Thighs, Knees, and Lower Legs Liposuction.pptx

Liposuction of Specific Regions:
Evidence Based Practice.
2002-2022
11/4/2022 email: askprof@moawadskininstitute.com 1

Dedication
The Journey of Liposuction
• This presentation is dedicated to the memory of my parents, Prof. M. Moawad,
and My mother, Iqbal S. They made me what I am today with encouragement and
sacrifices.
• To my family, my wife Salam. B., and my pride in life, my son Mo and my daughter
Noor with their unflagging support, turned the second part of my life journey into
success.

Acknowledgment
• Special acknowledgment is given
to Dr. Ibrahim El Dousky (M.D.,
IMRCS), not only because he is an
outstanding student but also
because he doomed me into the
life of plastic surgery with his
excellent work and experience.
• Dr. El Dousky is the general
secretary of ESCSL.

Acknowledgment
• Special acknowledgment is given
to Dr. M. Ramadan (MS., Ph.D.), a
brilliant scientist, chief of staff at
MSI and my right hand in all what I
do.
• Dr. Ramadan is on the board of
directors of ESCSL.

Appreciation
• The author would like to express his appreciation to the medical team at
L'institute (Riyadh, KSA) and Moawad Skin Institute (MSI) in Cairo, Egypt, for
taking care of the patient during the procedures.

Appreciation • To “PATIENTS” You’ve always believed in me
KEYWORDS: LIPOSUCTION., LIPOSCULPTURE., FAT GRAFTING, ADIPOSE FATTY TISSUES., BODY
CONTOURING

Introduction
email:
askprof@moawadskininstitute.com
• Concepts of beauty have
been continuously evolving
throughout the history of
humankind.
• Slimmer forms have
substituted the voluptuous
figure idealized by artists in
the past.
• With fashion promoting
body-revealing attire,
outdoor exposure, and the
emphasis on fitness and
good health, people have
sought to reflect these
trends by demonstrating
youthfulness and vitality in
their bodies.
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Introduction
email:
• On the other hand, a
sedentary lifestyle and
dietary excesses associated
with factors such as
genetic determination,
pregnancy, and the aging
process contribute to body
alterations that result in
the loss of the individual’s
body image, creating a
solid psychological
motivation for surgical
correction.
11/4/2022 8

Introduction
email:
• Localized fat deposits
may involve one
anatomical region and
extend to multiple body
regions.
• Therefore, it is
understandable that body
contouring surgery
includes most body
regions, including the
face, neck, and breast, in
all populations, be treated
by a one-stage operation
or require more complex
combined procedures.
11/4/2022 9

Introduction
• The current evidence-building
process in the healthcare industry is
riddled with conflicts of interest
regarding education, research, and the
practice of medicine.
• Medical specialists worldwide are
flooded with data they must collect,
process, and analyze.
• Medical images make up around 90%
of the data in healthcare.
• Experts across the globe point to the
harms of pervasive industry influence
on research, practice, and education in
healthcare, noting that it compromises
patient care.

Introduction
• The ESCSL, as an academic, non-profit
organization, is responsible for disseminating
unbiased findings to the industry, medical
health providers, and the public about
liposuction, among others.
• At the same time, it is entirely free of ties with
the industry.
• As the president of ESCSL, I retrospectively
reviewed patients' charts and photos
(thousands) who underwent body contouring
and fat grafting procedures in K.S.A. and Egypt
between 2002 and 2022.
• The unbiased evidence in this study is a way to
ensure that the benefits and harms of
liposuction are accurately reported.

Introduction
• It will guide members of ESCSL in delivering high-quality, evidence-based
practice and cost-effective surgery.
• During the journey, I developed my technique as any other medical provider;
trial and error, reading and seeing experts' techniques, and picking and choosing
what suited me based on science and skills.

