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MohanThomas
JamesD‘silva
Editors
Manual ofCosmetic
Surgery and Medicine
Volume 1 - Body Contouring Procedures
Foreword by Dr. Guillermo Blugerman MD
123
Manual of Cosmetic Surgery and Medicine
Mohan Thomas • James D’silva
Editors
Manual of Cosmetic Surgery
and Medicine
Volume 1- Body Contouring Procedures
Editors
Mohan Thomas
Cosmetic Plastic Surgery
Breach Candy Hospital and D. Y. Patil University
Mumbai, Maharashtra, India
James D’silva
Cosmetic Plastic Surgery
Breach Candy Hospital and D. Y. Patil University
Mumbai, Maharashtra, India
ISBN 978-981-19-4996-8 ISBN 978-981-19-4997-5 (eBook)
https://doi.org/10.1007/978-981-19-4997-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore
This book is dedicated to Sushruta, the First Plastic Surgeon, the Pioneer
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from India, and to all Stalwarts of the eld who carved a path for all of us.
Mohan Thomas M.D, FAACS
Foreword
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It is indeed an honor to write the foreword to the six-volume Manual of Cosmetic Surgery and
Medicine and particularly the rst volume titled Body Contouring Procedures edited by Drs.
Mohan Thomas and James D’silva.
The area of body contouring has undoubtedly been one of the most advanced in recent years
with the advent of new anatomical concepts, the introduction of safer advanced technology,
and newer anesthetic techniques. Patient safety concepts are very important and should be
applied when dealing with patients undergoing body contour surgery. It is essential to manage
the patient’s desire and balance the surgical desire of the surgeon with regard to patient safety.
From the rst dermolipectomies described in Hippocratic writings to the current techniques
of Lipoabdominoplasties have passed through centuries of evolution, leaving room in its wake
to a ow of experiences and ideas that the young surgeon can collect from in these pages. The
incorporation of liposuction into the arms of the cosmetic surgeon in the late 1970s took a
paradigm shift in how patients’ consultations were approached and offered solutions that left
less and less surgical marks on the skin surface by reducing scarring. We are happy to have
introduced the use of Laser in Liposuction (LAL) in 1999 and to have introduced Radio
Frequency Assisted Liposuction (RFAL) in 2009.
Another aspect that has radically changed body contouring surgery was the advent of
Bariatric Surgery and the emergence of post-bariatric sequelae that has opened up a new avenue for the cosmetic surgeons.
I invite you to enjoy and absorb the knowledge shared in the pages of this manual: The
wealth of knowledge shared by colleagues with a tremendous exposure in this subspeciality.
You have the opportunity to learn from the success stories as well as mistakes producing these
modern techniques, risks, and possible complications from the contributions made by these
world leaders. This will help you to have better results with an ability to avoid any complications as well as manage these if you should have any.
Buenos Aires, Argentina GuillermoBlugerman, MD
vii
Preface
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I have always thought of Aesthetic or Cosmetic Surgery as a Fusion of Art and Science. In
many ways it is hard to dene Aesthetic or Cosmetic Surgery as there are so many body parts
involved: perceptions of beauty, ethnicities, and sometimes psychosomatic disorders as well.
With reference to psychosomatic disorders, body dysmorphic disorders come rst to my mind
and the most common body part often associated with this disorder is the nose. There are cases
wherein a patient has undergone ten plus surgeries on the nose with disastrous results. Recently,
I have discovered another condition wherein this time it is gender based; men obsessed with
their chest. Within the description of gynecomastia, there is often a “complaint of puffy nipples.” The one’s obsessing the most about their chest are single men between the ages of 25 and
35 and “Buffs” for the most part.
There is a plethora of cosmetic surgical procedures out there ranging from Hair transplant
to Rejuvenation of Hands, Surgery of the Face, Nose, Intimate parts and Body contouring
procedures and now pretty feet. There is a segment of women that have taken on to high heeled
and narrow shoes, early in life leading to Bunions and other Foot issues.
I believe that this Surgical Manual is one of a kind, being a step-by-step presentation, comprehensive enough for private practitioners, students of the eld, those starting practice, and
surgeons already in practice ought to benet from the schematics, pictures, and short video
clips in relevant chapters.
