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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 XVIII

Liposuction of the Buttocks

If ever anyone felt embarrassed in a bathing suit, in pants (no matter how expensive and well-fitting they might be), or in party clothes, it was Eleanor.

She'd always felt ashamed of her figure, ever since those days in junior high school gym classes when she was teased about being fat. No matter how she tried to camouflage her deformity by wearing dark clothing with A-line or flared skirts, no matter how attractive her face, hair, and make-up looked, the truth of the matter was that Eleanor had buttocks which drooped. In fact, as I examined her naked body on her first office visit when she was considering liposuction, the downward slanting fold of her buttocks gave her the shape of a sad pear.

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1. Irregularly shaped buttocks are a common problem. Liposuction may well be the answer.

2. This patient's profile reveals the bulging protrusion at the rear.

3. Following liposuction, the body contour is smooth at the hips.

4. The side view also shows a much improved contour.

Eleanor wasn't happy about the way her buttocks looked, and neither was her husband. What made the situation more difficult was their mutual love of swimming. The swimwear fashions available seemed to Eleanor to accentuate her buttocks, and she felt embarrassed when she walked in front of men. In fact, she had almost given up swimming, to the dismay of her husband, and was almost resigned to swimming only with women.

Although the term is not at all flattering, A bubble butt is the way Wanda described her buttocks. I had to admit she was right.

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1. Rear view of this patient's buttocks reveals a condition called "Steatopygia.
-A common name for the deformity is "bubble buttocks."

2. The same patient shown in side view.

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3-4. This male patient suffered from an unusually large buttocks.

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5-6. This patient shouts a densely packed, large buttocks.

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7-8. This patient's problem was an enlarged buttocks, disproportionate to her small waist. Fat deposits at the hips and saddle bag areas distorted her shape.

The medical condition known as steatopygia, more common in Black men and women than among Caucasians, is a situation in which the buttocks are enlarged and stick out in the back. Usually they have a rounded appearance. Often, they are uneven in size and height with extensive dimples and irregular skin contour. Wanda had been bothered by her appearance since she was a teenager. Now a secretary in a corporate office, she was eager to wear fashions that were appropriate for her position. Yet it was difficult for her to find clothes that fit well. Dresses and skirts tended to pull tightly over her buttocks, hiking up her hemline. Wanda had heard of liposuction, and hoped the surgery would make her feel less conspicuous.

Jack was a patient who'd been embarrassed for years, he told me, because of his large, uneven buttocks. When he entered an elevator or a room, he always tried to be as close to the wall as possible, so no one noticed him. Jack belonged to a health club, but felt embarrassed about being seen naked in the locker room, or even while wearing shorts in the gym.

He felt smaller, tighter buttocks were appropriate for a man. Yet no matter how hard he pushed himself to exercise, he still had that irregular, lopsided look when seen from the rear. In his job as manager for a chain of pizza parlors, he had to meet and deal with many people. His buttocks were a constant embarrassment to him. Even though he tried to hide his feelings, Jack was acutely conscious of the way he looked, and desperately anxious to change it. Fortunately, the skilled surgeon with experience inperforming liposuction of the buttocks can use this corrective surgical process to remove excess fat, and to skillfully contour the unshapely deformity into a more pleasing appearance.

Both men and women have problems with buttocks. In general more men than women seem to have buttocks that are inappropriately large, while women are often more concerned with the direction of the fold.

Both situations can usually be improved with liposuction.

I explained her problems to Eleanor, who was re- lieved to learn her situation was by no means hopeless. She originally wanted the drooping fold moved higher, thinking this would improve her appearance. I told her, however, that although body contouring could be done during the operation, we could alter the fold's direction but not change its location significantly. Nevertheless, I promised her, the optical illusion of the new direction would make her buttocks look shorter, and her legs look longer.

Fortunately, I was able to reassure each of these patients that their situations were by no means unusual. In fact, liposuction of the buttocks is one of the more common surgeries for fat removal. Many women and men are dissatisfied with the shape of their buttocks. They are delighted and relieved to know liposuction often can make a substantial improvement of their contours in this sensitive area. Performing liposuction of the buttocks is not an easy task for the surgeon. So often, women or men come to me and complain that they do not like the shape of their buttocks. However, they do not know what they want. The usual statement I hear from my patients is, AI don't like what I have, but I don't know what I want. I leave it up to you, Doctor.

Performing this particular liposuction surgery is difficult, and the surgeon's experience in this particular operation is extremely important. The liposuction surgeon must have extensive personal experience and artistic knowledge in order to be able to contour the perfect buttocks that best suit the body, legs, and shape of an individual patient.

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1. The photo shows an extreme deformity of the male buttocks.

2. Male saddlebags along with buttocks were a problem to this patient.

3. This illustration shows a nearly ideal contour of the male buttocks.

To the novice, the surgery may seem simple. It is not. However, results can be beautiful, when surgery is performed by the experienced liposuction surgeon.

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1. Rear view of this patient's buttocks reveals a condition called "Steatopygia.
-A common name for the deformity is "bubble buttocks."

