Liposuction can be performed almost anywhere there is some thickness of subcutaneous fat. The thick leg, between the knee and the ankle, represents differing thicknesses of subcutaneous fat which yield an amorphous lower leg that has a straight line shape. Creating an improved shape comes by creating a thinner profile, or inward indentation, from the lower end of the calf down to just above the ankle bone. (particularly above the inside of the ankle) Discrete small-cannula liposuction can be safely done to reduce the appearance of a chubby ankle.
The key is to not overdo the liposuction area and focus on a limited treatment area that will make the most difference. Because of the elevated venous and lymphatic pressures, the ankle swelling after surgery is more prolonged than liposuction does in almost any other area of the body. But the results can be very visible later and a modest shape improvement is definitely achievable.
Even though the earlobe is small, it is extremely visible. Its appearance can definitely create an impression as to one’s age. (much like one’s hands) An abnormal earlobe, like the ‘pixie earlobe’ deformity after a facelift, is particularly unflattering and a well-known sign of a ‘bad facelift.’
As we age, the earlobe for some people actually deflates losing some of its fat volume. It may also get elongated, particularly in women, due to decades of ear ring wear. The deflated or stretched out earlobe can be rejuvenated. Injectable fillers are an easy and immediate fix to the wrinkled and delated earlobe. A few tenths of a cc of Juvaderm (or amost any filler) provides an instant plumping. Fillers in the earlobe seem to last longer than almost anywhere else in the face, perhaps due to its slow lymphatic clearance. This is a not uncommon request after someone has had a facelift. The floppy thin earlobe looks out of place after.
In the elongated earlobe, a simple earlobe lift can be done by removing a full-thickness wedge of tissue. Done under local anesthesia, a shorter and fuller earlobe is the result.
Neuromuscular injections have found a low of uses but no matter where it is placed on the face it is for muscle weakening or paralysis of an area of hyperactivity. One of the uncommon but very effective uses for this treatment is in the softening of chin fasciculations. Some patients will experience excessive muscle activity of the mentalis muscle. This is a small but thick muscle that envelopes the bony chin with attachments into the overlying skin. When this muscle becomes stressed, through habit or from straining in a short chin, the chin skin will develop irregular dimples and assume an almost golfball shape. In the extreme, it can be quite noticeable and peculiar-looking.
Muscle weakening injections, like Botox and Dysport, can lessen these chin skin irregularities. While not permanent, repeat injections over time make allow for some expression re-education.
When looking at the legs, it is important to look at the entire legline particularly its inner aspect. The inside of the knee is one small area that can stick out and breakup a smooth transition from the inner thigh down to the calf. It is one of the most bothersome leg areas for many women. It is an easy area in which to do liposuction from a small incision located in the backside of the knee. A surprising amount of fat can be quickly removed and it is important to blend the fat removal down into the upper calf and upward into the knee and lower inner thigh so a smooth flow of the inner leg line is obtained.
It is uncommon to just do knee liposuction alone. It is almost always done as part of inner and outer thigh reshaping. One important patient consideration is that the knee will be sore for some time, often longer than any other liposuction area. Because the knee is a moveable joint, there is a lot of continuous motion across the area leading to prolonged swelling and discomfort. I advise my patient to wear an elastic athletic knee strap afterwards for several weeks. Not only does it stay on but the contiunous support helps reduce discomfort.
Even after a good facelift, low neck lines (necklace lines) may still be present. No form of a necklift can produce as much improvement way down in the neck below the adam’s apple as it does above it. These low horizontal lines across your neck are a telltale sign of aging. One of the only methods to treat it are Botox or Dysport injections.
While claimed to produce a bit of a neck lift, some go as far as calling it a “Nefertiti lift.” While there are no other options to treat these neck lines, I have never been impressed that a true neck elongation actually occurs. But a slight softening effect can be seen and it is quick and easy to do. Whether injections into this neck area is beneficial is ultimately based on whether one feels that the cost is worth its temporary effect.
Dr. Barry Eppley