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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring
By Dr. Leon Forrester Tcheupdjian, M.D.
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Dr. Leon Forrester Tcheupdjian, M.D., respected scientific researcher, teacher innovator and surgeon. As the Medical Director / Chief Surgeon of a Chicago, Illinois Plastic Surgery Practice, Dr. Tcheupdjian has supervised and performed probably more liposuction procedures than any other American doctor.

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Chapter XVII

Liposuction of the Thighs




1. This patient's inner thighs exhibit heavy fat deposits high on The leg, and all the way down to the inner knee.

2. The patient from the rear shows bulging fat deposits at upper inner thigh and outer thigh.

When Christine looked in the mirror, all she could see were here Athunder thighs. That's what she called them. From groin to knee, her were masses of fat flab. The insides bulged, so they nearly touched each other. When she stroked the tops of her thighs, she felt wavy pockets of fat. Even the sides and backs of her thighs bulged.

Christine felt that no matter how hard she worked on her face, hair, and make-up, no matter if her legs below the knee were trim and shapely, her thighs still were the major detractor from her appearance.

In my opinion, there is always at least one body part that dissatisfies patients. When I examine a patient in the initial visit to determine if liposuction can be beneficial, I never have to identify that body part. Patients almost always tell me what is bothering them, even before I begin the physical examination.

Christine had worried for years about the way her thighs looked. Then she read one of my articles about liposuction, and thought she might benefit from the surgery. She was willing to take vacation time from her job as a hospital laboratory technician, she said, if having the operation would reduce her thighs.

That won't be necessary, I reassured her. The surgery for liposuction of the thighs is not complicated, and you will miss only a few days of work. In fact, if we schedule the operation for Thursday, you can probably be back on the job the following Monday morning.

Christine was typical of the many patients I have seen who are troubled with localized fat deposits in this area. Sometimes fat in the thighs goes along with fat elsewhere-in the abdomen, in the buttocks, or in the calves. Although exercise after liposuction can help define the muscles of the thigh and improve the appearance, exercise by itself cannot always shrink the troublesome pockets of fat that originally lie underneath the skin.

Many patients who have fatty deposits in various areas of the thighs have experienced lack of success in bringing these areas under control through exercise. There can be several factors involved, including circulation, skeletal alignment and other sometimes hereditary, factors. Consultation with the doctor can help determine whether or not liposuction is an appropriate solution.

WHERE FAT LIES
Fat distribution throughout the thighs is most pronounced in four parts.



1. Fat regularly deposits on the inner thigh, the outer thigh, especially at the saddlebags area, and on the hips.

2. This patient shows extreme deposits on the hips, outer and inner thighs.



3-4. Another patient exhibits very heavy front thighs, and at right, heavy hips and inner thighs.



5. Many patients have more than one problem area. For Instance, this patient shows unusually heavy thighs, upper legs, knees, and calves.

6. Male patient's body shows extremely heavy deposits at outer thighs, hips, front thighs, and upper legs, legs, knees, and calves.

Some patients have fat deposits only at the outside of the thighs. Others have bulges on the inside. In gross deformities, the fat pads on each leg may even touch, when the patient stands normally. The most unfortunate patients have fat also on top of the thigh, in what we call the anterior position, and puffy knees. The fourth area is in the back of the thigh-what we call posterior thigh fat, better known as the Abanana. Patients who have this problem have a roll of fat in the back of the upper thigh just below the buttocks. Such individuals also have saddlebags, and may have pronounced buttocks.

MULTIPLE PROBLEMS
Usually, a patient who has fat deposits in the thighs extensive enough to consider liposuction also has other fat pads in the region. For example, those who have fatty thighs in the front, or anterior, portion may also have fatty knees and calves, fatty inner thighs, and saddlebags.

Saddlebags may also be combined with fatty outside thighs, and fat in back of the thigh.

In short, a person with fatty thighs usually has un- sightly fat deposits in other body parts close by.

