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Liposuction in children
While liposuction is traditionally performed in adults, the procedure can help treat contour deformities in paediatric indications such as lipoma and Klinefelter syndrome, writes Dr Beatriz Berenguer
Liposuction has become the most commonly performed cosmetic surgery procedure worldwide. It is useful for a range of indications and can often be the superior treatment approach when compared with traditional open surgery. Refinements in technique and the maintenance of high safety standards have led to improvements in cosmetic outcomes and fewer complications. These developments have expanded the use of liposuction for other pathologies of adipose tissue, particularly in a formerly unheard of population—children and adolescents.
Necessity is the mother of invention. Liposuction arose from the need and desire of patients to remove unwanted adipose tissue from areas such as the thigh or abdomen. Liposuction procedures performed in the typical adult population remove unwanted fat deposits in the trochanteric region to achieve a more aesthetic body contour.
Indications
The indications in which liposuction can be used in children may be viewed as atypical. They are very different from the classic age and the usual etiologies of adipose disharmony prompting the usual aesthetic indications. But the indication for using liposuction in children and adolescents is, in essence, the same as that in adults.
Children and adolescents may sometimes require remodelling or contour sculpting of areas of the body where fat deposits are in disharmony or disproportion to the rest of their physique. This can result from abnormal configuration or abnormal location of fat deposits.
Atypical indications for liposuction include post-traumatic lipoma, post-traumatic asymmetry, lipodystrophy regardless of the etiology, adiposis dolorosa or Dercum syndrome and Klinefelter syndrome.
I have performed liposuction procedures in children and adolescents for all of these etiologies. In Klinefelter syndrome, the patients are phenotypically male but their genotype is XXY, which results in a more feminine distribution of their fat deposits. Liposuction is performed in puberty to defeminise their body contour and better match their phenotype.
Another indication for liposuction can be in patients with atypical congenital lipodystrophy or Dercum syndrome. This is a painful condition where patients have very large accumulations of fat in the trochanteric area. Liposuction can result in a cosmetic correction of their body contour and can help to reduce and even eliminate the pain associated with the disease.
Involuted hemangiomas are another common indication for liposuction in children and adolescents. Infantile hemangiomas, formerly known as strawberry hemangiomas, are the most frequent benign tumours in childhood. They will typically regress over time but often leave a residuum that is mostly composed of adipose tissue. This is particularly seen in infantile hemangiomas that are very voluminous—imaging techniques such as MRI can demonstrate the extent of involution of the remaining tissue.
If the tumour proves to be predominantly fat, liposuction can be useful in removing the adipose tumour and aesthetically correct and smoothen out the area. But it is crucial that the clinician performs a liposuction procedure only on verification from an MRI that involution of the hemangioma is complete. If involution is incomplete, there is a danger that the canulas employed in the liposuction technique may pierce and rupture any remaining blood vessels in the target area.
Children and adolescents with post-traumatic lipomas can be potential candidates for liposuction. The abnormal fat distribution of these tumours, which typically occur after accidents, can easily be corrected with the non-invasive procedure.
Liposuction and lipofilling techniques can be used after the surgical separation of conjoined twins where each patient often has visible contour deformities at the site of separation.
Advantages
Liposuction has some key advantages over conventional open surgery used for the aesthetic correction of body contours including a smaller wound and scar, a faster recovery time and fewer complications. Compared to open surgery, the aesthetic surgeon can more easily assess the degree to which the fat deposits are removed in a liposuction procedure, which can help optimise aesthetic outcomes.
In a literature review, liposuction in younger patient populations is only mentioned anecdotally and apparently the technique is not readily practised here. This may be why many plastic surgeons think that liposuction is only performed in a private aesthetic setting and exclusively in an adult population, which is simply not the case.
For any contour deformity caused by fat resulting from disease, trauma or iatrogenic etiologies, physicians should consider liposuction. The techniques and goals of both adult and pedriatric populations are the same. Sometimes children, adolescents or their guardians do not think about asking the plastic surgeon about body contouring treatment using liposuction because there is a false notion that this technique is reserved for adult patients with aesthetic rejuvenation goals.
Liposuction can be performed in most age groups, as it is a bona fide technique for the right indication. Aesthetic surgeons should recognise adults are not the only patients who can benefit.
Dr Beatriz Berenguer PhD, is a plastic surgeon at the department of plastic and reconstructive surgery, St Rafael Private Paediatric Hospital, Madrid, Spain. E: beaberenguer@gmail.com
