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Key Points
- The typical patient undergoing a liposuction procedure is female with unwanted fat deposits in the trochanteric region whose goal is to improve body contour.
- The indications in which liposuction can be used in children may be viewed as atypical in the sense that they are very different from the classic age and the usual etiologies of adipose disharmony prompting the aesthetic indication normally seen.
The "typical" patient undergoing a liposuction procedure is female with unwanted fat deposits in the trochanteric region whose goal is to improve body contour. According to one expert, the indications for liposuction treatments are growing, particularly in the pediatric population.
"Necessity is the mother of invention and in this same vein, the technique of liposuction arose from the need and desire for adult patients to remove unwanted adipose tissue such as in the thigh or abdominal areas. As the technique became safer and continued refinements led to remarkable cosmetic results, plastic surgeons began to realize that the procedure can be readily used not only in adults but in children as well — for the right indication," says Beatriz Berenguer, M.D., Ph.D., a plastic surgeon at the Department of Plastic and Reconstructive Surgery, St. Rafael Private Pediatric Hospital, Madrid, Spain.
NOT SO DIFFERENT
The indications in which liposuction can be used in children may be viewed as "atypical" in the sense that they are very different from the classic age and the usual etiologies of adipose disharmony prompting the aesthetic indication normally seen. Nevertheless, the indication for using liposuction in children and adolescents is in essence the same as in adults, namely remodeling or sculpting areas of the body where fat deposits are in disharmony or disproportion to the rest of the general physique of the patient. "Basically, what changes in this younger patient population is the etiology of the adipose disharmony, where the fat is in an abnormal location or in an abnormal configuration. Some of these atypical indications for liposuction include post-traumatic lipoma, post-traumatic asymmetry, lipodystrophy regardless of the etiology, adiposis dolorosa or Dercum syndrome and Klinefelter syndrome," Dr. Berenguer says.
PEDIATRIC PROBLEM SOLVER
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Pix1. And Pix2. 14-year-old girl with juvenile Dercum experiencing painful, abnormal trochanteric fat deposits (before) and 6 months after regular liposuction, which resulted in pain elimination and normal contour.
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Dr. Berenguer has used liposuction in many children and adolescents for all of these etiologies. In Klinefelter syndrome, the patients are phenotypically male but their genotype is XXY, typically giving these patients a more feminine distribution of their fat deposits. Liposuction is successfully performed in puberty in these patients in order to de-feminize their body contour. Atypical congenital lipodystrophy or Dercum syndrome is a painful condition in which patients have very large accumulations of fat in the trochanteric area. According to Dr. Berenguer, patients who undergo liposuction procedures here not only get a better contour of their body line but the procedure often helps to significantly reduce and even eliminate the pain associated with the disease.
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Pix2.
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Another common indication for liposuction in children is its use in involuted hemangiomas. Infantile hemangiomas formerly known as strawberry hemangiomas are the most frequent benign tumors in childhood with a very typical lifecycle. Over time as these hemangiomas slowly regress, they often leave a residium that is mostly adipose tissue, especially those infantile hemangiomas that are very voluminous. An MRI exam can clearly demonstrate if involution is complete and then if the resulting tumor is mostly fat, liposuction can be used here to aesthetically remove the tumor and smoothen out the area.
"Liposuction should be used only if there is an MRI verification that the involution is complete. This way there is no danger that the cannulas employed in the liposuction technique will pierce and rupture any remaining blood vessels in the target area," Dr. Berenguer says.
Dr. Berenguer has also successfully treated the abnormal fat distribution seen in children after traumatic etiologies such as post-traumatic lipoma that can occur after accidents. The technique can also be used after the surgical separation of twins where each patient often can have very visible contour deformities at the site of separation. Here, Dr. Berenguer employs liposuction as well as lipo-filling to improve and harmonize the contour at the site of separation.