UNCOMPLICATED PROCEDURE
As in liposuction of most body parts, the operation to recontour the thighs is not complicated in the hands of the experienced liposuction surgeon. Using appropriate anesthesia, I make tiny incisions, each 3 mm. long (about 1/8 inch). I have previously discussed with the patient where those incisions will, if possible, be placed. It is easy for the experienced surgeon to make the incisions in body folds, or in an inconspicuous location, so that after surgery, the patient will be able to wear shorts or a bathing suit without embarrassment. I am always conscious of the fact that liposuction is aesthetic surgery. Consequently, I try, insofar as is medically feasible, to perform the operation in such a way that the body's appearance will be enhanced by the final result.



1. Before, the patient shows fatty deposits at inner upper case. and lower thighs, and outer thighs.

2. After liposuction, the patient's outer and Inner thighs are gently curved and much healthier lookin.

In Christine's case, liposuction of the thighs was successful. I removed fat deposits from the front of the thigh, from the inside of the thighs, from the back of the thighs and from the knees. Naturally, both legs were operated on at the same time, in order to make sure the results were symmetrical. All told, I removed 1800 cc (nearly 60 oz.) of fat.

Other patients with fat deposits that were not as extensive have received liposuction only of the affected parts of the thighs. Michelle, a successful saleswoman for a computer store, came to me wanting liposuction for her bulging thighs. However, her condition was not as extreme as Christine's. I removed a total of 1000 cc (33 oz.) from the fat pads on the front of her thighs, and that was the extent of the surgical procedure she needed. You may already have a pretty good idea of what areas are the likely ones for liposuction in your own. Because every case is unique, however, you will be able to get exact details and make plans only after consultation with your doctor, who can help you make a realistic decision.

THE SURGERY
Each patient must be evaluated on an individual basis, since fat deposits in the hip area vary a great deal from person to person in amount, thickness, and location. The surgery itself is usually performed with a form of anesthesia, since body contouring must be done skillfully for best results, and should not be rushed. Of course, fat deposits of the hip on each side of the body are removed during the same operation, so the patient's appearance after surgery will be symmetrical.

As is customary during liposuction operations, the surgeon will tape the area. Unless he gives you other specific instructions, you will leave the tape on for one week after surgery. When you shower for the first time-always at your surgeon's specific direction- the force of the water will loosen the tape, and it can easily be removed.

On top of the tape, I have my patients wear a special garment similar to a panty girdle, made of a lightweight, yet firm, material. The 'girdle' is slipped on while the patient is still on the operating table. Its purpose is to aid in compressing the skin, helping it bind to underlying tissues. In this way, healing will take place faster, and the desired smooth appearance can eventually be achieved.

Your surgeon will give you specific instructions as to when you can stop wearing the girdle. I ask my patients to keep it on, day and night, for one week after surgery-removing it only long enough to go to the bathroom.

I instruct my patients not to take a bath or shower for one week after surgery. However, if they wish, they may wash their hair or take a sponge bath.

After I have instructed them to shower and remove the tape, (usually one week after surgery), I still have them continue to wear the girdle for two to three 147 weeks more-a total of four weeks in all. I find that best results from liposuction can be obtained if the skin is given that gentle, yet firm, compression to bind it together and to help establish the new contours I have sculpted.

YOUR RECOVERY



1. Before surgery, the patient's front view shows the inner and outer thigh bulges.

2. Before surgery, the patient's side view is heavy at front of legs and hips.



3. The same patient as in Fig. 1, above, shows much better contours after liposuction.

4. Her side view, also, is much improved, with slimmer upper legs and thighs.



5. Before liposuction, this patient shows heavy thighs and upper legs, to the knee.

6. After liposuction, the patient's legs are much improved and slimmer.

When you awaken from anesthesia, you will discover that your thighs have been bandaged with a special tape which compresses them tightly from groin to knee. The tape is not uncomfortable, but it binds the skin to the underlying tissues in the area from which the fat has been removed. Compressing the skin helps healing, and contributes greatly to the desired post-surgical smooth appearance. That is why I instruct patients to leave the tape on for one week following surgery.

During the first week after surgery, you may wash your hair and take a sponge bath. However, do not shower or take a bath for one week after the operation.

