77 Male High-Definition Liposculpture

Alfredo E. Hoyos and Mauricio E. Perez

Abstract

Male patients have increasingly become more interested in body contour surgeries, since new technologies and devices have improved outcomes and are now suitable for many of them. The chest, abdomen, and buttocks are the main concern our patients ask about at our office. High definition (HD) lipoplasty is assisted by ultimate generation ultrasound devices and has important differences between male and female procedures, mainly regarding multiple muscle enhancing areas through fat grafting and enhanced muscle definition. The male body shape resemble power and strength throughout history in different cultures around the world, so our main purpose in male HD liposculpture is to restore and define the underlying anatomy to make the body muscular and athletic again. Basic important clues to pursue this goal are: the markings phase, the specific zones for superficial versus deep liposuction, and selective fat grafting. Critical concepts also need to be mastered to understand the principles that rule HD liposculpture. These include artistic anatomy, lights and shadows, negative and dynamic zones, and stem cell fat grafting. Although many safety considerations have been stablished to perform HD lipoplasty, some complications might occur, most of them related to inappropriate postoperative care. Finally, insomuch as many patients have reported above expectations results, immense expertise and good training are needed to achieve the desired results.

Male liposculpture – high-definition lipoplasty – male dynamic definition – ultrasound assisted liposculpture – VASER – fat grafting – stem cells

77 Male High-Definition Liposculpture

Key Points

Athletic appearance with pectoral and buttocks enhancement, six-pack sharpness, and deltoid prominence are main concerns that male patients request for at our office.
Male high-definition (HD) liposculpture has clear differences compared to the female procedure. Buttocks and pectorals usually need volume augmentation.
As muscular enhancement is crucial for the male figure, dynamic concepts become very important to reach exceptional outcomes.
Multilayer fat grafting enriched with stem cells is almost always used to enhance some areas lacking projection or volume.

77.1 Preoperative Analysis

77.1.1 Patient Criteria

General good health.
Low preoperative risk assessment (ASA < III) according to American Heart Association (AHA) guidelines.
Body mass index <32 kg/m².
Preferably without previous liposculpture procedures or without severe fibrosis nor biopolymer injections.
Nonsmokers or who have quit.
Patients with comorbidities need attending physician’s assessment to be cleared for surgery.

77.1.2 Markings

They are the initial step to understand and plan this kind of procedure.
Start with the anatomical landmarks (Fig. 77.1): muscles, bony prominences, limits, etc.
Then, mark the negative spaces as triangles and transition zones for smooth definition (Fig. 77.2a).
After that, fat grafting zones are drawn in different muscles to improve projection and volume (Fig. 77.2b).

Warning: Remember to use a color code for your own markings. This will help you to differentiate structures and the intraoperative process.

Some adhesion zones in the male (prohibited in the female) need to be considerably defined as they will enhance the masculine appearance. These comprise the trochanteric depression, paravertebral, and pectoral triangles (Fig. 77.2a).
In the obese patient, ultrasound may be useful to delimit some additional anatomical features.

**Fig. 77.1** Gross anatomical landmarks: Muscular limits and disposition for subsequent definition.

**Fig. 77.2** Specific markings (code of color): Negative spaces and transition zones **(a)** are marked in *green* while fat grafting zones **(b)** are drawn with *red and purple*. Note that some adhesion zones **(a)**—prohibited in the female lipoplasty—need to be treated to exalt the muscular appearance.

77.2 Operative Steps

See Video 77.1.

77.2.1 Stealth Incisions

Incisions should be placed over hidden skin creases or maybe over the underwear’s line, as scaring can leave horrible marks (Fig. 77.3).
As the male patient needs an athletic definition, additional incisions are sometimes needed.
Gentle flap and incision manipulation helps the healing process.