to the inside of the knee.
Liposuction of the knee is very straightforward to do. But the technique is critical if too much fat is not to be removed or irregularities and indentation of the overlying skin is not the result. A very small cannula is used with a small stab incision just behind the inner aspect of the knee in the popliteal crease. While the knee must be bent to do the procedure, it is important to regularly check the progress of fat removal by re-straightening the leg and checking how the inner esthetic line is progressing. When done as a stand alone procedure, it is important to make a gradual transition up into the inner thigh so there is not a demarcation line between the inner knee and the inner thigh. I find it esthetically important to also make sure that the liposuction is carried down into the upper calf area so I slight inward curve is placed before it bows back out again into the upper calf area.
I have found that knee liposuction can make a dramatic difference in the knee area and can get rid of the handful of fat in the inner knee that many women have. Even somw women with thin thighs and shapely calfs can still have a slight inner knee bulge. This area is clearly not metabolically active no no amount of diet and exercise can remove it. I usually have my patients wear a knee wrap or knee brace for a week or so until they feel comfottable without wearing it. The biggest issue with knee liposuction is that, because it is a flexion area, stiffness in the knee can be expected for 4 to 6 weeks after surgery when bending. Normal physical activities, including running, can be resumed three weeks after surgery.


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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