Q: Dr. Eppley, I’m interested in knowing more about the liposuction for calves and ankles. I’m 24 years old and am 5’ tall and weigh 140 lbs.. Many surgeons where I live have refused to perform liposuction in that area because of the risk of prolonged edema. I was wondering how much you would charge for liposuction of the entire leg( thighs, calves and ankles). Also, can I expect the whole leg to be done in one session? Thank you very much. I look forward to hearing from you.
A: What you referring is, as you have mentioned, total leg liposuction or near circumferential extremity liposuction. Your surgeons are correct in my opinion that performing liposuction on the whole leg will result in prolonged edema. And it is even possible that some of the edema may even be permanent. (rare risk) It is much more prudent to think of trying to thin the whole legs in two stages, upper (thighs) and lower liposuction. (knees to ankles) The lower legs should be done first, followed six months later by the upper leg section. This is the safest approach to prevent prolonged lower leg edema and also provides an opportunity to touch up any uneven or under corrected areas on the lower leg.
Q: Dr. Eppley, I hope you can help me. I am almost 30 and I have had ‘fat’ legs since my early teens. My grandma and mother have the same. When I lose weight my legs still stay fat; I go to the gym regularly and this has gone some way to improve muscle tone but not to achieve any fat loss from my ankles or calves. I would love my legs to look slimmer and more shapely.
A: Lower leg liposuction can be effective at improving the fuller lower leg from the knees to the ankles and making them more shapely. But it is not done in a circumferential manner as many people think. Rather it is done by treating selective areas to improve their silhouette or profile through inner knee, upper medial calf, and inner and outer lower ankle liposuction. While such lower extremity liposuction can be very effective it can take several months to get to see its benefits. As the lower legs have increased venous pressure and slower lymphatic outflow due to gravity they hang onto swelling for some time after the surgery. It usually takes about three full months to see the final results of the lower leg reshaping.
Q: Dr. Eppley, Do you do liposuction on “cankles” and calves?
A: Cankle liposuction is more than a myth, It is very real surgical procedure! Reshaping the legs from the thighs down to the ankles are liposuction procedures that I commonly do. Do not think of reshaping the lower extremities as a 360 degree circumferential procedure as that is not the approach that is taken. The most effective thigh, knee, calf and ankle liposuction technique is known as ‘silhouetting’. This is done by selectively changing the inner and outer contours to give the entire leg more shape as seen from the front. This means that the inner and outer thighs are done, the knees from across the top, inner aspect and curving below the knee into the upper calf and tapering the lower calf above the ankle area above both areas of the ankle bones. This is how one uses liposuction to make the leg more shapely from top to bottom.
While effective, cankle liposuction invokes a lot of persistent swelling around the ankles that takes months to completely go away and see the final result.
Q: Dr. Eppley, I would like to have liposuction on my calfs, but,I have been told by several doctors not to do it? Is it safe? I see on your website you do calf and ankle liposuction.
A: Liposuction can be done safely on the lower extremities, including calf and ankle liposuction. It is not a question of safety but effectiveness. Can enough fat be taken from the right places to make a visible difference. While most people that seek liposuction below the knees would like a large circumferential reduction, such changes are not usually possible. However, selective small cannula liposuction done in the right areas (high inner calf, lower inner calf, low posterior calf and inner and outer ankles) can give the calfs and ankles some shape so that they don’t look like ‘cankles’ and straight tubed calfs.
The issue with liposuction below the knees is that there will be some prolonged swelling due to the high venous pressures that naturally are present in the ankle and feet. It usually takes about 3 months for the full effects of the procedure to be seen.
Q: Dr. Eppley, I had liposuction done to my calfs out of state. My calves look great and I am happy with results but I’m not happy with the indented scars that are left. Three of the eight incisions are indented. The incisions were left open to drain and were not stitched up. I understand some docs do this and some don’t. I guess it’s a preference thing. They are very small incisions but I still do not like that they are indented. Because of the location on my calves, they show a lot. I feel like everyone will now know what I had done. I can’t enjoy the results because of this. I feel like I would have been better off if they were stitched up and became keloid scars this way I could flatten them with scar strips like I have done in the past. Even with scar revision, I know they will not go away completely. I am realistic about this but as indented as they are, they will attract more attention. I have had liposuction in the past on other body parts and the incisions were sutured up and now you cannot even see the scars. So I do have experience with this. That is what I was hoping for these too. Now there is nothing I can do to pull them out. I have included pictures. I would like to discuss what method you would use to pull them out or even cut out the scar and resuture. I heard some doctors make another incision and then loosen the connective tissue (with a needle) that is pulling it down and then suture it up. This is what I would be interested in. What would you charge per indentation? If this is something that you are comfortable doing or have experience with, please have your assistant contact me.
A: Indented scars from liposuction are common on the calfs if they are not sutured closed because the skin is so naturally tight and thick. This is particularly true on the back of the calfs. The best approach would be to a simple scar revision by excision, release the indentations by needle (subcision) and then reclose them. This would be a fairly simple procedure done in the office under local anesthesia.
Q: I was wondering if liposuction can be done on the calfs? Ever since I was little my calfs have always been disproportionate compared to the rest of my body. I have been teased my whole life because of them, even now at 24 I still am teased, and I have tried everything short of surgery to reduce their size. I am 5’7″ and 145 lbs and my calves are 16.5″ around, but if I workout or am on my feet all day, which I usually am, they can be 17″ to 17.5″.
I am tired of not being comfortable in a skirt, or swimsuit, and not being able to find boots that will fit around my calves. I have attached pictures of them so you can see what I mean. They are muscular, but they do have fat, when I flex I can grab a handful of fat from my ankle all the way up to just under my knee. I don’t know if it is possible to remove this. I have contacted a few other clinics, and they said they do not perform the procedure. I have attached some pictures so you can see what I mean.
A: Thank you for sending those excellent pictures. I can clearly see your calf size concerns as they do not seem to fit the rest of youor body frame. Liposuction of the calfs can be done and definitely make a contour improvement. Think of calf liposuction not as completely circumferential but done is select areas that will provide more shape to the calf. Fat removal on the inside of the lower calf, at the outside of the ankle, and in the inside of the upper calf be low the knee are all good shaping areas. Circumferential liposuction of the calf causes a lot of swelling that takes a long time to go away. It is better to think of calf reshaping rather than calf size reduction.