Body Contouring Using VASER-Assisted Liposuction

Fig. 13.1

(a) Healthy fit female. (b) Healthy male

Nowadays, there is no single leading trend; the particular desires have to be addressed based on the individual aspects as the geographic location, age, fashion trends, and ethnicity.

Surgical improvement of the human shape was greatly enhanced with the development of the liposuction techniques. The first attempts to do so only removed the extra fat tissue to create a flat contour. As the quality of the procedures improved the patient’s expectations began to grow, asking for better and more natural outcomes. The natural ideals comprise a complex mixture of shapes consisting in concavities and convexities which translate the underling muscles and bones to the superficial envelope and create the desired contour. By contouring with a selective extraction of some places and grafting the fat tissue on others, better outcomes can be achieved and the desired athletic body can be reached. This method lets us individualize the needs of each patient to offer a tailored option according to each body biotype [3] (Fig. 13.2a–c).

../images/978-3-030-26875-6_13_Chapter/978-3-030-26875-6_13_Fig2_HTML.jpg — Fig. 13.2

Body biotypes: (a) Slim/ectomorphic. (b) Athletic/mesomorphic. (c) Fat/endomorphic. Each biotype requires a different approach to achieve the best results

The Ultrasound

The improvement of the ultrasound technologies to assist the liposuction overcomes the limitations and serious complications of the first ultrasound generations. The pulsed low-power ultrasound with a solid small-diameter titanium grooved-tip probe increased the efficiency of fragmentation of the fat tissue mainly by means of cavitation. The secondary thermal effect also had an effect on the underling dermis allowing to improved retraction of the skin.

Becoming a safer procedure with a better control of most complications leads to extraction of higher amounts of fat and facilitate the secondary procedures. As the learning curve improves, the replicability of the results enhances.

The marking process is an essential part of the procedure. The superficial anatomy must be considered as a dynamic structure that must be tailored to each patient’s condition, anatomic landmarks, and muscular movements. This approach implies an extra effort in preparation and the anatomical and artistic knowledge about body aesthetics to identify the dominant or “alpha” muscle from each anatomical area. The alpha muscles are responsible for defining the body shape in every region of the anatomy; it may be not the bigger muscle but the one that gives the “identity” of an athletic shape as seen in Fig. 13.3 [4, 5].

../images/978-3-030-26875-6_13_Chapter/978-3-030-26875-6_13_Fig3_HTML.jpg — Fig. 13.3

Sample of the alpha muscles: The deltoid is not the biggest muscle of the arm, but it is the one that gives the impression of power and health and contributes to the V shape of the torso

The adequate warping of the skin after the fat removal is a pivotal issue to be considered to reach the desired outcome. This is an intrinsic characteristic of the skin that is related mainly to age, nutritional factors sun exposure, body type, and weight changes. For this reason, each patient must be individualized and analyzed to get the best possible result. The retraction has to be considered in a three-dimensional way: horizontal, vertical, and depth level. Better results are achieved when the sculpturing is done in a circumferential manner (Fig. 13.4).

../images/978-3-030-26875-6_13_Chapter/978-3-030-26875-6_13_Fig4_HTML.jpg — Fig. 13.4

(a) Pre surgical images. There is a lack volume the medial ans superior gluteal area, poor definition on the lowerback and a trochanteric depression. (b) Post surgical images. There can be seen a smooth transition from the waist, hips and the upper tigh and an aquedate superior volume

Complications

The complications derived from the liposculpture and the ultrasound must be prevented and carefully addressed for patient safety and the success of the procedure.

The seromas are the most frequent complications caused by the mechanical disrupting of the lymphatics and the trauma to the soft tissue. The systematic use of drainages on selective areas like sacral in women and inguinal in men easily reduces the presence of seroma.

Coloration changes are a common issue due to the trauma in the vascular subdermal plexus resulting in the cutis marmorata. This can be addressed using smaller 3 mm cannula for superficial use in some areas: waistline, inner thighs, posterior arm, and neck.

The burns are closely related to the learning curve. Virtually all of them can be prevented by systematically protecting the skin with an adequate infiltration, wet surgical towels, and tightly secured ports.

As the skin flap is thinned searching for retraction, irregularities on the contour derived from wrinkling and irregular draping can occur. To properly drape and avoid this issue, the use of a foam compression garment enhances and makes even the pressure reducing the irregularities and enhancing the recovery time [2].

The Contouring Process

Preparation

The fat extraction must be done in a multilayer and anatomical basis aiming to reproduce the superficial muscular anatomy. Fat grafting is an essential part of the contouring enhancement to achieve a realistic athletic shape. The muscular definition process can be easily done by means of extraction, grafting, and a good skin retraction. Special attention must be taken over specific “alpha” muscular groups: the rectus abdominis, serratus, obliques, pectoralis, latissimus dorsi, and deltoids.

The patient selection is critical and directly related to the outcomes and the patient satisfaction. Obese patients, with severe skin laxity or after massive weight loss are not good candidates due to the higher risks of complications and poor outcomes. The lack of adherence to a healthy lifestyle including physical activity and adequate diet also makes the patients bad candidates for the procedure.

The surgical planning begins with the anesthesia consultation and individual analysis of the patient. The marking process must be carefully done according to the patient particularities. The incisions are designed to reach all the desired areas and to get the best possible hidden scar.

The Procedure

To ensure an appropriate and safer emulsification of the fat, a tumescent solution with an infiltration/extraction ratio close to 2:1 must be administrated. The ultrasound emulsification must begin on the superficial layers using non-continuous mode (Vaser mode) and then emulsification on the deeper layers by using the continuous mode. Be extremely careful to avoid burns by the use of skin protection on the port, an adequate volume of infiltration, and protection from the body of the probe.

The use of vibration or power assistance to the vacuum extraction is a helpful way to facilitate and enhance the process by saving time, reducing the effort and blood loss.

The deep fat must be adequately removed and the superficial removal must be emphasized over the superficial muscle groups to define athletic depressions, such as the linea alba, lateral borders of the rectus, or the deltoid edges.

Fat grafting helps to restore volume and the appearance of the buttocks, deltoids, pectoralis in male, and breast in female. The graft technique is done according to the target area: for most cases decantation is enough, whereas for areas with less amount of graft needed, it is preferred to use inner thigh and lower abdomen fat for graft source and centrifugation with the aim of concentrating the largest possible amount of viable adipose tissue and stem cells [6].

Active drainage plays an important role in avoiding complications however its use is not universal; it is recommended to be used only in the places with high risk of seroma such as the lower back in males (Fig. 13.5).