Introduction
• As new techniques are introduced, we must temper
our enthusiasm and base treatment on solid scientific
evidence. The journey is ongoing. It is like riding a
bicycle; to keep balance, you should keep moving.
2021
2022

Introduction
• The data collected are given to those who want
to deliver the best care to their patients armed with
the most innovative techniques and the latest
technology in the battle of aging, rejuvenation, and
body contouring, in a reproducible and safe
outcome-driven manner.
• It also is given to novice(s) in professional and
educational standards.
• A compendium of the author’s practice, journal
publications, and books read will put the entire
liposuction process in a volume that surgeons
interested in this topic need to read.

Thigh
Liposuction
• Opinions regarding the ideal proportions of the female figure have varied
widely through time and across cultures.
• In the current era, the aesthetic appeal of long legs seems to transcend
culture.
• Artists portray long legs as attractive and defined.
• Many prospective liposuction patients want this "look."

Thigh
Liposuction
• Males and females have varied distributions of fat in the thigh region.
• Women tend to accumulate the fat either circumferentially or in isolated
fatty deposits medially and laterally.
• Men tend to get more compact fat in the proximal thighs.
• The fatty layer tends to be more fibrous, preventing extensive superficial
contour irregularities and cellulite.
Female vs. Male Fat Distribution

Thigh Liposuction
email: askprof@moawadskininstitute.com
• The thigh should be evaluated as
a complete esthetic unit from the
waistline to the knee
circumferentially.
• Attention must be paid to "gender
ideal" muscular shape/ mass, fat
distribution, and adherent areas.
• The adherent areas of the thigh
are the gluteal crease, the lateral
gluteal depression, the posterior and
distal lateral thigh, and the site of
the mid-inner thigh.
• If superficial liposuction or
"liposculpture" is planned, a detailed
exam of the subcutaneous fat
distribution is essential.
11/4/2022 17

Thigh Liposuction
• In small volumes, circumferential thigh
liposuction should be considered in patients
with either lateral or medial lipodystrophies.
• However, in large volumes, liposuction
should be done in stages, reducing the degree
of edema-induced venous stasis and the risk
of thromboembolic venous disease as the
untreated portion of the thigh provides
cushioning lymphatics that compensate for
the impaired lymphatic drainage in the
treated.
• For example, the surgeon might treat the
outer thighs, hips, and buttocks during one
session, then the anterior thighs, medial
thighs, and knees in the next session.

Anterior
Thigh
• In practice usually patient
present with lateral, medial and
anterior thigh, and medial knee
liposuction
• Patients often have more
fullness proximally compared with
the distal anterior thigh.
• Prominent fat bulges can extend
from the lateral or medial thigh
onto the proximal anterior.
• The fat surrounding the patella
is less and more fibrous than the
fat of the distal thigh.

Anterior Thigh
• The anterior thighs are one of the areas most
susceptible to post-liposuction skin irregularities;
therefore, careful contour drawings of the
subcutaneous fat are essential for accurate liposuction
of the anterior thighs.
• I usually divide the anterior thigh into 3 zones with
differential liposuction. Zone 1 is proximal, and it has
the fattest.
• The surgeon must also avoid complying with patients'
requests to "take just a little more" from the area
proximal to the patella.
• The middle zone is a transition zone before the most
distal with the most negligible fibrous fat content, zone
3.

Anterior Thigh
• Some areas of the body may fatten even if
a small lamellar layer is present, such as the
anterior thighs, the legs, or the dorsal
region.
• In these areas, the areolar fat enhances its
volume, but its ability to do so is less than
that of the lamellar layer.
• Results obtained by liposuction of the
areolar layer, a structural fat, are considered
practically permanent as this layer poorly
changes its volume with fattening or
thinning.

Anterior
Thigh
• Fine cannulas should be used in
the deeper planes.
• It should be directed parallel to
the long axis of the thigh, with a
crisscrossing of tunnels occurring
with small angles of intersection.
• For smooth results, it is important
not to direct the cannula paths
transversely across the thigh.

