Jason Emer, MD

Liposculpture and Body Contouring Specialist, Cosmetic and Laser Dermatologist, Beverly Hills, CA.

In today's CrossFit era, many people want to look good naked or minimally dressed. So, they watch their calories and spend lots of time at the gym—and that's great. But all the chest presses in the world can't always erase gynecomastia. A diet packed with salmon, green tea, and dark chocolate won't always make thigh cellulite disappear. That's where liposculpture comes in. Liposculpture features a variety of new liposuction techniques to safely and effectively remove fat from areas where people don't want it and deposit it where they do in order to contour and shape the body, rather than simply to reduce size. Those who fail to obtain the body they want despite the most disciplined diet and exercise regimens are the best candidates, because they are driven to achieve and maintain their best body. These passionate and focused people are turning to cosmetic surgeon artists who effectively use these new techniques to help them get there.

The Evolution of Liposuction

Modern liposuction has been around for more than 40 years, and is the second most common cosmetic procedure (behind breast augmentation). It has come a long way from the days when fat removal resulted in burned or bruised skin and lumpy tissue and left the removed fat damaged and therefore unusable. Large cannulation by hand or power devices aggressively broke apart the fat, which caused irregularities and actually worsened cellulite. Then the laser came along and, while results were smoother, it damaged fat cells so they could not be used elsewhere in the body. Further, when untrained people used these energy-based devices, the results often included burns, internal scarring or fibrosis, and indentations or irregularities.

Today, thanks to a number of cutting-edge technologies, a skilled artistic approach, and pre- and post-surgery optimization, patients can have their entire bodies sculpted, contoured, and reshaped like never before. The benefits of these techniques range from tightening the skin to reshaping body planes, using fat to define muscles or lift and shape other parts of the body. The result is a patient who looks (and is) fit and defined.

New Techniques, New Body

Recently, a plethora of new devices and techniques have been developed to avoid common issues of previous methods and allow whole-body contouring and reshaping. Skilled cosmetic surgeons trained in these new techniques and devices can perform procedures in deeper layers of fat, as well as more superficially than done by traditional liposuction, in order to both reshape the body and smooth the skin. These techniques remove fat without damaging it, allowing it to be reused elsewhere in the body to provide high-definition contouring and improve cellulite and dimpling, even that resulting from previous surgeries. As a result, patients can have shapely buttocks, breast augmentation without implants, and body definition where they want it, from the abdomen (six pack) and pecs to shoulders and calves. These newer techniques include:

Ultrasound—The VASERlipo device uses ultrasound energy to break apart scar tissue and allow the fat to be separated from tissue without being harmed or damaged, like wind blowing leaves off a tree. It enables a large area of fat reduction and promotes good body-shaping because the device is gentler and tightens the skin more effectively than traditional procedures. This is due to steam heat being released under the surface of the skin, which promotes internal skin shrinking.

RF energy—Devices such as ThermiRF use radiofrequency (RF) energy to enable subdermal heating without fat reduction to smooth skin. J-Plasma combines RF with cold helium plasma, which heats intensely while simultaneously cooling and allowing the skin to tighten while limiting the risk of burns.

Water-assisted liposuction—Body-jet liposuction gently harvests the fat using water, improving the viability of the fat cells.

Stem-cell therapy—While it's early, stromal vascular faction (SVG) and platelet-rich plasma (PRP) are proving to be helpful in rejuvenating fat. Adding PRP to fat helps improve its survival and longevity and promotes healing in areas that it is injected.

Combination Therapies for Best Outcomes

The latest trend is to combine therapies to achieve a significant transformation. Performing liposuction and skin removal (e.g., tummy tuck) at the same time gives a much better athletic contour. During this procedure, a water-assisted device is used to hydrate the treatment area and prepare it for fat extraction with limited blood loss or damage to overlying skin; ultrasound is then used to soften the fat, tighten the skin, and create contour; and a power-assisted device then removes the fat and creates contour. PureGraft filtration produces the purest fat without oil, debris, or blood; fat is then reinjected in the body musculature or face to give shape and definition; and lastly, internal heating devices such as ThermiRF or J Plasma are used in problem areas to shrink wrap and tighten the skin. Skin removal in areas of significant sagging is then performed to get the most toned look. A combination approach by a team of skilled cosmetic surgeons can give results unparalleled to previous traditional approaches. Patients must be individually assessed by this team to determine the most impactful combination of procedures based on the person's skin and body desires.

Preparation and Follow-up Care

The importance of optimizing a patient for surgery and then accelerating recovery is becoming increasingly clear, particularly for cosmetic surgery. Why treat a side effect when you can prevent it? Previously, the protocol was limited to having a patient wear a compression garment and waiting for nature to take its course, resulting in a healing process of six to nine months.

Today, there are a number of things that should occur in the three to five days before surgery to best prepare the patient's body for having surgery and healing from it afterwards. They can include: providing intravenous (IV) fluids with vitamins, amino acids, calcium, and electrolyte hydration; lymphatic massage; LED therapy such as LightStim; and trigger point therapy.

For seven to 14 days after surgery—in some cases longer—various methods can be used to help rid the body of fluid, increase blood flow, and stimulate the draining of waste products. These methods include wearing specialized compression garments, lymphatic massage, IV therapy, hyperbaric oxygen therapy (which increases the amount of oxygen that reaches the tissues, promoting healing), RF treatments (such as Venus Legacy and Exilis Ultra), shock therapy to break apart scar tissue and prevent it from forming (using Cellutone) and LED therapy. This multimodal protocol helps tighten the skin, prevent irregularities from occurring and promote healing.

Ultimately, today's artistic and high-tech liposculpture options, supported by pre- and post-optimization protocols, give patients confidence and motivation to maintain their best bodies by eating right, exercising and staying fit. It's important that patients know that they need to turn to highly skilled cosmetic surgeons who have the credentials—including extensive education, training and experience—to safely perform these procedures and deliver high-quality care and results.

Visit CosmeticSurgery.org for more information on how the American Academy of Cosmetic Surgery (AACS) is advancing the field of cosmetic surgery and ensuring patients receive safe, high-quality care and results.

Dr. Emer and other leading cosmetic surgeons provide their expertise on advanced liposuction techniques and other topics at AACS educational programs, including the 2017 World Congress on Liposuction, which took place on September 14-17 in Chicago and the 2018 Annual Scientific Meeting, which will take place on February 1-3 in Las Vegas, NV. Visit cosmeticsurgery.org for more on AACS educational programs.