Laser liposuction shapes ankles and calves safely, precisely

WASHINGTON — Lipoplasty has become a popular cosmetic procedure for sculpting the ankle and calf region, and though classic liposuction may be more efficient for this indication, in experienced hands, laser liposuction is more precise and can result in superior aesthetic outcomes.

Classic liposuction is a commonly used technique for aesthetically shaping the ankle and calf region in cosmetic patients. For more enhanced aesthetic outcomes, however, laser liposuction appears to be the technique of choice, as the surgeon can better sculpt and artistically fine-tune the ankle and calf area.

According to one plastic surgeon, modern laser liposuction devices used for the ankle and calf region are more forgiving in that they are fine instruments specifically adapted for difficult-to-treat areas such as the ankles and calves and can help preserve vital structures such as blood vessels, nerves and lymphatics.

CURVES AHEAD According to Dr. Garde, the technique is ideal for the ankles and calves because of the curvy anatomy of the region. Using laser liposuction, the surgeon can meticulously sculpt the region much more precisely compared to classic liposuction. A laser liposuction procedure of the ankles and calves is easy to perform, and desired aesthetic results can be achieved in just a few sessions, Dr. Garde says.

AVOIDING AES Prior to performing laser liposuction surgery in his patients, Dr. Garde always conducts a number of exams to help avoid adverse events, including a duplex scan to map out the perforating veins that can occur very frequently at this level.

A 44-year-old female patient before (left) and after laser liposuction procedure. Claude Garde, M.D., uses the SmartLipo device (1,064 nm, 10 watt) from DEKA. The duplex sonography device he uses is the Synergy from Hitachi. (Photos credit: Claude Garde, M.D.)

According to Dr. Garde, it is also wise to exclude lymphatic insufficiency using isotopic scintigraphy prior to classic or laser-assisted liposuction. Though laser liposuction is less traumatic than classic liposuction and is thought to reduce lymphedema in the short-term, both techniques could destroy the remaining lymphatic vessels and could result in recurrent lymphedema.

In patients where the fat layer around the ankle and calf region is more than 13 mm to 15 mm between the skin and the fascia (measured by duplex sonography), Dr. Garde advises physicians to first perform a classic liposuction procedure and debulk the area with larger debulking cannulas. A follow-up laser liposuction procedure could be performed afterwards, should fine-tuning of the region be necessary.

"In my experience, laser liposuction or any surgical liposuction surgery should not be performed in patients who have less than 8 mm of fat in the calf and ankle region. In these cases, there would be too much of a risk of damaging delicate blood vessels, nerves and lymphatics and these cases should be left alone," Dr. Garde says.

POST-PROCEDURE STEPS In addition to compression stockings that all patients must wear for three months following any liposuction procedure of the lower leg, Dr. Garde suggests that patients undergo five sessions of pressotherapy to assist lymph drainage, followed by the application of stiff bandages underneath compression stockings to be worn throughout the day. Adequate lymphatic drainage could also be achieved with daily massage therapy and could replace pressotherapy.

"It is paramount that the surgeon has an in-depth knowledge of the local anatomy and has performed important clinical work-up such as Doppler and duplex sonography prior to all liposuction procedures of the ankle and calf. I believe that surgeons should first gain experience with laser liposuction on less challenging target areas, such as the abdomen, before setting their sites on the ankles and calves, which could prove difficult to treat for surgeons with less experience," Dr. Garde says.

Disclosures: Dr. Garde reports no relevant financial interests.