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    Patient selection, surgeon experience key to success with circumferential procedure

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    Female patient before (far left, near right) and six weeks following (near left, far right) circumferential liposuction of the calves and ankles. All photos credit: Patrick J. Lillis, M.D.
    LOVELAND, COLO. & SAN MARCOS, TEX. Circumferential liposuction of the ankles and calves is a tricky procedure. Without the luxury of a flatter surface (e.g., the abdomen or thighs) surgeons must meander through tighter curves to retrieve less, and, sometimes, more fibrous, fat. While surgeons say they do lower-limb circumferential liposuction far less often than liposuction of other body parts, they maintain that the circumferential procedure has a place in body sculpting and can have a dramatic effect on the appearance of patients' legs.

    IDEAL CANDIDATE Patrick J. Lillis, M.D., a dermatologist in Loveland, Colo., and assistant clinical professor, University of Colorado Health Sciences Center, Denver, says that all of his circumferential liposuction patients have been women. The ideal candidate, according to Dr. Lillis, is someone who is out of proportion — that is, whose calves and ankles are thick — but who's not generally obese.

    "If you pinch the area, you can pinch fat. Sometimes when you do the pinch test, it feels like everything is muscle and, if that's the case, you do not get as much reduction in size as you would with obvious, pinchable fat present. Most people who have this inherit the tendency [to retain fat] and cannot change the shape of their lower legs with diet and exercise."

    Obese patients are generally poor candidates, agrees Thomas Narsete, M.D., a plastic surgeon in Austin, Tex., because it is difficult to achieve good contour on these patients. Neither is it the answer for the big-boned, muscle-bound types, Dr. Narsete adds.


    Dr. Lillis
    ANESTHETIC CHOICE Doctors differ on whether they use general or local anesthetic during the procedure. Dr. Narsete uses general or a Ketamine-type anesthetic, with a fluid dilution technique using the Hunstad formula. To avoid the risk of deep vein thrombosis (DVT), he uses sequential tourniquets on the feet and elevates patients' legs. The Ketamine anesthetic, he says, has low incidence of blood clots.

    Dr. Narset's partner, Robert A. Ersek, M.D., a clinical assistant professor of plastic surgery at Southwest Texas State University, San Marcos, says, however, he never does the procedure under general anesthesia because of the threat of DVT.

    "When you use general anesthesia, it causes all the muscles in the body to be paralyzed and, as a result, the veins in these muscles fill with blood and become stagnant. This is the cause of DVT and pulmonary embolism," he tells Cosmetic Surgery Times.

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    Lisette Hilton
    Lisette Hilton is a writer in Boca Raton, Fla., who heads up her company, Words Come Alive.

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