Anterior
Thigh
email:
• Superficial liposuction is
unnecessary because the skin
typically contracts nicely.
• Irregular superficial liposuction
can lead to irregularities that
become evident after the edema has
subsided and can frequently occur in
inexperienced hands.
• Avoiding superficial liposuction
will leave a smooth, relatively thick
layer of superficial fat.
• To treat the anterior knee
adequately, the surgeon must taper
the degree of liposuction proximally
over most, if not all, of the anterior
thigh.
11/4/2022 23

Anterior
Thigh
email:
• On the anterior thighs, optimally
smooth results are more important
than maximal volume reduction.
• Removing more than 50% to 60% of
the subcutaneous fat of the anterior
thigh is associated with a high
incidence of patient dissatisfaction.
11/4/2022 24

Anterior
Thigh
email:
• The surgical endpoint
reaches a smooth
transition into the medial
and lateral thigh with a
tapering reduction in the
posterior-to-anterior view.
11/4/2022 25

Medial Thigh
• The appearance of the medial thigh
depends on the position of the
underlying muscles.
• The medial thigh muscles are the
proximal adductor group, sartorius, and
semitendinosus.
• The saphenous vein courses
superficially within the subcutaneous
fat, while the femoral artery is deep
into the muscle and relatively remote
from the subcutaneous fat.

Medial Thigh
email:
• In a lean patient, the
medial thigh can be an
isolated problem.
• The area of most
significant medial
prominence is where the
two thighs rub together.
• If the thigh is lifted to
the front, the amount of
fat in the upper area of
the medial thigh can be
figured out.
11/4/2022 27

Medial Thigh
Prof. Moawad email: askprof@moawadskininstitute.com
• An overweight patient
usually presents with fatty
deposits in the anterior, medial
thigh, and medial knee.
• In some patients, there are
extensions from the lateral and
posterior thighs.
• Distally the depth of medial
thigh subcutaneous fat tends
to diminish gradually and
reaches its nadir at
approximately two-thirds of
the thigh's length; distally,
where the subcutaneous fat of
the medial knee becomes
prominent.
11/4/2022 28

Medial Thigh
A hollow area between the adductor longus
goes forward to the inside of the thigh and
gracilis. This area is called the furrowing of the
inner thigh.
• The furrowing of the inner thigh is usually
diagonally from the proximal anterior
thigh to distally over the media thigh
toward the posterior knee.
• As a patient bends forward at the hip to
view her inner thigh, muscle contraction
causes the mid portion of the medial
thigh to become more concave.
• When the patient stands erect, the subtle
concavity disappears—informing patients
of this phenomenon before liposuction
will avoid unnecessary worries and
deliberate techniques.
11/4/2022 Prof. Moawad email: askprof@moawadskininstitute.com 29

Medial Thigh
• The medial thigh is the most
unpredictable and difficult area to
treat in body contouring.
• Fat in the medial thigh is loose
and soft, and the overlying skin is
thin and often lax, making this one
of the challenging areas to treat
without leaving "divots.
• Medial thigh liposuction is prone
to developing loose skin because
the amount of fat that needs to be
removed is more than the ability of
complete skin retraction.

Medial Thigh
email: askprof@moawadskininstitute.com
• It is accessible to over-resect
because this fat does not
contain much fibrous tissue.
• However, it is my favorite
site for fat extraction, and
realistic expectations must be
established with the patient,
and certainly the possibility of
skin redundancy or laxity
should be reviewed.
11/4/2022 31

Medial Thigh
• The upper area of the medial
thigh is marked according to
the fat distribution, delineating
the highest fat point and
feathering margins in
surrounding areas.
• The most proximal area
along the sulcus between the
thigh and the perineum should
be well marked.
• Access sites are placed in the
inguinal crease, at the thigh
furrow, and below the distal
marks.

Medial
Thigh
• The patient is placed in a supine position with the thigh spread somewhat apart.
• Proper positioning is vital, and one must be very careful if suctioning with the legs in a "frog-
leg" position.
• It is better to do liposuction with the assistant holding the leg straight and slightly adducted.
• The surgeon can then work from the inside of the leg, constantly feeling for any depression
or irregularity.

