Background: The distribution of fat throughout the body is highly variable and is affected by numerous factors including gender, body habitus, weight, lifestyle and genetics. While excess fat (lipodystrophy) is commonly associated with a variety of central trunk areas, it can occur in the extremities as well. When occurring in the extremities without truncal adiposity, it occurs not because of diet but because of congenital lipodystophy. (just the way one was born and developed)
When excess fat occurs in the lower extremities at the ankles, it is commonly called ‘cankles’. This unflattering description signifies that there is little to no difference in diameter between the calfs and the ankles. While this is often associated with patients that are overweight, smaller amounts of ankle lipodystropy can occur in patients of normal weight.
Case Study: This 42 year-old male has long been bothered by the lack of shape of his ankles. He was of normal weight but has excess fullness on the inner side of his ankled between he ankle bone and the lower end of the calf muscle on each side.
Under general anesthesia and in the supine position, local anesthesia with epinephrine was first injected into the marked inner ankle areas. Using a small 3mm cannula the inner ankles were aspirated of 65cc of fat per side with a total of 130cc removed. (this picture shows the difference between one inner ankle treated and the other not yet treated) For the ankle area in an otherwise thin person this is a lot of fat for such a small extremity area. Compression wraps were placed for dressing.
In the properly selected patient I have always been impressed with with ankle liposuction can accomplish. The area has to be treated aggressively with the intent of leaving little fat between the skin and the underlying muscle fascia and achilles tendon. Because it is doing liposuction around a functionally loaded and moving joint, the patient should expect that there will be some prolonged swelling and walking discomfort. Because the ankles are in the most dependent position on the body, they will take months for all the swelling to completely resolve and see the final result.
Highlights:
1) Excess fat collections due to congenital fat distribution can affect non-overweight patients.
2) Small cannula liposuction can be very effective at removing fat from the inner and outer ankles.
3) While it is a small area of liposuction it takes the ankle area longer to recover than one would think.
Dr. Barry Eppley
Indianapolis, Indiana