Multimodal Approach for Lower Leg Liposculpture: A Case Series and Lessons Learned

Lower leg lipodystrophy can be distressing to patients. Liposuction can contour the ankle, calf, and medial knee areas but requires the understanding of anatomy, thorough preoperative evaluation, and diligent postoperative care. Previous studies focused on a single liposuction technique. In this preliminary report, the authors presented a multimodal technique for lower leg liposculpture for aesthetic lower leg contouring and discussed lessons learned. The authors performed a retrospective review of patients undergoing bilateral liposculpture contouring using a combination of laser, power-assisted, and fine-cannula liposuction of the ankles and calves with or without medial knee contouring between 2021 and 2025. Patients undergoing unilateral procedures, revision surgery, or surgery for lipedema were excluded, as were cases involving liposuction limited to the ankles or knees. Of 40 cases undergoing lower leg liposuction procedures, 30 involved liposculpture of the ankles, calves, and medial knees. The average lipoaspirate was 793 ± 418 cc (range, 300-2700 cc) from each leg. The mean operative duration was 115 ± 33 min (range, 72-200 min), including concurrent procedures. The mean follow-up was 4.2 ± 4.3 months (range, 1 week to 20.5 months). Three patients experienced complications: one developing skin hyperpigmentation, one with scar thickening, and one with pressure injury with cellulitis and prolonged edema. The application of lower leg liposuction has been limited by concerns about complications. The authors present a multimodal approach to lower leg liposculpture. With appropriate preoperative assessment, patient counseling, and postoperative care, this approach can improve lower leg aesthetics with limited adverse events. Level of Evidence: 4 (Therapeutic) For image description, please refer to the figure legend and surrounding text.