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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 XVI

Liposuction of the Hips and Saddlebags

One of the most distressing areas for fatty deposits is the hips. Those who suffer from a genetic predisposition to fat bulges in this area know only too well how embarrassing and how unattractive they can be.

CULOTTE DE CHEVAL
The condition of having heavy fat deposits in the hips has been, in my experience, exclusively limited to women. In fact, what often happens is that fat settles on the outside of the hips, giving the woman a pear-shaped, padded appearance. The French have a term for it: culotte de cheval, which roughly translates as riding breeches. The common English term you may have heard is saddlebags. No matter what it is called, the condition has caused misery and psychological anguish for millions of women sufferers. Typical, perhaps, is the case of Eileen, a fashion consultant and designer. When she first contacted The Liposuction Institute, she expressed dismay at the size of her hips, even before she had been examined.



1. A female patient showing the bulges often called saddlebags.

2. A female patient with a clearly defined "violin-shaped" deformity, showing bulges on hips and outer thighs.

The triggering incident which caused her to consider liposuction occurred when she came home from shopping with three pairs of expensive slacks she had not bothered to try on in the store. She was dressing to go out, when she discovered she could not fit into any of her new clothes comfortably.

I bought a size 16, she said. That's what I generally wear. But when I put the slacks on, I had trouble pulling them up over my hips. When I finally got them on, they were tight and uncomfortable. They pulled across the hips. I looked like a stuffed sausage. Finally I gave them to my thin neighbor. I guess I'm stuck with women's sizes and full-hipped pants forever.

Eileen felt better about herself when I quizzed her about her neighbor's figure. A1 never thought about it before, she said, Abut Ruth has always worn straight skirts. She never has a hip problem. But me-I needed the A-lines before I was out of junior high. I've always been self-conscious about my hips, because I know how ugly they are.

After I explained to Eileen about the genetic component that often is responsible for fat deposits in hips and saddlebags, we talked about her problem.

THE VIOLIN DEFORMITY
At that Eileen was more fortunate than some of my other patients. Those who have the 'violin deformity' generally have unsightly fat bulges in the hips and saddlebag areas (like Eileen), but also have bulging fat deposits in the area called the iliac crest. Futting it bluntly, their bodies look like the classic contour of the body of a violin. They bulge out at the iliac, or upper hip area, go in slightly just below the bulge, and curve outward again in large saddlebags. Eileen was unfortunate, too, in having a problem with cellulite, which troubles so many women. She had the dimpled, puckered skin that often accom- panies fat deposits in this area.



1. Above, the patient's hips and thighs bulge in two spots.

2. The same patient after liposuction surgery, looking normally rounded.



3. A rear view of a patient with violin deformity, before liposuction.

4. The same patient,a fter liposuction of both the upper hips and thighs.


LIPOSUCTION CAN HELP
As Eileen and I talked, I told her there is a great deal that liposuction can do to help Eileen and others with similar problems. Diet and exercise, though they certainly should be encouraged, do not seem to be the answer. What women who have lost weight find is that the scale may read less, but the problem is still there. In fact, the unsightly bulges may even be more conspicuous because of the weight loss.

A woman with saddlebags looks and feels uncomfortable in much of today's fashionable clothing. Naomi, who worked as a designer for a major corporation, was in her mid-twenties when she first came to The Liposuction Institute. She wanted to wear tailored clothes for work, and traditional suits when she met with clients. Many designer fashions, however, just made Naomi's figure look worse. Even though she was only slightly overweight, her hips and saddlebags were so grotesquely deformed that she had to wear extra-large pantyhose in order to accommodate them.

The tests we gave Eileen during her pre-surgical consultations showed that she was a good candidate for liposuction. The thickness of the fat on Eileen's hips was more than twice that of her surrounding fat-a condition found in many women. In addition, we looked at the shape of Eileen's pelvis around her hips and abdomen. Despite her two previous pregnancies, her muscles underneath all that fat were not sub- stantially out of shape. I felt definitely that liposuction of the hips would help her improve her appearance. Freviously, Eileen had minimized her condition by wearing dark, A-line or flared clothing.

Below the knee, her legs were slim and shapely. They measured just 15 inches in circumference. But Eileen's hips at their widest point were over 42 inches in circumference, making her appearance in straight-cut pants almost ludicrous. Fortunately, I was able to reassure her that liposuction of the hips would be beneficial.



1. A rear view showing abnormal deposits that have caused an exreme deformity of hips and outer thighs.

2. A front view of the same patient, clearly showing the bulges on outer thighs and hips.

3. After losuction, the patient's contours are smoothly rounded and normalized.

I was quite frank with both Eileen and Naomi before surgery, as the experienced physician should 11 prospective liposuction patients. be with a 'Liposuction can help correct and eliminate the genetic predisposition you have,' I told them, 'but you must not look at it as a total, lifelong remedy. Your would like to build up fat tissue,replacing the fat we removed. .Consequently, you must pay attention to diet and exercise for the rest of your life, and make them part of your daily routine.