After that time, unless your surgeon has given you other specific instructions, you may take a long, warm shower. The water helps to loosen the tape, and it can be easily removed. After surgery, over the tape you will also wear a special garment, like a long panty girdle, which helps to hold in the skin. If you can remember panty girdles with long legs, this garment is very similar. It too is lightweight, and firm, rather than rigid. Wearing the tape and girdle will not hinder your movements in any way. You will still be able to sit, stand, and walk as you normally do.

Patients are asked to continue to wear the girdle day and night for one week after surgery, removing it only to go to the bathroom.

FLUID RETENTION
The body has a natural reaction to trauma, which- unless patients know about it beforehand-can cause concern and dismay. This response, common after surgery, does not mean infection or a problem unique to you. You can expect bruises, discoloration, and considerable swelling that will take several weeks at least to subside. In some cases, your thighs may even look larger than before.

Do not be upset or worried. Liposuction has not made your thighs bigger. Liposuction has not hurt you or made your condition worse. Instead, what you are seeing is normal and temporary fluid retention- fluid that has, as a result of the trauma of surgery, come out from between the cells and has temporarily accumulated in the tissues. It is a perfectly normal reaction, and one that you can almost certainly expect.

Christine and I had discussed this before her surgery, so she was not surprised or dismayed. As I had promised, the bruises and discoloration cleared up rapidly. Within two weeks, her skin appeared normal. The extra water and swelling took longer to absorb, but by four weeks after surgery the extra fluid had subsided.

The final result for Christine was thighs greatly reduced in size. Her new appearance gave her symmetrical, well-contoured thighs. Several months later, I received a postcard mailed from one of the Caribbean ports. I'm on a cruise, she wrote. I bought three new bathing suits, and I'm sitting on the sundeck most of the day. It's great to be told how good I look. And it's all due to liposuction! I am so glad I had the surgery!

MASSAGE
Massage of the thighs can begin two to three days after surgery. Using both hands (one on each thigh), gently start near your groin, and massage in a circular motion, moving your hands downward towards your knees. The objective is to massage the entire thigh area, giving special attention to the part of the thigh where liposuction has been performed. The massage should last for one or two minutes. Repeat the massage three times a day.

EXERCISE
Unless your surgeon advises you differently, you can begin exercising at home one week after liposuction. Both men and women should do the following exercises once a day.

1. Standing leg lift (front). Stand at the side of a desk or table, holding it with one hand for balance. Slowly raise the opposite leg as high in the air as you comfortably can. Your leg will be pointing towards the front. Hold the position for two to three seconds; then lower your leg gently to the floor. Repeat 10 times. Do the same exercise with the opposite leg. Repeat 10 times.

2. Standing leg lift (side). Do a standing leg lift, but this time, raise your leg so it points to the side. Hold in position for two to three seconds; then lower your leg to the floor. Repeat 10 times.

Next, do the same leg lift (to the side) with your opposite leg. Repeat 10 times.

3. Standing cross-over leg raises. Stand by the side of a desk or table. Hold it with your right hand, for balance. Keeping your left foot on the floor, raise your right leg slowly and gently, crossing it over your left leg. Go as high as you can comfortably manage. Hold the top position for two to three seconds; then lower your leg to the ground. Repeat 10 times.

Change your position so that you are holding the desk with your left hand. Raise your right leg, crossing it over your left leg. Hold the A highposition for two to three seconds; then lower your leg. Repeat 10 times.

4. Half squats. Sand. Bending your knees slightly forward, as needed for balance, lower your body to a half-squatting position. Hold for two to three seconds; return to upright position. Do this exercise 10 times.

Two weeks after surgery: If your doctor has no objection, do the first three exercises at home, but wear ankle weights two to five pounds, as you can tolerate them. However, do not do Exercise No. 4 (half squats) with weights on.

5. Universal thigh rotation. Wearing ankle weights, lie down. Do a leg lit one leg at a time ... first, straight out; then, to the side; then, to the return position, and finally, to the floor. Do this exercise 10 times.

6. Scissor leg lift (one leg). Lie on your right side. Rest your left foot on a bench. Keep your leg straight. While still keeping your left leg straight, bring your right foot up to meet it. Stop. Rest a moment. Then bring it slowly down to the floor. Do 10 times. Then repeat, using the opposite leg.

