American Society of Plastic Surgeons
For Medical Professionals
 

Body contouring's latest frontier: High-definition liposuction
Refined techniques, contoured effects and long-lasting results are just a few reasons why requests for hi-def liposuction are soaring

Liposuction continues to be one of the most popular cosmetic surgeries in the world. Even during a pandemic year, more than 210,000 liposuction procedures were performed, making it the fourth most popular procedure of 2020, according to the American Society of Plastic Surgeons.

Noninvasive fat-burning treatments, like EmSculpt and CoolSculpt, are also still incredibly popular, but despite the leaps in technology, no device rivals the efficacy or the results of good, old-fashioned liposuction. That is, except for the next-gen lipo: high-definition liposuction.

Surgeons attribute the spike in hi-def liposuction requests to our culture's increasing hype surrounding fitness (revenge body, anyone?), wellness and #bodygoals. The growth in popularity may come as a result of hi-def's ability to target and zap stubborn pockets of fat in a way that no other surgery or treatment can.

Two ASPS members, Philadelphia's Christian Subbio, MD, and San Francisco-based David Sieber, MD, share their knowledge and nuance of the still-mysterious hi-def liposuction.

Hi-def lipo vs traditional lipo

Both types of liposuction are a transformational, dependably safe, procedure for stubborn pockets of flab nearly anywhere on the body, but as its name suggests, hi-def offers next-level visual effects.

"Classical liposuction is just volume reduction," Dr. Subbio says, but hi-def is a specific "more focused and sculpting intensive" technique to "give the appearance of tone and definition of the musculature."

Hi-def only works well in a highly selected group with pinchable amounts of fat that haven't budged to diet or exercise and who are otherwise super fit and follow a healthy lifestyle, says Dr. Subbio.

"In high-definition liposuction, you're still sucking the fat out," explains Dr. Sieber. "However, you're leaving those muscles a tiny bit thicker than the surrounding areas, to give the muscle more definition and contour." This leaves natural shadows in the newly formed dips to highlight the musculature.

Surgeons that perform hi-def often turn to Vaser, a machine that uses ultrasonic energy to help break down the fat more gently than traditional liposuction.

"I always tell patients that if you think of the fat like grapes on a vine, with traditional lipo, you're just going in and sucking the grapes off the vine," says Dr. Sieber.

In contrast, Vaser liquefies fat cells, making them easier to extract, and "allows surgeons to be more aggressive in those areas where you really want to achieve that definition," explains Dr. Subbio.

Can anyone get hi-def lipo?

First things first: an ideal candidate is a healthy adult usually within 10 pounds of their goal weight, or with a BMI of 28 or below, for Dr. Sieber to consider the procedure. But hi-def or not, "no form of liposuction is really ideal for weight reduction or for massive volume reduction," cautions Dr. Subbio.

Surprisingly, the limited candidate pool rarely disqualifies someone due to fat, but rather whether their skin has a rubber band snap-back quality. "You really want the skin to kind of shrink wrap down around the areas you've treated," says Dr. Sieber. Otherwise, the sudden volume loss will just result in hanging, excess skin, which defeats the entire purpose.

What are the go-to areas? Are there any risks?

Hyper-chiseled abs, precisely cut deltoids and other areas boasting superhero muscles are the most convincing benefit of a hi-def lipo procedure, especially for pockets of fat many of us struggle with toning. "The most popular areas for both sexes are abdomen and flanks," notes Dr. Sieber. "Then the second or the third most popular spot for women is likely the back, and for men, it's the chest. There's also arms and inner thighs, which are probably four or five on the list."

Still, suctioning fat out of these hi-def hotspots is only half the battle to an overall cut look – your new jaw-dropping definition has to work in harmony with the rest of your physique. Meaning that lipo shouldn't only be performed in these high-demand spots.

"So when they're done, it looks like they've been working out their entire body, not just one part, and their arms, legs and torso all have the same degree of musculature to them," explains Dr. Sieber. "It sounds silly, but it's really important that when you do this technique, you need to make sure that all the body parts match."

The reality is that unethical surgeons who "are trying to sell this to as many patients as possible, are pushing the limits," says Dr. Subbio, noting that a high BMI or overall unhealthy lifestyle automatically should disqualify a patient.

"But they'll go ahead and do this hi-def technique, and it looks very odd, right from day one, like someone who has this very crisp six or eight pack etched into their abdomen, yet their arms are kind of flabby, or the rest of their body is out of shape."

Aftercare is everything

Every surgeon will have a unique set of recovery dos and don'ts, but to optimize your final result, this is one surgery "where the aftercare is going to be just as important, if not more important, than the actual procedure itself," warns Dr. Subbio.

Typically, aftercare is going to be a combination of ultrasound-assisted massages or lymphatic massages, starting the day after surgery, several times a week, for two months, along with 24/7 compression dressings.

"Both of these things are going to prevent fibrosis, contour irregularities and lumps and bumps," notes Dr. Subbio. "Massage will help facilitate the drainage of the lymphatics and make the result more even and smooth."

The Vaser's heat is strong, and the post-op swelling it induces is no joke, with surgeons often using drains to help clear fluid and avert risky seromas.

Compression garments are staggered over several months – and the longer the better, says Dr. Subbio, adding that some swelling will take a full 12 months to subside.

Takeaway

"This procedure has really only blown up in popularity over the last five years," notes Dr. Subbio, despite its nearly 20-year origins. "We really don't have long-term, 30-year follow-up for high-definition. It's a relatively young field."

When in doubt, follow Dr. Subbio's bottom line: don't fall for buzzwords – hi-def is a highly specialized subset of liposuction that can offer muscles that rival Zeus, but if performed improperly, results can be difficult to reverse.

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