Medial Thigh
• Infiltration of the medial thigh must be
uniform, which requires patience and
thorough, deliberate technique.
• In a lean patient with isolated deformity, I
use awake tumescent anesthesia.
• The TLA magnifies the fat's volume and
defects, so that syringe sculpting can be
accomplished with greater accuracy and
better feathering to blend into the
surrounding.
• In large volumes, I use superwet anesthesia
with IV sedation.

Medial Thigh
• After pretunneling with a syringe attached to a
2.0mm cannula, I collect fat for later fat injection if
needed.
• The plane of liposuction will be determined
according to the amount of fat collected.
• The fat is gently reduced smoothly using 2.0-3mm
multiholes cannulas with ventral holes.
• Blend the upper medial thigh into the mid-anterior
and medial knee distally.
• Do not over-resect in the mid-thigh area, or one will
leave a bow-legged appearance.

Medial Thigh
• When reducing the inner thighs from
the posterior approach, most of the
posterior fat can be reduced through
an incision in the inner thigh at the
mid-portion below the marking.

Medial Thigh
• As in any area prone to irregularities, I milk
out the tumescent solution and massage the
area with a hand-made roller.
• Wearing a garment is essential to mold the
inner thigh.
• The skin of the inner thigh is fragile, and
the garment could cause depression.
• I use foam padding under the garment to
mold the inner thigh and prevent depressions.
• External ultrasound postoperatively helps
smooth minor irregularities.
Awake
Patient

Medial
Knees
• Fatty tissue deposits around the knees are usually
confined to the medial and anterior leg.
• Most medial knee fat is located within an oval-
shaped area overlying the medial condyle.
• It may extend proximally onto the thigh just
anterior to the diagonal groove of the medial thigh
and distally over the anterior tibia.
• Although this bulge is not unattractive, the
patient should be forewarned that after liposuction,
when the knee is bent at 90 degrees, the medial
knee may appear slightly concavity.
• Two or three concentric ovals usually suffice to
designate the medial knee fat.
Medial
Knees
Ant. Leg
Suprapatellar

Medial Knees
• The fat pad of the medial knee is most
prominent when the patient stands erect in
the anatomic position.
• Most patients have a small area that will
need to be reduced on the medial side just
below the knee to obtain the most
admirable thigh contouring results.
• Although the amount of fat removed is
minimal, the results are often quite
impressive.
• However, the degree of improvement is
limited in the suprapatellar thigh because of
the fibrous nature of the fat.
Suprapatellar fat

Medial Knees
• A fully awake patient is initially
infiltrated using a pediatric spinal needle,
followed by a 20-gauge spinal needle.
• The adits at the distal extent of the
knee should be placed 1 or 2 cm distal to
the target mound of subcutaneous fat.
• The area designated for infiltration
should extend more distally than the
area to be suctioned.
• The subcutaneous fat of the knee is
susceptible to distortions when the knee
is bent.
• This distortion is eliminated when the
operative position approximates the
anatomic position.
11/4/2022 email: askprof@moawadskininstitute.com
40

Medial Knees
• When the medial thigh and knee are
treated simultaneously, the Thigh Aside
pillow is recommended to help position
the patient and provide optimal access to
the targeted fat.
• There is often a tendency to over-resect
the medial knee and not address the
anterior portion; visualization is the best
way to determine the endpoint.
• Post-operative care is like the medial
thigh

Medial Knee
Microcannula tumescent liposuction of the medial knee consistently produces excellent
results and rapid recovery

Saddle bags Deformity
• Women present with different thigh
deformities due to the tendency to have
subcutaneous fatty deposits, often
resulting in a disproportionate size
problem when buying clothing.
• Localized fatty deposits may occur on:
• Lateral thigh," saddlebags
• On the lateral thigh and high hip
(violin deformity)
• Thunder's thigh (circumferential
fatty deposits.
• Horseshoe deformity (lower back,
hips, lateral thigh, and upper
posterior thigh.