Do scissor leg lifts with both legs, 10 times a day (one set) two times a day.

7. Rear leg lifts (one leg at a time). Wear ankle weights two to five pounds. Fut your elbows on floor, and rest your head on your arms. Keep your right knee on the floor. Lift your left leg until it is straight out behind you, or as far as it can go. Hold for two to three seconds, then bring your leg back to the beginning position.

Repeat with the other leg, so that your left knee stays on the floor and your right knee is extended.

Ten repetitions (both legs) equal one set. Do one set two times a day.

Exercises for Health Club/Gym
Men and women can do these exercises, if your surgeon permits, within two weeks after surgery. It is a good idea to talk to the club manager or fitness instructor, who can explain how all the equipment works. You should also explain to the manager you are recovering from surgery, but you have your doctor's permission to do the exercises.

1. Leg press machine. Set the machine with 10-pound weight at first. If you are not uncomfortable, you can gradually work the weight up to 20-pounds. Start with your legs bent. Then push the pedals of the machine till your knees are straight. Ten repetitions equal one set. Do two sets.

2. Leg extensions. This machine looks something like a chair, with its back at an angle, and its footrest off the ground. Grasp the handles. Keep your back straight, but put your knees over the bench. Push the bar up until your legs are straight. Hold for a few seconds; then return to the starting position. Ten repetitions equal one set. Do two sets.

3. Leg curls. Lie on the bench of the machine. Your heels should be placed under the lever bar. Use your hands to brace and balance yourself. Curl your legs upward, so that the bar moves towards your buttocks. Hold at the highest position for a few seconds; then slowly lower the bar. If possible, keep your thighs still and move only your lower legs. Ten repetitions equal one set. Do two sets.

4. Adduction machine-leg push-out. Sit in the machine. Adjust the tension or weight. Push your thighs out, away from each other, by opening your legs. Bring your legs back to the starting position. Ten repetitions equal one set. Do two sets.

5. Adduction machine-leg pull-in. Sit in the machine. Adjust the tension or weight. Start with your thighs spread open, as far as they can comfortably go. Pull your thighs together. Hold the position for a few seconds. Then return to the starting position. Ten repetitions equal one set. Do two sets.

6. Cable pulley, outer thigh. Lie on the floor, facing a cable machine. Adjust the machine for 10 pounds of weight. Put the collar on your right ankle. Bend your left leg at the knee. Start with your right leg in the air. Push that leg outward until your toes point away from the machine. Try to keep your left leg and pelvic area as quiet as possible.

This exercise will help trim the muscles in your outer thigh. Do 10 repetitions. Then repeat, switching position until your left leg is wearing the collar and your right leg is bent at the knee, helping to support you. Do 10 more repetitions. Then repeat, for 10 times with each leg.

7. Cable pulley, inner thigh. Adjust the machine for10 pounds. Then lie down, facing the cable machine. Put your right ankle in the ankle collar. Keep your right leg straight as you lower it slowly. Your left leg still rests on the floor, slightly bent. Try to keep your knee pointed straight ahead. Ten repetitions equal one set. Do one set two times a day.



1-2. Both female patients pictured have problem areas. Although their waistlines are small, each has disproportionate saddlebags, buttocks, and hips.



3. Pattern of marks show the discoloration of subdermal strokes during surgery.

4. Liposuction surgery has been completed on the patient's left side. Now the doctor indicates the amount of fat to remove from the patient's right hip area.



5. Lines indicate pattern of strokes to treat the area.

6. A front view of the same area.
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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring - By Dr. Leon Forrester Tcheupdjian, M.D.
ISBN 0-9621284-1-4 | Library of Congress registration #: 2-414-199
copyright © 1988-2006 Dr. Leon Forrester Tcheupdjian M.D.
Published by Dr. Leon Forrester Tcheupdjian M.D. 875 Rush Street Chicago, IL 60611


All rights reserved. No part of this book may be reproduced in any medium whatsoever, including photocopy or other electronic medium, without the express written permission of Dr. Leon Forrester Tcheupdjian M.D..