**7. Specific sites**

The gluteal sulcus is a problematic area. This area must be strictly avoided and there should never be an attempt to create an artificial gluteal sulcus using liposuction in patients. Disruption of the fibrous septae that create the inferior gluteal sulcus can lead to gluteal ptosis. Correction of this deformity is almost entirely surgical, although autologous fat grafting has shown some benefit in rebuilding the curvature of the buttock. Sozer and Eryilmaz described a successful split gluteal flap for this repair [53]. Others have described using anchoring de-epithelialized skin flaps. Subcutaneous threading improved to grade 2–5 gluteal ptosis to grade 2 or better. More severe ptosis improved in only 14% of cases [54].

The banana fold represents redundant fat and skin below the gluteal sulcus. Most authors recommend superficial liposuction of this area. This procedure should be reserved for the most experienced practitioners. Deeper or more aggressive liposuction can cause a double banana fold. Autologous fat transfer can improve double folds [55]. Gonzalez reported a dermotuberal anchorage buttocklifting technique which must be performed surgically [56].

Liposuction of the submentum is straightforward and takes very little time. Overcorrection is common in this area and bound down skin is the result. Small areas can be injected with triamcinolone and only rare cases may need subcision. Massage can make a dramatic difference if tissue is bound down to the platysmal fascia. The laxity common in this area may tempt a clinician into over-treating the subdermis. However, the normal inflammation occurring in the subdermal layer has a profound effect on neck laxity, as can also be seen with cryolipolysis and mesotherapy. The marginal mandibular nerve traverses the jawline within 2 cm of the area below the melolabial fold. The nerve is superficial but beneath the platysmal muscle. The clinician can easily penetrate the plastymal muscle without realizing it, although the patient usually describes some discomfort. When this happens, suctioned fat is noticeably blood-tinged and bleeding often occurs from the port. Likewise, it is not wise to suction on the superficial surface of the platysma because inflammation can cause a paralysis of the marginal mandibular and the corner of the mouth will drop. Over 90% of marginal nerve injuries recover over several months without treatment. In severe cases, a platsymal motor nerve transfer can restore nerve palsy [57].

Breast deformities include depressions and dimpling, especially in the upper pole. This area rarely needs to be liposuctioned. Most problems occur during fat grafting. If fat is injected in a fan-like pattern from the axillary fold a potential space is created and unsightly fat collects in the axillary fold. It is common for liposuction to result in temporary lumpiness that persists for several weeks. That said, mammography is recommended if a new lump appears greater than a month after liposuction [58].

The calves and ankles can be difficult when trying to maintain a natural curvature. In women, overcorrection in this area results in a markedly masculine appearance. Liposuction should not be performed on the calf if the pinch test is less than 2 cm of fat. The calves should be assessed when standing normally, standing on the toes, and supine [59]. The ankle is at special risk of ulceration, as well as nerve damage and varicosities. Fat transfer to over corrected areas of the calf and ankle suffers from lack of vascularity for the graft, and results are disappointing. While there are no case reports, dermal fillers may be preferred.

#### *Complications and Solutions for Post-Operative Liposuction Deformities DOI: http://dx.doi.org/10.5772/intechopen.101284*

In summation, the physician is faced with a canvas of options for body contour correction. When in capable hands, liposuction has evolved to be an extremely safe and gratifying option. As with any surgical procedure, the complications are many. But with the advent of new energy technologies, new research of combination treatments, and a more mature understanding of older options (e.g. fat grafting) the options available for correcting the inevitable rare complication are better than they have ever been. In addition to energy devices, new injectables, such as nanofat, collagenase, deoxycholic acid and PLLA to name, a few have given the surgeon a palette of options never before available. Armed with these, we can provide our patients with the absolute best outcomes available to modern medicine.
