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Leg Aesthetics

Leg Aesthetics

The leg is the part of the human body between the hip and the ankle. The leg is divided into 3 sections: the upper leg (thigh section), the knee section, and the lower leg (calf section). Leg aesthetics includes many topics depending on the procedure to be applied to the problematic leg section. Different procedures are applied for thick and fatty legs and thin legs. Since such problems are mostly structural, no improvement occurs unless there is external intervention. Methods such as thigh lift, calf implant, liposuction, and fat injection are applied to solve the problems occurring in the leg area. Each of these methods can be sufficient on its own, or several methods can be used simultaneously.

Liposuction and Thigh Lift

For non-aesthetic appearance disorders in the legs of young people and those without a history of excessive weight gain, liposuction in one area is generally sufficient. Such patients usually complain of excess fat in the hip, basin, and inner sections. Usually, an application similar to laser/vaser assisted liposuction is sufficient.

However, for advanced disorders in older patients or those who have been overweight for a long time and have lost a lot of weight, liposuction alone is often insufficient. Lift and liposuction can be applied together. Pre-liposuction application can reduce the extent of the lift surgery.

Thigh Lift (Leg Lift)

Thigh lift surgery is based on the removal of excess tissues that cause sagging and stretching of the thigh skin in a horizontal or vertical plane. Patients should have realistic expectations and understand the risks and disadvantages of surgery, the placement of scars, that wound healing is not the same for everyone, and that scars may be prominent.

Lifting with Horizontal or Vertical Scars

Liposuction is sufficient for regional excesses on the inner thigh, hips, and inner knee. However, for people with advanced skin laxity and sagging, leg lift surgery can be performed on the inner thigh. If regional fat excess is present along with sagging, liposuction is performed in addition to removing excess skin for support. In lifting the inner thigh, horizontal scars are hidden in the groin, inside the leg, and in the crease under the buttock. With the upward lifting process, the skin causing sagging in the inner thigh is stretched upwards and the excess skin is removed.

Laxity in the Entire Thigh Area

If there is laxity and sagging involving the entire thigh area, only lifting the inner thigh upwards will be insufficient. In such cases, the entire thigh is lifted circumferentially with an incision that can extend from the groin to the knee on the inner thigh. It is a very beneficial and valuable surgery. When done properly, the results are very satisfying. It does not prevent walking and movement. One can return to daily life the next day. Active sports are not allowed for 1 month. Scars usually decrease significantly in about 1 year. If desired, they can be made invisible by tattooing over them. Sometimes it may be necessary to lift in both directions.

Knee Area

The knee area is usually sufficiently recovered with liposuction or laser-assisted liposuction procedures. The point emphasized here is to reveal the delicacy and beauty of the female knee structure. Thinning is done by taking fat from the inner and outer knee areas. The kneecap is revealed.

Lower Leg Area, Thick Calf

The lower leg area is the area between the ankle and the knee. Problems due to thickness and thinness are seen in this region. Sometimes this area can be structurally thick in women. Although thickness is partly due to bone and muscle structure, fat thickness still holds an important place. Significant thinning in the legs can be achieved with fat removal / liposuction or laser/vaser lipolysis operations. Lipolysis or liposuction applications in this area are generally comfortable and problem-free. Mild edema may occur in the feet after the operation. It is temporary. The desired result appears after about 3 months. The patient gains thinner and more elegant legs.

Lower Leg Area, Calf, Weak and Crooked Leg

An interesting problem in this area is that it can be thinner than desired. An excessively thin and bony lower knee area causes a crooked leg appearance. This problem affects the smoothness and beauty of the entire leg structure. Even if there is no problem in the upper knee section, it causes a perception as if there is a curvature in the entire leg when wearing a skirt. In our patients from whom we can obtain a sufficient amount of fat, the lower leg can be corrected with a simple fat filling. Another method is the calf prosthesis application. If we do not have the opportunity to take sufficient fat, a volumizing prosthesis is simply placed behind the leg by entering from behind the knee. They are problem-free and fast surgeries. Recovery processes are fast. It is possible to return to routine life immediately the next day.

Ankle Aesthetics

The problem related to the ankle is usually that the ankle is thicker than desired. A thick ankle is an undesirable feature. Besides structural bone thickness, fat accumulation can also occur. Shaping and thinning can be performed around the ankle with laser lipolysis and liposuction procedures.

