Abstract
Abdominal enhancing is one of the most common concerns in the daily practice of the aesthetic surgeon. There are differences in the female and male ideal abdominal shape and are very important to understand and make a correct diagnosis. The type of abdominal definition procedure is determined by the individual body biotype. For the procedure, it is needed to adequately identify the particular anatomy paying special attention to the rectus abdominis muscle. Energy-based liposuction aids are very useful but requires an adequate infiltration and timing to avoid complications.
21 High Definition Body Contouring of the Abdomen
Enhancing the abdominal wall due to aging and weight changes are one of the most common concerns on the daily practice of the aesthetic surgeon. Achieving a muscular, toned, and athletic-looking body is synonymous with health, youth, and beauty. Now it is becoming the goal of body contouring as well.
21.1 Female versus Male Anatomy: Landmarks, Planes, and Superficial Anatomy
The abdominal contour identity is given mainly by the appearance of the “rectus abdominis” muscle. It is a vertically oriented pair of strap muscles that run along the central part of the anterior abdominal wall arising from the pubic symphysis, crest, and pecten of the pubis and goes upwards to insert into the xiphoid process and costal cartilages of the fifth to seventh ribs. Inferiorly is covered only on its anterior surface by the rectus sheath, and above the arcuate line is covered on both sides by the rectus sheath.
The surface anatomy can be easily palpated in slim patients. The muscular intersections divide the muscle into segments that create individual muscular bellies otherwise commonly referred to as the six-pack.
The Thoracic arch forms an angle of about 90 degrees in males and 60 degrees in females being more rounded in males due to the highest tendinous intersection of rectus abdominis medially.
The umbilicus lies within a defect in the linea alba at the level of the fourth lumbar vertebra. In athletic males, a sharp rim is usually present at the upper border of the umbilicus, whereas the lower border is less well defined. In females, a peri-umbilical fat pad deepens the navel and obscures its borders.
There is a clear structural and functional division of the fat layers: A superficial, dense-packed with a vertical and organized structure metabolically stable less prompt to changes with the weight variations; A deep fat layer separated by the Scarpa’s fascia, containing a less organized fat tissue where most of the fat is deposited.
21.2 Steady versus Fluctuating Beauty Standards
The female ideal biotype is not a static concept; it constantly changes influenced by fashion, cultural trends, age, ethnicity, and other tendencies. In the last half-century it has had dramatic changes.
After World War II with the return to a healthier lifestyle, the curvy, hourglass shape with more importance given to the breast size and little attention to the waist was the ideal.
During the 60s everything changed, with the empowerment of the women’s liberation movements, women start to take part in the social and political life, the miniskirt was the official trend and the curvy woman was not the ideal anymore, the popular Twiggy model leads to a thinner body image with long legs, chic bodies, and outfits.
The 70s were a reaction against the established patterns in social, political, and of course aesthetics could not escape from this. Hippie trends took place; the informal look was the rule.
The 80s were the birth of the supermodel era: a sexy, curvy, and pretty woman could be rich, famous, and successful just because of the way she looked. Women everywhere found this as the ideal and started to look forward to imitating them.
The 90s woman was known as the “junkie” chick. The new idea was the “thinner the better,” up to a point that the health started to be a serious concern and an anorexia epidemic started to grow.
The big question to ask nowadays is what the woman wants. The answer can only be addressed based on distinctive aspects: the geographic location, age, fashion trends, and ethnicity. Younger women tend to search for an athletic body type while one after giving birth tends to look for a more subtle look. Asian women prefer to have a rounded face (full moon) while occidental women like a defined, bony, square-like face.
For males, the ideal body biotype has been almost the same throughout time. Artwork from different ‘cultures and times share the same concept about the ideal male body, from ancient Greek and Roman, the Renaissance masters, and even the contemporary movements. The ideal of athletic must have a very well-defined muscle figure that implies youth, vitality, and health.
21.3 Biotypes and the Influence Results
Sheldon in the 1940s defined three body somatotypes to classify the body and fat tendency.
21.3.1 Ectomorphs
These individuals have scant body fat and muscle, they are usually tall, flat chested, lack curves, and not easy to gain weight. Psychologists also give them some personality trends towards anxiety.
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