Recurrent Lumbar Roll Following Liposuction
(From the Magazine “Aesthetic Surgery”, Fall 1994)
Recently; a middle-aged male patient scheduled a consultation for a touch-up of his lumbar roll area, which I had previously suctioned. My entry point for the cannula during the primary procedure was the intragluteal fold; I routinely do both superficial and deep liposuction through that incision. Although I have performed primary liposuction for this problem on almost 100 patients, I have never before seen a residual fullness following a thorough suctioning of this area.
Editor’s note: Aesthetic Surgery asked S. Larry Schlesinger, MD, of Maui, Hawaii to respond to our reader’s problem.
The male lumbar roll area, commonly called the “love handles,” normally occupies the L2 and L4 levels inclusively along the posterior and lateral flanks. This fat lies superficial to the external oblique and latissimus dorsi quadrates lumborum complex, and I believe it appears to be genetically and/or hormonally determined fat. The lumbar roll is difficult to reduce with diet and exercise; in fact, it is almost impossible to eliminate without surgical intervention. Fat in the lumbar flank region resembles the festoons of fat of the upper back and is separated from mid and upper back fat by transverse fibrous bands as described by Guerrerosantos.
Based on the information provided, I think the patient’s recurrent fullness may be due either to prolapse of the -mid back fat following fenestration of the transverse fibrous bands with incomplete fat removal of the supra-flank area and/or to incomplete liposuction of the lumbar roll area itself.
I recommend making a second entry point for suctioning at the LI/I.2 interspace in the midline (figure 1). Transverse suctioning of this area will clear the supraflank fat, and diagonal suctioning will create a crisscross, or grid, pattern when combined with an intragluteal incision or mid axillary line incision in the bathing suit area. Grid suctioning more efficiently clears the fat from this and other areas of the body. For grid suctioning, I routinely use a Mercedes cannula, with diameters of 3.7 mm and 3.0 nun and lengths of 28 cm, 21 cm and 17 cm.
I, too, superficially suction the lumbar roll area, and I am extremely aggressive in my own patients. I suction a portion of the fat from an anterior approach, with incisions in the pubic or inguinal area and the umbilical area. One should be particularly careful when suctioning from both the front and back, as the watershed area at the mid axillary line may be overly traumatized and could lead to cutaneous ischemia.
Postoperatively, I dress the area with Reston sponge directly on the skin. This is left for three days under a compression garment, after which the area is covered by the compression garment only for two weeks or more. The use of oral bromelain, a selective prostaglandin inhibitor, both before and after surgery, can diminish postoperarive Swelling. Topical DMSO and postoperative ultrasound have the same effect.