2. The same patient shown in side view.

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3-4. This male patient suffered from an unusually large buttocks.

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5-6. This patient shouts a densely packed, large buttocks.

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7-8. This patient's problem was an enlarged buttocks, disproportionate to her small waist. Fat deposits at the hips and saddle bag areas distorted her shape.

THE SURGERY ITSELF
In liposuction of the buttocks, a general form of anesthesia is almost always used, because of the time necessary for the surgeon to make multiple tunnels through the tissue. Skill is extremely important here, so as not to damage blood vessels.

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1. The patient's side view showed a large bulge.

2. The same patient following surgery.

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3. Side bulges bothered this patient, and her profile showed extreme deformity.

4. The same patient following the liposuction.

Several small incisions are made, each 3 mm. long (about 1/8 inch), usually in the folds of the buttocks or in an area of the body which will be hidden later by clothing, and the excess fat is removed by contouring the buttocks. Of course, all the time I am working, I am acutely aware of the effect gravity will have on the body's long-term appearance, and plan the surgery accordingly. Again, the experience and control of the surgeon is extremely important in these cases.

SURGERY HELPED
All of the patients I have described did well during surgery. From Eleanor's drooping buttocks, I removed 400 cc of fat (about 14 oz). Wanda, who suffered from Abubble butt,@ had some 800 cc of fat removed (about 18 oz), and Jack, the pizza parlor manager, lost 450 cc (about 16 oz).

AFTER SURGERY
Patients considering liposuction of the buttocks need to understand that they will most likely be taped tightly after surgery. They will be asked to keep the tape on for at least one week. The special tape, made in Europe, helps healing to proceed faster. When I tell them it is all right to remove the tape, patients take a long shower. The tape is loosened by the water, and is easily removed.

Men who have liposuction of the buttocks will wear only the tape, for about one week after surgery.

Women who have the surgery will wear the tape, and will also wear an additional garment, resembling a panty girdle, which is put on over the tape while they are still on the operating room table. I instruct them to keep the girdle on continuously for one week after surgery, removing it only long enough to go to the bathroom. Since it is small and lightweight, it is not difficult to wear, and fits easily under clothes. Wearing the girdle definitely helps healing by compressing the skin tightly in the area in which liposuction has taken place.

No showers or baths are allowed the first week after surgery. However, patients may wash their hair and take a sponge bath. Approximately seven days after the operation, you will be instructed to take a long shower, and gently peel off the tape. You will not, of course, take the shower until your own doctor instructs you to.

One week after surgery, a woman patient needs to wear the panty girdle only during the day. She can remove it at bedtime. She can usually stop wearing the girdle three weeks after surgery.

During one of the patients' visits before surgery, I carefully explain to the man or woman who will have liposuction of the buttocks that there will be some swelling immediately after the operation. They will notice the reduction in volume of their buttocks right away. However, there will be some fluid in the tissues that results from the trauma of surgery. At times, this fluid will give the temporary impression that not enough change has resulted from the operation.

Fortunately, the swelling does disappear, although it may take longer than patients wish. Bruises will generally fade away within two weeks, but some degree of swelling may still be present as long as six weeks post-operatively. If patients know and understand this before the operation, they are much less fearful and anxious during their convalescence.

THE SATISFACTION OF SUCCESSFUL SURGERY
Three months after the surgery, I saw Eleanor. She and her husband were swimming together again. I'm glad I had liposuction, Eleanor said, proudly. APeter has even promised to help me shop for new bathing suits because he thinks they'll look good with my new figure. She smiled. We're going to the Caribbean for our vacation. Since Wanda was a secretary who sat at a desk much of the day, she was concerned about how her work would be affected by her surgery. I suggested she change her position frequently, to help rotate the areas of pressure.

In addition, I suggested she walk around the house. By the time I saw Wanda three days after surgery, she was feeling much better, and was bored with being at home. I was able to reassure her that she could return to work the next day, and be able to perform her duties with minimal discomfort In fact, sitting helps to compress the buttocks, as well as massage them.

Because Wanda was eager for her appearance to improve, she worked hard at the exercises I prescribed. She followed her post-liposuction diet faithfully. As the extra fluid in the tissues gradually was absorbed, Wanda began to find herself able to achieve the tailored, professional look she coveted. Just before the holidays, I received a letter from Wanda, enclosing a photograph of herself at the office holiday party. I wore a designer dress, she wrote, and I didn't feel embarrassed. It looks like next year is going to be much happier, now that my liposuction Has given me a new chance to be attractive.

Jack, too, did well after liposuction. He stopped by the office to tell me how pleased he was with his trimmer appearance. I don't feel self-conscious any more, he said. I'm not upset about having to talk to the supervisors, wondering if they are laughing at mebehind my back.

The effects upon self-confidence and sense of well- being are among the greatest of satisfactions following liposuction.

