Is extreme swelling 4 weeks post op for cankles normal? (Photo)

This area is one of the slowest to recover. The circulation is poor so it takes much longer for swelling ans bruising to clear. There also is very little space for swelling, so this area is usually more tender postop. No reason to worry at 4 weeks.

Thank you for your question. This area is known to give swelling for longer time and will take more time to recover. Please follow instructions from your PS and ask for evaluation.

Hi and welcome
to our forum!
Congratulations
on your recent procedure...The procedure of liposuction is an
"insult" to the soft tissues, resulting in swelling which will
initially totally obscure the operative result. As swelling represents an
accumulation of tissue fluid within the soft tissues, it will tend to
gravitate downward. When in bed with extremity elevation, it will improve,
and when up and around, it will again gravitate downward. We recommend limiting
activities and practicing leg elevation whenever possible until swelling
subsides.
Picture a cylinder filled with water...Puncture the vessel near the top and water will spill out. Puncture near the bottom, and water will pour out under pressure. Venous pressure is higher at the ankles than at the trunk when standing erect. Swelling will last longer in the lower extremities than the trunk. It may take 6 months or so for the swelling to totally subside. 
The
purpose of a compression garment is to prevent bleeding and to control
swelling. We usually recommend its use for 3 months after the
procedure. 
60-80%
of the swelling should subside within the first 6 weeks, with the remainder
slowly subsiding over 6-12 months.
Continue
followup care with your plastic surgeon...
Best wishes...

you need to give it months for this area to fully resolve. You should still be active but when you rest and sit and sleep, try and elevate your legs to your heart level. also i would suggest months of a comfortable compression garment. You need lots of patience for this area to see your final result.david berman md