Advances in liposuction contouring of calves and ankles.

Achieving a predictable, aesthetic result in liposuction contouring of the lower leg is now possible. The evolution of the technique has brought about preoperative, intraoperative, and postoperative advances. This article describes in detail these advances and their rationale.

Circumferential "intermediate" lipoplasty of the legs.

Circumferential intermediate lipoplasty of the thighs and lower legs is an expansion of the traditional lipoplasty technique. Rather than limiting the correction to defined bulges, the goal is to thin the thigh or the calves and ankles circumferentially. This procedure is not indicated for all patients. In selected patients with extremely heavy thighs, medial and lateral bulges, full anterior thighs, and a full posterior thigh in the upper third, circumferential liposuction improves the results and produces a slimmer thigh. In the calves and ankles, circumferential lipoplasty reduces the entire lower leg giving a more attractive result rather than just reducing the medial and lateral ankle bulges. The concept of intermediate lipoplasty is introduced. This technique has advantages over the superficial technique and the traditional deep lipoplasty. No special equipment, incisions, drains, or change in technique is needed. Using circumferential intermediate lipoplasty to contour the entire lower leg results in a slimmer looking leg. There has been no increase in complications. The author reviews his experience with this technique.

Updated muscle suspension and lower blepharoplasty.

The challenge of lower lid blepharoplasty surgery is to get the lid tight enough to smooth out wrinkles and not produce scleral show or round eye. The updated lower lid muscle suspension blepharoplasty can meet this challenge. The technique uses an easily placed muscle suspension suture to help support or elevate the lower lid.

"No-touch" submuscular saline breast augmentation technique.

This article represents a retrospective view of the author's 17-year experience with 2863 saline implants in 1327 patients and details his "no-touch" technique. The experience included almost an equal number of submammary and subpectoral procedures. The submammary procedures were done early on and were replaced with subpectoral procedures, done exclusively at the present time. There were significantly less complications--capsules, wrinkling (visible folds), and deflations--with the subpectoral procedures. Followup is longer for submammary procedures which could be the reason for the slight difference in number of deflations. Analyzing the results from three different periods, during which the technique changed, the last period in which the no-touch subpectoral technique was used had markedly fewer complications. The no-touch technique, which had been introduced in orthopedic surgery over 50 years ago, was added to the augmentation procedure in an attempt to eliminate any possible contact with skin or breast bacteria. There were no infections in the entire series, and, during the no-touch period, capsules were almost eliminated (0.6%). Saline implants can achieve excellent results when placed subpectorally using the no-touch technique.

Twelve months of experience with Bioplastique.

Over a 12-month period, 40 patients were treated for various facial defects using a new, injectable microimplant material--Bioplastique. Areas treated included cheeks, chins, lips, nasolabial lines, nasoglabellar lines, infraoral lines, noses, and miscellaneous depressions. Patients were observed for overcorrection, inflammation, morbidity, allergic reaction, or other complications. Both patient and physician satisfaction were recorded. Use of Bioplastique was found to offer permanent results by means of a quick, simple procedure administered under local anesthesia without scarring. With proper training and a good "eye," subtle corrections are possible. The author anticipates wide application of Bioplastique for the treatment of numerous soft tissue deficiencies.

Male body contouring.

Male body contouring is discussed in regard to indications and patient selection. General guidelines are given for anesthesia, positioning, preoperative marking, and operating room preparation. The technique is discussed for facial, chest, and abdominal contouring. Suction lipoplasty, abdominoplasty, flankplasty, and thigh contouring are discussed in detail.

Gynecomastia. Liposuction and excision.

Lipoplasty has facilitated the correction of gynecomastia and improved the morbidity and end results. The author details his technique of combining lipoplasty with excision for gynecomastia.

Alloplastic cheek augmentation.

Alloplastic cheek augmentation can achieve an attractive malar prominence that is in balance and harmony with the other facial features. To reach this goal, the surgeon must first identify the proper candidate and then determine the type of malar deficiency. A vertical line through the lateral canthus allows the malar deficiency to be classified as anterior-medial, posterior-lateral, or combined. The proper implant is selected on the basis of the type of the defect and the degree of the deficiency. Different techniques are described that help the surgeon locate the site of the ideal malar eminence. Once that site is located, the surgeon outlines the proposed pocket for the implant. Both silicone and Proplast implants are successful. The insertion may be through the intraoral route, blepharoplasty approach, or under the face lift flap. The possible complications are discussed, but the complication rate is minimal.

Lipoplasty of the calves and ankles.

The author details his experience over the past 6 years with 53 patients who had lipoplasty of the calves and ankles. The patient selection and diagnosis are critical. Determining whether the problem is localized or circumferential (generalized) influences the approach. The incisions are outlined as well as the best technique to provide excellent access to the entire leg. Although the results take a considerable period of time to appear because of long-lasting edema, after 3 months in the localized cases and 6 months in the generalized cases, an excellent configuration of the lower leg may be obtained. The author has had no significant complications in this series.

The big six. Six important tips for a better result in lipoplasty.

From my experience with lipoplasty, all the points discussed are important to gain good results. They have been especially helpful to surgeons who have taken the courses given by the Lipoplasty Society of North America over the past 5 years.