Ankle thickness and lower knee area thickness are often accompanied by water retention in the fatty tissue. This condition is called LIPEDEMA. There can be various degrees of lipedema. In advanced stages, even deterioration in skin quality can be seen. There may be pain in the legs, usually being more prominent in the later hours of the day.

Lipedema

Lipedema is a chronic and progressive adipose tissue disorder characterized by asymmetric and abnormal fat accumulation in the legs, hips, and sometimes arms, seen especially in women. Although it is often confused with a simple weight problem or obesity, its etiology and clinical course are completely different.

From a medical professional's perspective, the pathophysiology, symptoms, and current approach strategies for lipedema are as follows:

1. Pathophysiology and Etiology

Although the exact cause of lipedema has not yet been fully solved, the following factors play a role in its development:

  • * Hormonal Triggers: It usually starts or worsens during periods of hormonal fluctuations such as puberty, pregnancy, menopause, or oral contraceptive use. This strongly points to the role of estrogen receptors in the tissue.
    * Genetic Predisposition: Family history (suspicion of X-linked dominant or autosomal dominant inheritance) is present in a significant portion of cases.
    * Microcirculation Disorder: The permeability of capillaries in adipose tissue is increased. This leads to fluid leakage into the interstitial space (microedema) and chronic inflammation. Over time, fibrosis develops in the tissue.

2. Clinical Signs and Differential Diagnosis

Lipedema is distinguished from obesity and lymphedema by certain clinical features:

  • * Symmetrical Distribution and Ankle Border ("Vest/Cuff" Sign): Fat accumulation extends symmetrically from the hip to the ankle, but the dorsum of the foot is completely normal. It ends like a "cuff" at the ankle. (In lymphedema, the dorsum of the foot is swollen and Stemmer's sign is positive).
    * Trunk-Limb Disproportion: While the patient's upper body (trunk and waist) is usually thin or of normal weight, the lower body is disproportionately wide. It is resistant to diet and exercise.
    * Pain and Tenderness: There is extreme sensitivity to touch and pressure, and a spontaneously developing chronic dull pain.
    * Easy Bruising: Due to capillary fragility, ecchymoses (bruises) occur even with very light impacts.
    * Tissue Consistency: The tissue, which is soft in the early stages, takes on a nodular, nodular-fibrotic, and hard structure as the stages progress.

3. Stages of Lipedema

  • Stage 1: The skin surface is smooth but the subcutaneous fat tissue is thickened, small nodules can be felt on palpation.
    Stage 2: The skin surface becomes irregular, takes on an "orange peel" or large wavy appearance (mattress-like structure). Larger nodules are palpated.
    Stage 3: Large fat lobules and sagging occur. Large tissue masses appear, especially on the inner parts of the knees and thighs, leading to mechanical gait disturbances.
    Stage 4 (Lipo-Lymphedema): Chronic fat accumulation and fibrosis completely disrupt lymphatic drainage, adding secondary lymphedema to the picture. The dorsum of the foot also begins to swell.

4. Current Treatment and Management Protocols

Although there is no curative (completely eliminating) treatment for lipedema, symptoms are controlled and progression is stopped with a multidisciplinary approach.

A. Conservative Treatment (Combined Decongestive Therapy - CDT)
  • Compression Therapy: Special round or flat knit compression garments are used to support microcirculation and reduce edema by increasing intra-tissue pressure.
    Manual Lymph Drainage (MLD) and Complex Physical Therapy: It is effective in reducing pain and inflammatory fluid by stimulating lymphatic flow.
    Anti-inflammatory Nutrition: Anti-inflammatory nutritional models with a low glycemic index, such as the ketogenic diet or Mediterranean diet, have been shown to reduce lipedema pain and progression.
B. Surgical Treatment (Gold Standard: Liposuction)

In patients who do not respond to conservative treatment, have high pain and limited movement, the surgical option comes into play. However, liposuction here is not for aesthetic purposes, but for therapeutic (treating) purposes.

  • Method: WAL (Water-Assisted Liposuction) or Tumescent TAL (Power-Assisted) techniques that do not harm the lymphatic system are preferred.
    Purpose: To reduce pain, lighten the lymphatic load, preserve joint mechanics, and increase the patient's mobility. A lymph-sparing approach in surgery is vital.

Clinical Note: Lipedema is a medical condition that seriously affects the patient's quality of life both physically and psychologically (anxiety, depression, body image disorder). Early diagnosis is critical in terms of preventing stage progression with tissue health-preserving approaches instead of aggressive surgical or conservative interventions.