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

Abstract Background Lower leg lipodystrophy can be distressing to patients. Liposuction can contour the ankle, calf, and medial knee areas, but requires understanding of anatomy, thorough preoperative evaluation and diligent postoperative care. Objectives Prior studies focus on single liposuction techniques. We present a preliminary report using a multimodal technique for lower leg liposculpture for aesthetic lower leg contouring and discuss lessons learned. Methods We 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. Results Of 40 cases undergoing lower leg liposuction procedures, 30 involved liposculpture of the ankles, calves and medial knees. Average lipoaspirate was 793 ± 418 cc (range 300-2700 cc) from each leg. Mean operative duration was 115 ± 33 minutes (range 72-200 minutes), including concurrent procedures. Mean follow-up was 4.2 ± 4.3 months (range 1 week - 20.5 months). Three patients experienced complications, one developing skin hyperpigmentation, one scar thickening, and one pressure injury with cellulitis and prolonged edema. Conclusions Application of lower leg liposuction has been limited by concerns about complications. We 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.