Noninvasive and minimally invasive treatments are increasingly supplanting, or complimenting, abdominoplasty. For optimal delivery of patient care and to maintain a dominant share of the body-contouring market, plastic surgeons need to embrace these new technologies. High capital purchases, costly disposables, maintenance fees, lack of experience, conflicting anecdotal reports, energy-related complications, marketing hyperbole, and rapid obsolescence are formidable barriers to this adoption. Receptive plastic surgeons may be best served by accepting brief short-term retrospective reports by reputable innovative body contouring surgeons who present a succinct and clinically supported message.
Key points
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New energy-based technologies may supplant invasive surgery for mild to moderate skin laxity.
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New energy based technologies may reduce the extent of surgery and resulting scars.
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Access to effective and safe energy based technologies provides a wide range of options for consumers interested in noninvasive and minimally invasive techniques.
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New energy based technologies can have a reasonable return on investment by increasing referrals for traditional body-contouring procedures.
Video content accompanies this article at http://www.plasticsurgery.theclinics.com .
Introduction
For decades in the senior author’s practice, the most frequent aesthetic surgery request has been for improvement of abdominal contour. Patient presentations vary from thin with wrinkles to obese with a hanging pannus and oversized girth. Additionally, patients are frequently concerned with oversized flanks and backs, and sagging mons pubises and buttocks. Once surgical options, which involve removal of excess skin and fat, are discussed, patients’ responses range from abhorrence to surgery and/or scars to acceptance of whatever incisions it takes to obtain the desired result. Most inquirers for contouring of the torso not only welcome but are intrigued by noninvasive and minimally invasive treatments to supplant or augment anticipated or revision abdominoplasty.
Patients readily grasp that in the process of correcting their abdominal contour deformities, their entire torso can be recontoured. To obtain the optimal result, the authors favor oblique flankplasty and lipoabdominoplasty supplemented with ultrasonic assisted liposuction, radiofrequency skin tightening, and electromagnetic energy muscular enhancement.
Comprehensive contouring of the torso involves up to 8 interactive tools. Complex and lengthy excisions are complimented with preoperative weight reduction and intraoperative energy-based technologies.
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Human choriogonadotropin (HCG)/500 calorie a day diet to reduce high body mass index ,
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VASER ultrasound-assisted lipoplasty to debulk fat, undermine flaps, and harvest adipose tissue ,
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BodyTite bipolar radiofrequency to tighten subcutaneous tissue
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Morpheus8 bipolar radiofrequency to tighten and rejuvenate skin
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Lower body lift with abdominoplasty when flank laxity is absent
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Oblique flankplasty with lipoabdominoplasty (OFLA) to narrow a sagging waist, tighten the torso, and lift the buttocks and lateral thighs
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J Torsoplasty with breast reshaping to compliment an OFLA or lower body lift
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EmSculpt high-frequency electromagnetic energy for muscular development and toning
This article now focuses on noninvasive and minimally invasive energy-based treatments that supplant, minimize, or compliment abdominoplasty. For optimal delivery of patient care and to stay competitive, plastic surgeons should embrace appropriate supportive technologies.
Nonplastic surgeons often working in noncertified clinics and spas are usurping patients through marketing of energy-assisted technologies for improved abdominal contour. Their message is that advanced, expensive technology offers scarless, painless, rapid recovery and a safer alternative to abdominoplasty. Having only 1 or 2 machines, these clinics are tempted to expand their limited therapeutics beyond the appropriate indications. Given their depth of training in traditional body contouring techniques, plastic surgeons are in the best position to provide quality care using these newer technologies. This is clearly in the best interest of our patients. Based on our conscientious effort to sift through competing manufacturers’ claims and clinical cases, this article presents the technology we have chosen and how we apply it into our patients concerned about their torso aesthetics.
External application of energy (SculpSure, TruSculpt)
The most popular noninvasive application of energy is the external freezing of adipose. Aware of the saturation of Coolsculpt machines in the Pittsburgh market, and its occasional side effect of paradoxic adipose hypertophy, we have purchased both the laser (SculpSure) and radiofrequency (TruSculpt) alternatives. Our TruSculpt from Cutera is too new to comment on. However, the Hurwitz Center has about an 80% patient satisfaction in more than 50 patients with using SculpSure. The set of three 20-minute applications of the penetrating CO 2 laser with immediate skin cooling requires mild sedation, while obtaining subtle improvements. We have had no incidences of paradoxic adipose hypertrophy in our small series.
Frustrated body builders have an alternative to enhancing strength and tone to both core and extremity muscles ( Fig. 1 ). We are applying EmSculpt to early postoperative abdominoplasty and VASERlipo patients and have seen encouraging improvement in core strength and shape ( Fig. 2 ). Abdominal etching can also be created naturally through muscular development.
Through the use of electromagnetic external pulses including 6 treatments of 30 minutes per treatment over 3 weeks duration, the electromagnetic external pulsations has resulted in stronger and more toned abdominal and gluteal muscularity in both young patients and postabdominoplasty patients with 85% satisfaction (see Fig. 1 ). Should patients be dissatisfied with the technique, we provide a 50% credit of their cost to other Medi Spa services or plastic surgery. EmSculpt has recently also been approved by the US Food and Drug Administration for extremity muscles.
Preoperative rapid weight loss human choriogonadotropin 500 calories a day 6-week diet
Overweight and obese individuals, especially those with excessive abdominal girth, requesting abdominoplasty are at risk for delayed wound healing and poor aesthetic results. Rather than rejecting these patients, for the past 14 years our center has offered the HCG 500 calories per day diet. This diet consists of a high-protein diet and HCG injections for 6 weeks. , The HCG hormone encourages visceral fat metabolism and reduces hunger for loss of nearly a pound a day. Preoperatively treating hundreds of patients, more than 80% have lost enough weight to successfully proceed with extensive body contouring operations. The demonstrative patient is a 32-year-old woman who lost 30 pounds on the HGC program to lower her body mass index from 32 to 27 ( Fig. 3 ). Her lipoabdominoplasty included imbrication of her diastasis recti and umbilical herniorrhaphy, plus VASERlipo of the flanks and lipoaugmentation of her breasts. Two years later, she has gained only 5 pounds and maintained her figure (see Fig. 3 ).