LIPOSUCTION CHANGES LIVES
Like many of my other patients, Eleanor, Wanda, and Jack found that one simple surgery made dramatic changes in their appearance. Even more important, liposuction boosted their self-esteem. The surgery made it possible for them to overcome their self-consciousness or embarrassment about certain parts of their bodies.

Eleanor's Caribbean vacation, Wanda's designer dress, or Jack's conferences with supervisors were milestones for each of them. These 'accomplish- ments' represented an improved self-image, a new confidence that released these patients from years of embarrassment. The stories they tell are typical of those I have heard from many other patients in whom liposuction has truly made a difference.

MASSAGE
No special massage is needed following liposuction of the buttocks. The very act of sitting, and the natural movements you will make as you automatically adjust the way in which you will sit are sufficient to serve as massage for this area.

EXERCISE
Home/Exercises
You can begin your exercises at home one week after liposuction of your buttocks, unless your surgeon has given you other instructions. Men and women both can do the following exercises:

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1. Squat. You may hold on to a desk or table for light support at first. This exercise helps to firm up the buttocks. Stand. Then, bend your knees slightly, and lower your buttocks till you are in a squatting position. Your thighs should be parallel to the floor. Hold for a few seconds. Then return to the original position. Do 10 times for one set. Do one set twice a day.

2. Leg backward swing. Stand. Rest your hand lightly on a desk or table for support. Swing your left leg backwards, balancing on your other leg. Take your leg backwards as far as you comfortably can, being sure to hold that leg straight. Keep your back straight, your lifted leg turned slightly outward, your head in normal position. Do not bend at the knee. Hold the position for a few seconds. Then return to your original position. Do 10 of these swings with your left leg.

Repeat, using the right leg, for 10 swings, which equals 10 repetitions. You have now completed one set. Do one set a day.

3. Front-to-back leg swing. This exercise is similar to #2 above. Stand sideways, holding a desk or table lightly for support. Raise your left leg in front of you as high as you comfortably can, while keeping your balance. Next, swing your leg backwards as far as is comfortable. Return to your starting position, standing on both legs.

Do this exercise 10 times for one leg. Then repeat 10 times for the right leg. You have now completed one set of 10 repetitions. Do one set a day.

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4. Leg side raises. Stand sideways, holding on to a desk or table for balance. Slowly raise your left leg, swinging it outwards to the side as high as you can comfortably go. Hold the position for a few seconds. Return to starting position. Do this exercise 10 times, using your left leg. Then switch legs, and do it 10 times, using your right leg.

You have now completed 10 repetitions for one set. Do one set two times a day. Two weeks after surgery, unless your surgeon has different advice, you should still continue the home exercises. Do not wear ankle weights when you do squats #1, at home. However, do exercises #2, #3, an #4 while wearing two to three-pound ankle weights. Also add:

5. Rear leg lifts. Kneel down. Put your elbows on the floor, and support your arms. Use a floor mat, both for stability and for comfort in these exercises. The standard exercise mat available at sports stores will do well. Keep your right knee on the floor. Extend your left leg behind you as far as you comfortably can. Hold the position for a few seconds. Then bring your leg back to the starting position. Do this 10 times. Now, switch legs. Keep your left knee on the floor, while you extend your right leg behind you. Hold the position for a few seconds. Then bring your leg back to the starting position. Do this 10 times.

You have now completed 10 repetitions, which equal one set. So one set two times a day.

Exercises for Health Club Set Gym
Men and women can do these exercises beginning two weeks after surgery, unless your surgeon gives you other instructions.

1. Cable leg back pull. Use the health club cable machine, in the low pulley station. If you are not certain which one, ask the fitness instructor. Stand, facing the machine. Place your left ankle in the sling, or collar. Extend your left leg backwards, as far as you comfortably can. Keep your knee straight. Hold the position for a few seconds, then return to starting position. Do this 10 times with your left leg. Then switch legs, so your right ankle is in the sling or collar. Extend your right leg backwards, and do the exercise 10 times with your right leg. Ten repetitions (left leg plus right leg) equal one set.

Do two sets, and start using the weights that are most comfortable. Then gradually increase the weights with each set.

copyright-dr.leon tcheupdjian/liposuction2. Squat, with weights. Do the squat repeating the instructions in home exercise *1, above. However, hold dumbbells in your hands or use a barbell.

3. Hack's machine. Some health clubs or gyms have a buttocks machine or Hack's machine. If so, ask your fitness instructor for directions. Gradually work up to 10 repetitions per set, and do two sets.

If your health club or gym does not have this machine, don't worry. Just do the other exercises.

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1. The diagram above shows the most common areas of extreme buttocks deformity: the Iliac Crest fat at the top of the hips; the double fold "bananas"; the Gluteal Fold, and the Gluteal Depression

2. The photo shows the actual situation of the patient's heavy arewas, indicating where the fat deposits were treated. 

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3. The steps in the liposuction operation, as it affects the skin. fat and bulk of an area, are shown. At top, the suctioning of subdermal fat; at center, creating a furrow in deeper fat, and at bottom, skin drops into the furrow to form a fold.
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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..