High Definition Body Sculpting

This unique book details advanced techniques in lipoplasty and autologous fat grafting for high-definition body sculpting. Clear step-by-step explanations of techniques are accompanied by numerous color illustrations and photographs. The first section includes chapters on surface and muscular anatomy, anesthesia, assessment, technologies for ultrasound-assisted lipoplasty, and postoperative care. High-definition sculpting of the male and female abdomen, trunk, back, chest, and upper and lower limbs is then described in detail, and clear instruction is provided on autologous fat grafting for contouring the buttocks, breasts, and pectoral areas. The book will provide a fascinating insight into the art and practice of high-definition body sculpting for all surgeons who perform lipoplasty and body contouring techniques.  It will also serve as an ideal aid for all practitioners who are pursuing workshops and practical training in this exciting new area of aesthetic surgery.

CONTENTS
Part I Art and Science
1 The Human Form as Art: Contours, Proportions,
and Aesthetic Ideals 3
Introduction . 3
Art and Anatomy . 4
Liposuction Technology and Body Art . 6
Human Form . 7
Symmetry and Proportions . 8
Aesthetic Ideals and the Science of Beauty 11
References . 18
2 Muscular and Surface Anatomy 19
Introduction . 19
Trunk Muscles . 19
Rectus Abdominis 19
External Oblique . 22
Serratus Anterior 23
Pectoralis Major 24
Latissimus Dorsi . 25
Erector Spinae 25
Multifidus . 27
Shoulder and Arm . 27
Deltoid 27
Triceps 28
Biceps . 29
Brachialis 30
Thighs and Hips 30
Gluteus Maximus 30
Gluteus Medius . 31
Iliopsoas 31
Quadriceps 32
Hamstrings 34
Sartorius 34
Adductor Group 35
Contents
xii
Lower Leg . 36
Gastrocnemius 36
Soleus . 36
Fat Distribution . 36
References . 39
3 The Concept of Human Sculpting: Light, Shadow,
and Form 41
Introduction . 41
Lipoplasty as Sculpting . 41
Removal vs. Revealing 42
Chief Lines 42
Light and Shadows 42
Contours and Form . 43
Positive and Negative Spaces 44
Advanced Lipoplasty Techniques . 44
Infiltration . 45
Emulsification . 45
Aspiration . 46
Controlled Deformities . 46
Fat Grafting . 47
References . 48
4 Preoperative Assessment and Preparation
for High-Definition Body Sculpting . 49
Introduction . 49
Consultation 49
History . 50
Physical Examination and Assessment . 52
General . 52
Abdomen and Torso 52
Chest . 54
Arms . 55
Buttocks, Thighs, and Calves . 55
Patient Selection 56
Preparation 56
References . 64
5 Anesthesia: Tumescent, MAC, and General . 65
Introduction . 65
Preanesthesia . 65
Medical Record 65
Tumescent Anesthesia . 67
Monitored Anesthesia Care (MAC) 70
General Anesthesia . 70
Premedication and Indications . 71
Surgical Management . 71
Postsurgical Anesthetic Management . 72
References . 72
6 VASER Technology for Ultrasound-Assisted
Lipoplasty 73
History . 73
Principles of UAL and VASER . 74
VASER® Technology and Instrumentation . 76
VASER® Technique . 78
Advantages 80
References . 80
7 Fat Anatomy, Metabolism, and Principles
of Grafting . 83
Liquid Gold . 83
Fat Metabolism and Endocrinology 84
Fat Anatomy: The Subcutaneous Tissue
and Superficialis Fascia . 85
Equipment . 86
Technique 86
Donor Site . 87
Harvesting . 87
Graft Processing 88
Injection Procedures 89
References . 90
Part II The Male Patient: Technique
8 Male Abdomen and Torso 95
Introduction . 95
Stealth Incisions 96
The Use of Drains . 96
Markings . 97
Deep Markings . 97
Framing . 97
Negative Spaces 99
Procedure 100
Infiltration . 100
Emulsification . 100
Extraction . 101
Defining the Rectus Abdominis 102
Midline . 104
Postoperative Care 104
References . 107
9 Male Chest . 109
Introduction . 109
Stealth Incisions 111
The Use of Drains . 111
Markings . 111
Deep Markings . 111
Framing . 111
Negative Spaces 112
Procedure 112
Infiltration . 113
Emulsification . 113
Extraction . 113
Fat Grafting 114
Postoperative Care 114
References . 117
10 Male Arms . 119
Introduction . 119
The Arm Has Curves 119
The Youth Angle . 119
Stealth Incisions 120
The Use of Drains . 121
Markings . 121
Deep Markings . 121
Framing . 121
Negative Spaces 123
Procedure 123
Infiltration . 123
Emulsification . 123
Extraction . 123
Fat Grafting . 126
Postoperative Care 126
References . 127
11 Male Torso and Back 129
Introduction . 129
Stealth Incisions 129
The Use of Drains . 129
Markings . 130
Deep Markings . 130
Framing . 130
Negative Spaces 131
Procedure 132
Infiltration . 132
Emulsification . 133
Extraction . 133
Postoperative Care 136
References . 136
12 Male Buttocks and Thighs 137
Introduction . 137
Stealth Incisions 138
The Use of Drains . 138
Markings . 139
Deep Markings . 139
Framing . 139
Negative Spaces 139
Procedure 140
Infiltration . 140
Emulsification . 140
Extraction . 140
Fat Grafting . 141
Postoperative Care 141
References . 143
Part III The Female Patient: Technique
13 Female Abdomen and Torso 147
Introduction . 147
Stealth Incisions 148
The Use of Drains . 148
Markings . 148
Deep Markings . 148
Framing . 148
Negative Spaces 149
Procedure 150
Infiltration . 150
Emulsification . 150
Extraction . 150
Fat Grafting  . 151
Postoperative Care 151
References . 155
14 Female Dorsum, Flanks, and Hips 157
Introduction . 157
Stealth Incisions 157
The Use of Drains . 158
Markings . 158
Deep Markings . 158
Framing . 158
Negative Spaces 158
Procedure 160
Infiltration . 160
Emulsification . 160
Extraction . 160
Fat Grafting  . 161
Postoperative Care 161
References . 163
15 Female Buttocks 165
Introduction . 165
Stealth Incisions 166
The Use of Drains . 166
Markings . 166
Deep Markings . 166
Framing . 166
Negative Spaces 167
Procedure 170
Infiltration . 170
Emulsification . 170
Extraction . 171
Fat Grafting .172
Postoperative Care 172
References . 176
16 Female Breasts . 177
Introduction . 177
Stealth Incisions 178
The Use of Drains . 178
Marking . 178
Deep Markings . 178
Framing . 178
Negative Space . 178
Procedure 178
Infiltration . 178
Emulsification . 179
Extraction . 179
Fat Grafting . 180
References . 185
17 Female Arms 187
Introduction . 187
Stealth Incisions 187
The Use of Drains . 187
Markings . 188
Deep Markings . 188
Framing . 188
Negative Spaces 188
Procedure 189
Infiltration . 189
Emulsification . 189
Extraction . 189
Fat Grafting . 191
Postoperative Care 191
References . 191
18 Female Lower Limb: Thighs and Calves 193
Introduction . 193
The Ideal Leg 193
Stealth Incisions 194
The Use of Drains . 195
Markings . 195
Deep Markings . 195
Framing . 197
Negative Spaces 197
Procedure 198
Infiltration . 198
Emulsification . 198
Extraction . 198
Fat Grafting .200
Postoperative Care 200
References . 203
Part IV Postoperative Considerations
19 Postoperative Care 207
Targets of Postoperative Care . 207
Drainage 207
Compression . 208
Ambulation 210
CARE System of Postoperative Care 211
Manual Lymphatic Drainage . 212
External Ultrasound (US) . 214
Physiological and Therapeutic Effects
of External Ultrasound . 214
Precautions Using External Ultrasound 215
Pressotherapy 215
Physiologic and Therapeutic Effects of Pressotherapy 215
Contraindications to Pressotherapy 216
Energy-Based Therapies . 216
Diathermy . 216
Wet Heat 217
Carboxytherapy . 217
References . 217
20 Complications of High-Definition Body Sculpting . 219
Introduction . 219
General Liposuction Complications . 219
Bleeding 219
Infection 220
Necrosis 220
Seroma 221
Thromboembolism . 221
Pulmonary Edema 221
Lidocaine Toxicity 222
Perforation 222
Fat Embolism 223
Specific Energy-Assisted Liposuction Complications 223
Complications Related to High-Definition
Body Sculpting . 223
Contour Irregularities . 224
Skin Retraction . 225
Asymmetry . 225
Unnatural Appearance 226
Fibrosis and Nodularity 227
Unsightly Scars . 227
Loose Skin 228
Burns . 228
References . 228
21 New Developments in High-Definition
Lipoplasty . 231
Introduction . 231
Mini-abdominoplasty with Definition . 231
Full Lipoabdominoplasty with Definition . 233
The Initial Concepts of Dynamic Definition . 233
Post-Bariatric Surgery Patient . 233
High-Definition Breast Enhancement with Enriched Fat . 236
Cellulite and Secondary Fibrosis Patients . 236
Defining the Future . 237
Index . 239