Violin Deformity
Adhesion

Thunder’s Thigh
Circumferential fatty deposits

Horseshoe
Deformity
• The prevalence of
horseshoe deformity has led
to; the lateral thigh being
one of the most requested
areas for liposuction.
email: askprof@moawadskininstitute.com 46

Lateral Thigh
• Other women will come for a consultation, stating that their"
butt" is too large; most of the time, the enlargement is in the
high posterior hips and lateral thighs, which give the impression
of more prominent buttocks.
Lateral
thigh

Lateral Thigh • Old patients may present with buttocks sagging with bulging of
the inferolateral area due to the degeneration of their suspensory
ligaments.

Lateral Thigh
• The English language lacks a word to
designate the entire aesthetic unit of
subcutaneous fat that includes the
outer thigh, inferior lateral buttock,
and proximal posterior thigh.
• The lateral thigh is the missing term
for this cosmetic unit.
• Without the rest of its cosmetic unit,
the outer thigh has an obovate
(inverted egg) shape.
• Anteriorly to the subcutaneous fat
pad of the lateral thigh are the tensor
fascia lata and, more posteriorly, the
buttocks and thigh muscles.
Tensor
fascia
later

Lateral Thigh
• Thigh anatomic "zones of adherence"
are essential to identify and note
during the preoperative consultation
as high-risk areas for contour
irregularities.
• Superiorly, there is depression at the
distal extent of the high hip and the
proximal lateral thigh area.
• The mid-lateral thigh depression
(trochanteric) corresponds to the
femur's greater trochanter; formed by
the lateral border of the gluteus
maximus, the quadratus femoris, and
the insertions of the gluteus medius
and vastus lateralis to the greater
trochanter.
• An obese woman may lack this
depression, which indicates a
relatively deep fat deposit.
• There is another adhesion area in the
distal third of the lateral thigh.
G

Lateral Thigh
• In lean athletic individual relaxation, the trochanteric depression
may be apparent but disappear with the contraction of the
buttocks.
• An easy way to evaluate depression is to have the patient
laterally abduct the leg in an upright standing position.
• Excessive liposuction of fat overlying the trochanteric tubercle
produces an iatrogenic lipotrop (a depression).
• In our patient, we need to fill this depression if it is apparent.
• Iatrogenic depression can be avoided by knowing the dynamic
nature of anatomy, careful positioning, and meticulous surgical
technique.
• Posteriorly, the G point is the area of the junction of the buttock
with the lateral thigh, the gluteal crease.

Lateral Thigh
• While still standing, the patient is marked on the anterior surface of the waist, hips,
and thigh.
• I then draw a line starting at the waistline, making the appropriate concave and
convex curves to simulate the new figure.
• Areas of depression that may require lipo-augmentation are marked differently.
• The hip and the lateral femoral area must be treated during the same operative
procedure, and autologous fat grafting and liposhifting may be required to obtain
optimum results.
FG
F

Lateral Thigh
• The lateral thigh is exposed to malposition, namely, the
lipowarp and the trochanteric pseudobulge.
• A lipowarp of the lateral thigh is a distortion of the
thigh's subcutaneous fat compartments caused by the
hip's flexion, extension, or rotation.
• Adduction of the thigh causes the greater trochanter to
protrude outwardly, elevating and distorting the overlying
fat and creating a pseudobulge.
• It will lead to compressing the anterolateral aspect and
stretching the posterolateral.
• Since the disproportionate areas of fat deposits are
altered when the patient is placed on the surgical table,
the patient must be marked in the standing position, and
the markings must be followed when the patient is lying
on the surgical table.

Lateral Thigh
• The position for liposuction of the thighs is a version of the lateral decubitus position that
approximates the anatomic position, which minimizes the distortion of subcutaneous fat that occurs
in other positions.
• The Thigh Midine is a wedge-shaped surgical positioning pillow that helps to match the anatomic
position of the patient in the lateral decubitus position.
• The uppermost part of the thigh is elevated, and the Midine is placed between the thighs.
• This maneuver displaces the trochanter anteriorly and flattens the area of the lateral thigh that is
particularly susceptible to excessive liposuction.

