Roman Fenkl, MD
Plastic & Aesthetic Surgery
Moselstraße 1
64347 Griesheim
Phone: 0049 – 6155 / 87 88 84
Fax: 0049 – 6155 / 87 88 86
E-Mail: info(at)dr-fenkl.de
Internet: www.dr-fenkl.de

Opening Hours of our Practice
Mo   8:00 am – 6:00 pm
Tu   8:00 am – 6:00 pm
(ambulant operation day)
We   8:00 am – 6:00 pm
Th   8:00 am – 6:00 pm
(ambulant operation day)
Fr   8:00 am – 6:00 pm
(hospital operation day)

Liposuction and Modelling of the Lower Legs, Calves ans Ankles

Many women suffer from “thickened calves”. The problems about this issue are not minor, but more complicated than people without this problem may assume: shoes often do not fit these sufferers, neither do boots and even their zippers cannot be closed correctly to the top. In addition, narrow trousers do not fit and short dresses will not be worn, because the legs which are revealed are simply unattractive and bulky. Therefore, the inevitable choice for individuals with enlarged calves will be long dresses and loose fitting trousers. Public swimming pools are also usually avoided by women suffering from this problem.

Calves

This problem is more prevalent than one usually thinks, because people, suffering from this issue, have learned to hide their blemish from others. The general practitioner, who is frequently asked about this, gets overwhelmed with requests regarding medical help and advice and usually responds by disclosing that there is no solution, hence, one has to: “Learn to live with it.”

This is particularly wrong! We can help adequately with this problem, and provide our patients with a lifelong result.

If this is your concern as well, please read further…

What is the reason for Enlarged Calves?

Right at the beginning of explanation one has to state that virtually in every case the fact is not only “enlarged calves”, but rather enlarged lower legs as a whole unit, frequently including the ankles.

Heart and Kidneys

Female patients who are lucky to have a good general practitioner, have frequently already passed a diagnostic sequence to ensure that heart and kidneys work/function well. The reason behind that is an increased tendency of edema of the lower legs, ankles and feet in patients with a weak heart or insufficiently working kidneys. These are called “swollen ankles and legs”. These usually appear due to increased deposits of fluids in tissues.

The Veins

In young patients, the above-mentioned tests usually come out normal. Your experienced doctor still works at your problem and keeps an eye on your “insufficient veins” (medically “varicosis”). If vein valves do not close properly, the column of blood inside them sinks down according to gravity instead of correctly flowing back to your heart. This condition is especially prevalent during the summer months. Both young and elderly women suffer from this problem and their legs enlarge from the collection of fluids in their tissues. Pressing the tissue with your finger will move the fluids aside and leave visible dimples.

If this medical problem is apparent, there will be a remarkable difference in your legs’ diameter between mornings and evenings. Your legs will be slimmer in the morning after having been in the horizontal position throughout the night.

If not, then your veins and their valves are very likely in order, so that the reason for the enlarged legs might be different.

Too many unnecessary venous operations are performed in cases of enlarged lower legs, calves and ankles due to genetically increased fat deposits.

Lymphatic Edema

Perhaps your doctor used all his knowledge to find out more about your problem; maybe your veins have already been operated on. His last diagnosis might be a “lymphatic blockade”, assuming that the fluids in your tissues might not be transported adequately back to your heart???. So he may have sent you for regular lymphdrainages, which are really pleasant, in order to reduce the circumference of your lower legs somehow, but it has not worked for a long time, and within a few hours your problem is back again.

I saw patients who had lymph drainages for years without a positive result of getting better.

Usually after that, female patients come to my practice with the diagnosis of “lymphedema”, which usually is obviously incorrect. It takes me a single clinical examination to make things clear.

Increased Deposits of Fatty Tissue in Lower Legs and Ankles - an Individual Variation

According to family history one finds out quickly, that there will usually be at least one female ancestor with the same problem. Sometimes the problem is not found in one or two generations, but when we delve further, maybe to the case of a grandmother or a great-grandmother or aunt, we find a connection. Obviously, it does not have to be like this.

It is clear, that all previously mentioned therapies with regular fat tissue being apparent in greater amounts than esthetically expected, have to fail.

Irregular fat deposits will collect in the front of the shin and conceal its form, wrap around the ankles and cover their bony structure, quite often right down to the foot sole. Especially the Achilles tendon is sometimes concealed in such a way that its structure is not demarcated at all, which makes the ankles unattractive and clumsy/awkward.

In addition, the muscle contour of the calves is quite frequently covered with fat tissue which ends up in a uniquely column-like form, without any distinguished/discernable shape. If the sufferer had to stand on tiptoes, it would not show any muscle relief of the calves.

The fat tissue proceeds upwards to the knee and frequently ends up in an unwanted, “undefined” enlargement of the knee.

These fat deposits have got nothing to do with being overweight. They are very often found even in slim individuals, with good figures and acceptable weight . Frequently patients inform me, that these deformations of their lower legs first appeared during puberty or adolescence. Not even strict dieting or calorie reduction and weight loss could correct their issue; neither could intensive sport .

What can the Plastic Surgeon do against Enlarged Calves?

He can do a lot! He can free the patients from their lifelong problem completely. The magic procedure for this “disease” is the“liposuction”.