Alfredo Hoyos, MD, is a board-certified Plastic Surgeon from Bogotá, Colombia. He undertook his medical training at Rosario University and subsequently specialized in plastic surgery. Dr. Hoyos is the inventor of high-definition liposculpture (HDL) and other advanced body contouring techniques. Making use of cutting-edge VASER technology, he designed VASER Hi-Definition Lipoplasty (VHD), which produces a high muscle definition in both men and women. Dr. Hoyos and his associates have performed more than 1500 procedures with reliable, consistent, and safe results. Dr. Hoyos continues to refine these techniques as well as to develop and create new applications of HDL to additional anatomical regions. Furthermore, he has extensive experience as a lecturer and trainer for both VASER and Smartlipo. Dr Hoyos is also a medical illustrator, painter, and sculptor. Peter Michael Prendergast, BMedSc, MB, BCh, BAO (Hons), MRCSI, graduated from the National University of Ireland in Cork and De La Salle College in Waterford. After a final medical clerkship at Harvard Medical School and Massachusetts General Hospital, he completed his surgical training at the Adelaide and Meath Hospital, Dublin. Since 2005 he has been in private practice in aesthetic medicine as the Medical Director of Venus Medical. He is an official trainer for VASER-assisted lipoplasty. Dr. Prendergast is Founder and President of the European College of Aesthetic Medicine and a Founder Member of the Irish Association of Cosmetic Doctors. He has delivered courses and lectures across the world on a range of topics in aesthetic medicine and is the author of many book chapters and journal articles. In 2011, Dr. Prendergast co-edited the book Aesthetic Medicine: Art and Techniques with Melvin A. Shiffman.