To my good fortune about two decades ago I came across the American Academy of
Cosmetic Surgery which I gladly joined. Over the years, I have made many friends globally
from whom I have learnt a lot and I greatly respect them. I am afraid to mention names for fear
of missing someone out from the list of distinguished Cosmetic Plastic Surgeons. The Mission
and Vision of the AACS, started by Dr. Richard Webster, a Plastic Surgeon, had a very good
inuence on me and spurred me to start a fellowship program in 2003 through a University and
I have mentored many along the way. As a medical student in Pennsylvania I often came across
Dr. Julian Newman, a stalwart as well.
Cosmetic Surgery grew with inputs from many specialities such as General Surgeon—Dr.
Ilouz (France), Gynecologist—Dr. Robert Fisher (Italy), and Dermatologist—Dr. Klein (USA)
to mention a few.
I am a great believer in mentorship and committed to creating a second and third line of
surgeons who I hope one day would be better than me and I hope to learn from them as well as
time goes by. The learning process is a continuum wherein I like many learn something every
day. As a “Lifetime Student” I have learnt a lot from quarters other than surgical colleagues
such as nursing staff as well as patients. Humility and kindness (empathy) are virtues that one
must possess not only to be successful as a surgeon but also to serve the needs of the patients.
In entering private practice, the most important thing one must learn is to assess, evaluate, and
manage expectations of potential patients and obtain a Psychiatric Consultation to rule out
Body dysmorphic disorder, depression, etc. when indicated. This is critical when taking up a
decision to operate. In many ways, management of patient expectations and a gut feeling to
pick up obsessive nature in patients who may seek out care are important virtues. Having con-
ix
x
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ceived the idea of editing as well as contributing to the Manual I have tried to include Global
Leaders in various elds as well as provide a platform for younger surgeons to be seen and
recognized and “Undivide the great Divide.”
Mumbai, India MohanThomas, MD, FAACS
Preface
Acknowledgments
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This is perhaps the simplest and yet the most challenging part of my writing as I fear leaving
somebody out to mention.
First of all, I thank my parents, wife and children, for providing me the education which was
commendable considering they were just high school graduates and struggling to raise a
family.
My lack of nances and opportunities came as a blessing as I moved to the USA.I was
welcomed with both hands and turned me into what I am today. There were many Mentors
along this difcult journey from Medical School, Medical College of Pennsylvania, and postgraduate training at Mount Sinai Hospital, New York, and several Fellowships with many
Mentors in the eld globally. I sincerely thank all my friends and colleagues at the AACS and
many others, too many to mention.
I truly salute and thank the various contributors from various parts of the world, different
time zones, with their professional practices and family, for taking out their valuable time and
submitting what I consider to be the cutting-edge information, in COVID times on webinars,
conducted by us as well as this Six-Volume Surgical Manual. This is one of the largest body of
academic work done in this eld to-date.
The rst person who trained in my Fellowship program was Dr. James D’silva, a qualied
Plastic Surgeon in his own right. He joined me in practice later and there was no looking back
from there on and now has joined hands with me as a Co-Editor. All of the global and national
contributors mentioned above have helped in this Academic Venture.
Lastly, I thank Springer Nature and their amazing editorial team for believing in me and my
pit-bull nature of not letting go of any project that I undertake.
The Publishing House has done a wonderful job in editing, creating, marketing, and putting
out this Manual for which many have toiled endless hours.
Mohan Thomas MD, FAACS
xi
Contents
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Part I Introduction to Body Contouring
1 The Art and Science of Body Sculpting: Sculptor’s Perspective . . . . . . . . . . . . . . 3
Peter M. Schmid
2 Surgical Anatomy of the Body in Relation to Lipocontouring . . . . . . . . . . . . . . . . 13
Mohan Thomas and James D’silva
3 Preoperative Consultation and Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Mohan Thomas and James D’silva
Part II Lipo-contouring
4 Liposuction: Principles and Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Martin Jugenburg and Waqqas Jalil
5 Upper Limb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Gregory Alouf
6 Lower- Limbs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Kulwant Bhangoo
7 Back Rolls and Their Treatment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Mohan Thomas and James D’silva
8 Back and Buttocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Mauro Dalmiro Soriano
9 Male Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Mohan Thomas and James D’silva
10 Large-Volume Liposuction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Mohan Thomas and James D’silva
11 Complications in Body Contouring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Guillermo Blugerman
Part III Hi-Denition Body Contouring
12 Hi- Def Liposuction- My Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Carlos Mata, Michael Gadayev, Giovanni P. Ferrara, and Julie Kesserwani
13 Hi-Def Liposuction in Males and Females . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Grant Hamlet and Arian Mowlavi
14 Hi-Def Liposuction- My Way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
Aldo Perez
xiii
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