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When plastic surgeon Ahmet R. Karaca, M.D., began offering his patients liposuction of the calves and ankles in 1986, little had been written on the subject. So he paved the way, learning by trial and error how not only to thin the lower legs but also to make thick ankles, calves, and thighs shapelier.

Dr. Karaca started performing the technique carefully but found the more aggressive he was, the better the result. He discovered that many of his patients benefited when he addressed more than a localized area and instead suctioned around the circumference of the thighs, calves or ankles.

This led to circumferential liposuction, a procedure he performs on about 50 percent of his liposuction patients who need suctioning around the thighs and on about 80 percent of those who want their calves and ankles thinned, said Dr. Karaca.