Lateral Thigh
• Because the lateral thigh is adjacent to the hip, it is logistically convenient
to treat these two areas on the same day.
• For the same reason, the buttocks can be treated concomitantly.
• The finishing phase is done in the prone position, allowing the operating
surgeon to work on both sides and assess for symmetry.

Lateral Thigh
• The lateral thigh is amenable to all forms of
liposuction; both the intermediate and deep planes
can be suctioned.
• For patients with flabby skin and excessive fat in
this area, superficial liposuction might be required.
• In the superficial plane, extreme caution is advised
to avoid worsening pre-existing contour irregularities.
• At least two incisions are required; one is made
superiorly over the adhesion zone and another below
the distal margin of the proposed reduction.
• I, however, do not hesitate to make minor stab
wounds with a no. 11 blade or puncture wounds to
obtain better access.

Lateral Thigh
• Over infiltration is indicated in this
area, especially if there is flaccidity.
• In this area, I believe the
tumescent infiltration should be
carried out until there is a firmness
and slight "orange peel" appearance
to the tissue.
• It will help stabilize the tissue
during the liposuction phase

Lateral Thigh
• Like any area prone to irregularities, the 10-ml
Luer-lock syringe with a small amount of saline and
Coleman needles are used to harvest the fat for later
use.
• Depending on the body's habitus, I use syringe
reduction liposuction with awake tumescent
anesthesia in small cases.
• In large-volume cases, IV sedation is required.
• For the initial stages of liposuction, the cannula is
inserted through several incisions near the posterior
border of the peripheral contour line of the lateral
thigh.

Lateral Thigh
• After pretunneling with 2.0 mm
powered cannulas, I attempt to obtain
at least 2–3 times the amount of fat I
believe will be required.
• With the cannula in one hand, the
surgeon gently grasps and elevates the
tumescent fat with the other hand
while advancing the microcannula.
• This gentle grasping technique
stretches the most profound fat away
from the subjacent muscle.
• After multiple transverse tunnels
have been established throughout the
lateral thigh fat, longer cannulas can be
directed longitudinally more accurately
in a proximal-to-distal direction, and
vice versa, along the entire extent of the
thigh's long axis.
• The tunnels are made crisscrossed
but always in the vertical plane.
Scar
FG

Lateral
Thigh
• After debulking the later thigh properly, the surgeon must make a smooth transition between
the hip, the buttocks, the lateral thigh, the back, and the waist.
• Refinement is carried out to the superficial plane using small 2.0-mm or smaller cannulas for
creating the curves and decreasing the volume of the appropriate areas.
• The lateral thighs need to be sculptured into the hips, buttocks, and waist to recapture the
lateral figure from the waistline to the knees.
• Often final contouring or transitioning from lateral to anterior is performed in the supine
position to remove any "shelf" that may exist following the prone position.
• The suction in this area is made around the lateral thigh–buttocks junction in such a way as to
create roundness and not a flattening.
G
Riyadh, K.S.A 2002

Lateral
Thigh
• The post-operative care
includes foam padding and a
compression girdle.
• After removing the padding,
the patient is only placed back in
the garment.
• She will wear the garment 24 h
per day, removing it only to
shower for the first week.
• At the end of the first week,
she will return to the office for
external ultrasonic therapy for
irregularity and ecchymosis.

Posterior
Thigh
• In thin patients, the skin
adheres to underlying tissues
with a lack of fatty tissue.
• The lateral and posterior thigh
suctioning is easily facilitated via
the previously described lateral
gluteal fold access incision and a
more medial gluteal fold access
incision.
• The buttocks, depressions, and
elevations are handled with the
Toledo "pickle fork" cannula.

