Ferit Demirkan, MD

In order to differentiate lip edema from normal fat deposition you may apply the following criteria:
- Lipedema has a softer and more jelly like consistency while normal fat is firmer
- Lipedema fat has some characteristic locations like inner aspects of upper calves, outer part of the ankles
- Lipedema fat may be painful upon palpation and may bruise easily
- In more advanced lipedema there may be folds just over the knees and ankles due to excess fat deposition
- Usually there is a family history of women with fat calves and ankles in the family.

A good result in liposuction usually requires some etching if the patient has the correct BMI. Your BMI and photo shows that you are a good candidate for some shadows in the upper middle part of your abdomen (you already have some) and also in the outher edge of your rectus muscles. More etching may be done at the lower back as a midline depression and 2 dimples between the buttock- waist junction. If you want more etching this may not be suitable with your body type and may look fake.

You may be a candidate for cheekbone reduction as it looks like the zygomatic body is more prominent than the arch. This can be performed with a lower eyelid incision. For evaluating the need for eyebrow lift, a more frontal photo is required because here it seem like they are in the right place. If what you want is something like fox eyes, this can be discussed again over a better (and uncensored) photo.

I think you will benefit from a fat injection and getting some extra definition. The hip dip you have just breaks the but silhouette and there may be still some fat to remove in your waist line, so having a bit narrower waist and bit rounder butt has a synergistic effects to achieve a better body shape. I suggest you to gain a few pounds right before the surgery to help your surgeon.

You may have liposuction of a limited region under local anesthesia +- IV sedation. Best examples are upper arms and the neck. Just lower abdomen in a low BMI patient is also feasible. However, in larger areas general anesthesia is more safe and comfortable due to lidocaine toxicity and the extend of the surgical field. Power assisted devices (vibrating cannulas) do not decrease the need for general anesthesia, as well.