The Concept of Human Sculpting: Light, Shadow, and Form

and Peter M. Prendergast²

(1)

Elysium Aesthetics, Bogota, Colombia

(2)

Venus Medical, Dublin, Ireland

Introduction

Sculpting the human body in order to improve definition involves a careful process of selective lipoplasty to reveal underlying structures: muscles, tendons, and bony landmarks. A sound knowledge of osteology and myology is a prerequisite for high-definition sculpting; you have to know what you are defining before you can learn how to define it. The muscles and soft and hard tissue structures that lie beneath the subcutaneous fat contribute to the beautiful and organized irregularity that comprises the human form. No part of the human body is flat, nor is it completely convex or uniformly curved. Subtle irregularities, contrasts, and angles contribute to physical attractiveness in slim and athletic individuals, provided they are harmonious. Various convex forms, elegantly linked through transition zones and spaces, with myriad planes, curves, and contrasts unite to create the whole.

High-definition body sculpting is a form of free-standing sculpture or sculpture “in the round.” The completed masterpiece is meant to be viewed from all sides and is surrounded entirely by space. The beauty of the final work is manifest through the interplay between light and shadow. The palette, therefore, of the lipoplasty surgeon is black and white. Forms that fall away from the light source appear darker than those rising toward it. By developing artistic skills and an appreciation for the interaction between light and form, the surgeon can begin to define the anatomy and traits that represent cues for physical attractiveness. Instead of traditional materials, such as wood, bronze, or marble, the lipoplasty surgeon’s sculpting substrate is fat [1–3].

Lipoplasty as Sculpting

Techniques in lipoplasty have evolved considerably over the last century. In 1921, Dujarrier used a crude curetting technique to remove fat from the lower limb of a ballerina dancer. This led to gangrene that necessitated an amputation [4]. Schrudde, a German surgeon, described his method of “lipexheresis” using a special uterine curette through small incisions [5]. Unsightly scars, bleeding, infection, and irregularities plagued early fat removal procedures and hindered progression in the field. The curette method by Kesselring and Meyer was noted to be only beneficial for the greater trochanteric regions, and attempts by Goodstein and Hoefflin to use a cannula with a sharp trailing edge acting as a curette in the subdermal tissues resulted in lymphorrhea and skin necrosis [6]. In 1975, Giorgio and Arpad Fischer published their work using cannulae with rotating blades, or planatomes, to suction fatty deposits [7]. Ilouz and Fournier followed with their formidable work on the development of liposuction and were instrumental in popularizing the technique among physicians of several specialties throughout the world. Although office-based surgery was performed over a 100 years ago, initially, liposuction was only practiced under general anesthesia in a hospital setting [8]. It was not feasible to remove large volumes of fat using blunt or sharp instruments under standard infiltrative local anesthesia, since the doses required for body contouring would have almost certainly resulted in lidocaine toxicity. The practice of liposuction was revolutionized in 1987 when Jeffrey Klein published his ingenious technique of anesthetizing large areas of subcutaneous fat using a mixture of diluted local anesthetic and epinephrine [9].

The advent of the tumescent technique, refinements in the procedure, improved instrumentation and the development of new technologies have lead to an increase of popularity of body conturing surgery [10]. In 2011, lipoplasty was the most common aesthetic surgical procedure in the USA with over 325,000 procedures completed [11]. Modern lipoplasty has evolved from a basic, debulking, fat removal to a form of artistic body sculpting. Smaller multi-holed cannulae have replaced larger single-holed ones to provide smoother, more precise results. Power-assisted lipoplasty (PAL) instruments efficiently and evenly remove fat through gyration, rotation, or nutation. Third-generation ultrasound-assisted lipoplasty (UAL) technology and instrumentation allow very gentle lipo-emulsification even in superficial subcutaneous planes. While some improved definition may be possible with traditional suction-assisted methods, high-definition lipoplasty cannot be realized safely without these modern technological tools.

Removal vs. Revealing

In order to achieve a postoperative result that is aesthetically appealing, harmonious, and balanced, we must approach the human form with the eye of a sculptor. Although fat removal is part of high-definition body sculpting, it is not the chief aim. Traditional liposuction in overweight patients focuses on removal, whereas high-definition lipoplasty in patients of normal weight focuses on revealing. In essence, the advanced lipoplasty surgeon is a sculptor revealing the elegant underlying muscular and bony anatomy. The sculptor starts with the armature and adds clay to sculpt the human form; the surgeon starts with a form and modifies it by removing excess, adding in deficient areas, and creating controlled deformities that represent clues to suggest the underlying anatomy [3].

Chief Lines

As a sculptor, the surgeon considers the chief lines in the form. Anteriorly this runs from the suprasternal notch, through the midline of the sternum, and along the depressed linea alba. The posterior chief line runs along the midline of the back as a gulley between the erector spinae group. On profile, the posterior chief line depends on posture, spinal anatomy, and gluteal soft tissue volume. The latter can be augmented during lipoplasty to enhance the beautiful “S” curve that continues from the lumbar lordotic curve above. Anteriorly, breast projection in females and upper pectoral fullness in males dominate the chief line. The actual appearance of the chief lines, lines of contrast, and surface definition are produced as a result of the interaction of light and shadow. Gradations of light and shadow determine our perception of surface form and, ultimately, our perception of beauty [1–3].

Light and Shadows

The patterns of light reflection and absorption from surfaces determine what we see. In general, the skin is semi-matte, and light reflects from skin in a uniform way referred to as form light [12

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