Liposuction has given you a second chance. It's up to you to do your part.

'You will need to be vigilant-to do follow-up exercises, and observe proper nutrition in order to avoid gaining weight, since you have a genetic tendency to do so.'

'Even though the fat cells in the areas in which you have had liposuction cannot come back, this surgery does not give you a license to overeat or be lazy.'

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 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.

THE RECOVERY PERIOD
You may find that walking or standing for prolonged periods is a bit uncomfortable for a few days after liposuction has been performed on your hips. Sitting, however, generally is comfortable. Gradually you will start to feel better. You may also find that the trauma of surgery has caused bruising, slight swelling, and some fluid retention in the area in which liposuction has been performed. Do not be alarmed, even if swelling persists for up to four weeks after the surgery. Gradually, the excess fluid which has been released will return to its original location. It may take as much as three months after liposuction until your body has adjusted to its new contours that liposuction has given.

Follow your surgeon's specific advice about when you should return to worl,, especially if you must sit at a desk and work on a computer or paperwork. He or she may advise you to take more frequent breaks, or to stand and stretch or move about more frequently than you normally do, even if it is just to sharpen a pencil or get a drink. The activity causes more blood flow in the area, and that promotes healing.

Your doctor will almost certainly allow you to wear pantyhose over or under the garment when you go outside, and even then, only if you want to. Do not wear the pantyhose when you are at home.

RESULTS OF SURGERY
Like thousands of women who have had liposuction of the hips and saddlebags, Eileen was overjoyed at her 'new' appearance immediately after surgery. 'I can't believe it!' she exclaimed. 'My jeans felt loose after surgery on my way home, and now they look like they belong to someone else.'

She didn't worry any more about undressing in the health club locker room, or putting on her swimsuit for the health dub pool. In addition, she found it much easier to join her boss or clients for lunch, even in the most fashionable restaurants, since she was no longer embarrassed about her figure. 'The saddlebags are gone!' she told me trium- phantly. 'I feel great about the way I look! I never thought it could happen.' 'When you first assured me you could do what I wanted, I thought this was too good to be true! And now that they are really gone, I still say liposuction is too good to be true!'

It was easy to see why. During Eileen's liposuction, I had removed a total of 2200 cc (76 oz.) from her hips and 'saddlebags.' When healing was finally complete, surgery had made a great deal of difference in her appearance. Eileen reports she's a lot more sure of herself when she goes impulse-shopping, knowing what she brings home will almost always be some- thing she'll be keeping, because it fits.

She didn't worry any more about undressing in the health club locker room, or putting on her swimsuit for the health dub pool. In addition, she found it much easier to join her boss or clients for lunch, even in the most fashionable restaurants, since she was no longer embarrassed about her figure.

'The saddlebags are gone!' she told me trium- phantly. 'I feel great about the way I look! I never thought it could happen.'

'When you first assured me you could do what I wanted, I thought this was too good to be true! And now that they are really gone, I still say liposuction is too good to be true!'

MASSAGE
Two to three days after surgery, unless your surgeon gives you different instructions, you can begin gentle massage of the hip or saddlebag area. Fressing gently with the palm of your hands, and using both hands at once, massage with a circular motion, completely covering the area in which liposuction has been performed. Keep the massage up for approximately 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. 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, cross- ing it over your left leg. Hold the 'high' position for two to three seconds; then lower your leg. Repeat 10 times.

4. Half squats. Stand. 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, wear ankle weights two to five lbs., as you can tolerate them.

However, do not do exercise No. 4 (half squats) with weights on.

5. Ankle weight lift. Wearing ankle weights, lie down. Do a leg lift 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. 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, (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 the 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 Men and women can do these exercises, if your sur- Health Club/Gym geon permits, within two weeks after surgery. It is a good idea to talk to the club manager or fitness in- structor, who can explain how all the equipment works. Tell 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 lb. weight at first. if you are not uncomfortable, you can gradually work the weight up to 20 to 30 pounds, etc. 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 sec- onds; then slowly lower the bar. If possible, try to 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 ma- chine. 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 sec- onds. Then return your legs to the starting position.

6. Cable pulley, outer thigh. Lie on the floor, facing a cable machine. Adjust the machine for 10 Ins. of weight. Put the collar on your right ankle. Bend your left leg at the knee. Start with your right let 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.



1. The abdominal fat deposits on this patient's body bulged at her sides.

2. The same patient from 3/4 view, showing fat accumulations around the upper legs, on hips.

3. The patient from the side, showing bulging fat at top of belly, hips, upper legs.



4. The patient, during surgery, showing one side havin gbeen completed–the other side, not yet having been treated.

5. Following the completion of the liposuction, the patient's hips and thighs look much smoother, her overall contour normalized.
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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..