I once had a patient who wanted a revision of her liposuction. I have seen her already several times and she is unhappy about small areas on her hips. The small bulges are above and below the panty line so the indentation of the panties on the skin magnifies the defect. She recognizes that the result is an improvement on what she had before but these small things are irritating her.
I do all my liposuction with a 3 millimeter diameter cannula. The shortcoming of this approach is that I end up spending a lot of time and effort. It is like sucking beer out of a keg with a coffee straw. It is athletic work and you have to be in good shape to do it well. On the upside, it is pretty hard to take too much fat out of an area (creating dimples and irregularities in the skin contour). In addition, the fatty tissue left behind has been “mashed” more because of the multiple passes with the small cannula. This mashed tissue is easier to mold. Postoperatively I use pads on the skin and a compressive garment on top to help mold the skin and keep it smooth. The pads cause extra compression and help to decrease bruising and swelling. As a result of these precautions, I get very few requests for revisions.
It is also very important for the patient to have realistic expectations. The skin does not tighten after liposuction. The patient may look at post-op pictures where patients are wearing “photo panties” and see a better contour, but she is not touching the skin of the patient in the picture, so she assumes her own skin will be tighter. Thus when she puts on her own clothes after, she may be upset by the little bulges above the clothes edges. Another problem area is the lateral and posterior aspect of the thigh (Saddlebag) as it joins the buttocks. Patients seem to think that the more excess fat you take from the area, the better. Some patients want to see an almost straight line from the hip down the side of the leg. Apart from creating a somewhat boyish look, there is a danger that by taking out too much fat, the skin and the buttock may sag.
It is for this reason that I was conservative with the patient in the initial procedure. I did not want any skin sag and was comfortable leaving on “the plus side” which can be easily dealt with. She wants very small bulges taken out which I can do as “spot” liposuction. If I had taken out too much I would have ended up with saggier skin and skin depressions. I think she will eventually end up with another procedure as she wants tighter skin, and that will be another day’s topic.
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