Posterior Thigh
• One needs to work deeper laterally
until the desired reduction has been
achieved and work cautiously underneath
the buttocks in the superficial plane
• The posterior thigh should be
cautiously approached as liposuction
below the gluteal fold can drop the
buttocks and create a double banana roll
requiring autologous fat transfer or skin
excision.
• In females, overtreatment of this area
may elongate the gluteal fold,
masculinizing the female silhouette.

Lower Legs
• One layer of fat in the lower leg (superficial fatty layer) is
concentrated in the medial and posterior portions of the
leg.
• Patients may complain of a lack of definition and poor
tapering from the bulkier calf to the ankle.
• The patient is asked to stand on the tips of the toes, and the
skin is grasped, to assess if the muscle is hypertrophic or the
fat thickness is disproportionate.
• Entry sites include paired popliteal fossa and paired peri-
Achilles tendon.

Lower Legs
• Small, fine cannulas are essential,
utilizing multiple access sites to decrease
the risk for access site deformities.
• Care must be taken to avoid injury to the
underlying muscles
• Compression hose, leg elevation, and
sequential compressive garments can
reduce morbidity
• Treating the calves and ankles remains
challenging and requires more prolonged
recovery.

Liposuction
Caveat
1. Ensure proper patient selection.
2. Obtain preoperative examinations of the
patient, including photographs, weight and
measurements records, and informed
consent.
3. Ensure complete sterilization and
antibiotics.
4. Obtain patient photographs in the
operating room.
5. Prevent hypothermia and deep venous
thrombosis.
6. Anesthesiologist.
7. Ensure proper surgical technique.

Liposuction
Caveat
• 14. Supply postoperative dressing and girdles with adequate compression.
• 15. Provide monitoring devices for patients in an outpatient setting (i.e., pulse
oximeters, disconnect alarms, continuous cardiac monitoring devices).
• 16. Provide adequate patient surveillance.
• 17. Schedule a postoperative visit (on the day of and the first day after surgery).

Where to start? 68
For novice (s) who want to acquire the surgical skill of liposuction but do not know
where:
• Start doing fat grafting as a first step.
• Your cost will be minimum (a 10 ml Luer lock syringes and a few microcannulas).
• You will learn how to respect the fat (extracted) and the fat (left).
• As you move on, you will learn the skill of precision, whether you are extracting or injecting fat .
• Syringe reduction liposuction is the starting point.
• The most powerful fat melting energy is your energy (exertion) with the help of mechanical hydrodissection of
infiltrating tumescent anesthesia.
• Any extra energy added will indiscreetly damage the delicate nature of adipose tissue.
email: askprof@moawadskininstitute.com 10/21/2022

Conclusion
• The goal of liposuction is the reduction of localized fatty tissue to produce well-proportioned
body contours.
• The development of liposuction provided cosmetic surgeons with a safe and effective way to
sculpt the human figure.
• It brings as much contentment and joy to the person undergoing it as to the surgeon.
• Liposuction is more of an art than a surgical procedure; it entails a practical application of
scientific knowledge with precision and craftsmanship that attained with clinical experience.

Conclusion
10/21/2022
70
email:
• Although liposuction has
been considered a safe
surgical procedure for the last
30 years, to avoid
complications, one should be
mindful of all the factors that
could predispose them.

THE END
• This chapter, a unique educational manual, is dedicated to dermatologists
and cosmetic surgeons who want to excel in delivering the best care and
liposuction results to their patients with the most innovative techniques
and latest technology in a safe outcome-driven manner.
• I have assembled my experience and global experts to inform you how
liposuction is done in a simplified, efficient, and reproducible manner.
• Liposuction is more of an art than a surgical procedure.
• It entails a practical application of scientific knowledge with precision and
craftsmanship and is a skill attained with clinical experience.
• It brings as much contentment and joy to the person undergoing it as to
the surgeon practicing.

From Adding (1997) to Removing Fat (2022):
Evidence Based Practice
Prof. Osama B. Moawad, M.Sc. M.D.

Thighs, Knees, and Lower Legs Liposuction.pptx

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