But, to use “liposuction” alone, will not be enough. Too many people in the medical field claim, that liposuction did not solve their problem.

It took me quite a long time to understand the reason for that, because there is not a single patient of my practice with such a complaint.

The explanation is, that many physicians do liposuction to calves, but only dared it in a very diminished version. Basically they did not have any predisposed picture of an ideally shaped calf in their mind, that they could work at.

The secret of a successful treatment in this field is, that the physician is well aware of the aesthetics of lower legs and ankles. He or she should know that the calf muscles end lower in the inner (medial) aspect, and higher in the outer (lateral). The operator should have a vision, of how the ridge of the shin should look like, and how the Achilles tendon’s appearance should be. Not to forget the high importance of a defined bony ankle structure.

I had to realize myself, that in case of lower leg modelling the physician has to be some kind of a “sculptor”, some kind of Michelangelo. He “sculpts” with a very, very thin cannula. One fat drop after the other gets extinguished out of the bugging areas, leaving ideal forms behind.

On the other hand, it must be strictly prohibited to suction away all the fatty tissue below the skin, otherwise the skin gets fixed to the underlying musculature, which will pull in the skin, in these areas unsatisfactorily with every movement or muscle contraction, reminding of unwanted scarring.

Sculpting the lower legs and ankles with liposuction, therefore, not only demands perfect aesthetic and anatomical knowledge from treating physicians, but especially selected care at working with such sensitive regions of the body.

Using this technique, I reduced varying amounts of fatty tissue from the calves effectively and permanently. Frequently, it is more than one litre of fat (both lower legs together); in extreme cases I removed 2,6 litres of fat. The worst case in a 15 year old girl, who already had the varicose veins removed and had endured lymphatic drainage therapy for many years before, I was able to take away 4,5 litres of fat tissue from both lower legs in one operative session. This example is obviously an extreme case.

37 year old woman with lipomatosis of the lower leg

37-year-old woman with very conspicious lipomatosis of the lower legs and ankles before and 1.5 years after her reduction modelling. She suffered so much from her fat tissue distribution disorder that she only put on long dresses and long trousers with wide legs, skinny jeans were unthinkable. Boots never fit. The extreme excess of fatty tissue on both lower legs and ankles corresponded to a medically relevant physical impairment. The sculpting suction (modelling) of 2,860 ccm of pure fatty tissue corresponded - figuratively seen - to a relief of the lower legs by almost 3 litre packs of milk or more than 7 quarter-pound packs of butter! The skin surface of the lower legs is smooth and without dents, which also prevents them from being recognized as "operated on". Postoperatively one saw the pretty, happy woman almost only in short skirts...

"Photos: Dr. med. Roman Fenkl, with the written consent of the patient"

What are the Risks of Lower Leg Modelling?

Either too much or too little of fat reduction.

Care and experience are basic conditions for modelling of the lower legs. If suctioned too much, unfavorable indentations will result and the skin will stick to the underlying musculature.

If suctioned too little, the result will hardly be visible and, thus, unsatisfactory.

Too Aggressive Suction

One needs to bear in mind that the lower legs are exceptionally sensitive parts of our body. They involve very fine lymphatic vessels which react to rough operation methods with long-lasting swelling and edema. Even with careful treatment through very slim suction cannulas the post-operative swelling can last for a few months, or up to half a year. Obviously the swelling will reduce further through time and it will eventually be hardly noticeable at last.

Also the amount of liposuction will be responsible for the amount of swelling postoperatively, depending on the extension of operative trauma.

Lack of Sterility

This is dangerous point of view: More and more liposuctions are performed by physicians without adequate responsibility, virtually “on the living room table”, with parket floors and under disastrous hygienic conditions. Who puts himself into the hands of such “sales doctors” is himself to blame for arduous complications.

Bad infections of skin and underlying tissues happen all the time, because of “low cost procedures”. They can result in extensive and hardly correctable scarring, open wounds and - as extreme outcomes - in the loss of extremities.

Please do not let it come to this extent, be alert. In Germany nowadays, every physician is allowed to do anything with you as a patient, as long as you allow him to. Obviously, he has to take over responsibility for his doing, but a lost extremity is not replaceable in any form.

This is the reason why every form of liposuction is regarded as a highly sterile form of operation for me and my trained team and will solely be performed in a highly sterile operative environment, without any exception.

You can have a glimpse into our theatre through the gallery on this website , if interested.

Our establishment is kept thoroughly hygienic and we adhere to strict conditions, which have up to now preserved us from any of the complications, as mentioned above. Instead, we are proud about our happy and content patients.

Unexpected Risks

Unfortunately, there is one minor complication which we have to divulge / disclose which happens relatively frequently, so that we have to forewarn about. Almost all our patients who underwent modelling of their lower legs fell pregnant, mostly within 6 months postoperatively … of course not through us.

We cannot prove, whether our operative results increased our patients’ attractiveness in a way that lead to this “complication” and we will not be able to find out about it statistically, either.

So, in case you would consider this op, please be cautious… for we do not take responsibility for such complications… of course.

Back to Start Page

Your Appointment in Our Practice

I would be pleased to meet you in my practice for a consultation in Darmstadt-Griesheim. Please book an appointment telephonically.

For a personal consultation call the number below at any time between 08:00 – 18:00 from Monday to Thursday

Tel. 0049 6155 - 87 88 84