76 High-Definition Liposculpture

Alfredo E. Hoyos and Mauricio E. Perez

Abstract

In recent decades, women and men have been constantly looking for an athletic and fit body. Although CrossFit and gym routines are very important for general health, some individuals struggle to get their desired outcomes and do need some help in achieving and keeping them. High-definition (HD) liposculpture was created and then improved through time and expertise to introduce new concepts regarding body contour surgery.

Since the first description of the tumescent technique, many updates and improvements have been done by introducing new technologies and concepts in body contouring. Nowadays, HD liposculpture is not only based on cutting-edge devices for liposuction and fat grafting, but also constantly evolving with evidence-based safety performance. In the following paragraphs we will describe the key points and also warnings that we need to take into account while performing HD liposculpture. Patient inclusion criteria and postoperative care compromise are significant information that need to be addressed before surgery. Some critical basic concepts include: artistic anatomy, lights and shadows, negative and dynamic zones, fat grafting, and stem cell autografts. Finally, the main premises to avoid complications and how to manage them (if they occur) are also reviewed in this chapter. We feel so honored to share our knowledge and expertise with our readers and hope to build on their strategies and techniques while performing body contour surgery.

Liposuction – high-definition liposculpture – dynamic definition – ultrasound assisted liposculpture – VASER – fat grafting – stem cells

76 High-Definition Liposculpture

Key Points

High-definition (HD) liposculpture is based on the individual’s underlying structural anatomy.
Markings are critical to ensure the correct zones to enhance (lights) and define (shadows) for an optimal result.
Negative and dynamic zones are determined by the muscles and spaces between them for specific definition.
HD liposculpture encompasses the whole-body contour, including arms, chest, abdomen, torso, buttocks, thighs, and calves, rather than independent zones.

76.1 Preoperative Steps

76.1.1 Patient Criteria

General good health.
Body mass index (BMI) <32 kg/m².
American Heart Association guidelines for low risk patients (ASA < III).
Nonsmokers or who have quit smoking.
Patients with comorbidities need attending physician assessment to be cleared for surgery.
Review the records of any previous procedures or surgeries performed.

76.1.2 Markings

Optimal markings are essential to recognize deep, superficial, and smooth zones for definition.
Create your own color code to understand operative procedures on each marked zone.
Anatomical landmarks and some fat pads should be marked in black (Fig. 76.1).
Blue can be used in more obese individuals where deep thorough liposuction must be done (Fig. 76.2).
Red could delineate dynamic and adhesion zones (Fig. 76.2).
Green markings are used for negative spaces and transition zones where smooth liposuction must be done (Fig. 76.3a).
Purple could be used for enhancing (light) zones where fat grafting should be considered (Fig. 76.3b).

Warning: Take special consideration of some “forbidden” (adhesion) zones for liposuction (can be marked with another color) if you do not have enough expertise (e.g., trochanteric depression, popliteal zone, lumbar depressions, inner arm and thigh, chest, Cooper’s ligament of the breast, inguinal ligament) (Fig. 76.2).

**Fig. 76.1** General landmarks are preferably marked with black. Muscle insertions and underlying disposition are marked as a guide.

**Fig. 76.2** Liposuction on adhesion zones (*red*) need to be avoided, otherwise contour defects and abnormal skin retraction might develop. Deep liposuction should be performed in areas with abundant fat pad deposition (*blue*).

**Fig. 76.3** **(a, b)** Preoperative markings and code of color. Artistic anatomical landmarks and specific negative zones are drawn first **(a)**. Triangles are helpful to delineate areas for smooth definition. Transition zones **(a, b)** are marked later to not only guide superficial and deep liposuction but also define zones for fat grafting **(b)**.

76.2 Operative Steps

See Video 76.1.

76.2.1 Stealth Incisions

Incisions should be placed over hidden skin creases or maybe over the underwear’s line, as scaring can leave horrible marks (Fig. 76.4).
The less the incisions the less the risk of complications.
Gentle flap and incision manipulation helps in the healing process.

Fig. 76.4 Stealth incisions are covered by underwear or hidden by normal skin folds in order to avoid undesired scarring and visual marks of surgery. This will also masquerade natural results in high-definition liposculpture.