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Part IV Use of Technology for Lipo-contouring

15 Ultrasound Assisted Liposuction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Javier Palacios

16 Radio Frequency Assisted Liposuction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

Mohan Thomas and James D’silva

17 Laser Assisted Body Contouring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Zoran Žgaljardić and Ivonne Žgaljardić

18 Use of J Plasma in Body Contouring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287

Ehab Akkary

Part V Abdominoplasty

19 Abdominoplasty Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Aldo Perez

20 Lipoabdominoplasty Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315

E. Antonio Mangubat

21 Lipoabdominoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331

Julian Duran

Contents

22 TULUA Abdominoplasty: Unrestricted Liposuction

and Wide Transverse Plication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341

Francisco Villegas

23 Secondary Abdominoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359

Guillermo Blugerman, Diego Schavelzon, Victoria Schavelzon, and Guido Blugerman

24 Abdominoplasty in Combination with Breast Surgery . . . . . . . . . . . . . . . . . . . . . . 375

Rene Calderon

25 Neoumbilicus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393

Mohan Thomas and James D’silva

Part VI Body Contouring After Massive Weight Loss

26 Classification of Contour Deformities After Massive Weight Loss:

Utilization for Proper Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403

Erik J. Nuveen

27 Thighplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

Erik J. Nuveen

28 Upper Body Lifts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425

Joachim Finckenstein

29 Brachioplasty (Arm Reduction) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433

Jeffrey A. Swetnam

30 Circumferential Body Lift with Breast Procedures . . . . . . . . . . . . . . . . . . . . . . . . . 453

Rene Calderon

31 Complications of Fat Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .469

Soa Santareno, Javier Palacios Ferat, Mohan Thomas, Cesar Velilla, Rene Calderon, Sandra Knight, Edwin Zara, and Gregory Alouf

Contents

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32 Spiral Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491

Tarick Smiley and Rania Agha

33 Liposuction Assisted Body Lift in a Patient with Massive Weight Loss . . . . . . . 505

E. Antonio Mangubat

Part VII Gluteal Contouring

34 Modern Concepts and Safety in BBL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525

Carlos Mata, Giovanni P. Ferrara, and Michael Gadayev

35 Autologous Gluteoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535

Mohan Thomas and James D’silva

36 Body Reshaping Using Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549

Shahin Javaheri

37 Gluteoplasty: Submuscular Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567

Mario Gioia

Part VIII Miscellaneous

38 Male Body Contouring with Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585

J. Howell Tiller

39 Treatment of Banana Rolls (Folds) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597

Aldo Perez

40 Hand Rejuvenation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 607

Mohan Thomas and James D’silva

Editors and Contributors

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About the Editors

Mohan Thomas is an American Trained and Double Board-

Certied Cosmetic Plastic and Facial Plastic Surgeon and a Senior Consultant at Breach Candy Hospital in Mumbai, India. He is also the Chief Mentor and Program Chair of the Advanced Fellowship in cosmetic surgery at the D.Y.Patil University. He has graduated from the Medical College, University of Pennsylvania, and completed his fellowships in Mt. Sinai Hospital, NewYork. He has completed his Fellowships with the Master’s in Surgery of the Nose, Face, Body, and Breast in the USA, Europe, Mexico, and Latin America. He is chairman and managing director of Dr. Mohan Thomas Aesthetics, Mumbai. The institute under the leadership of Dr. Thomas has been a pioneer and is still a leader in the eld of cosmetic surgery and medicine. He has been in practice for about two decades practicing the full scope of Cosmetic Surgery. Dr. Thomas has made signicant notable contributions to the Plastic and Aesthetic surgery literature with more than 51 peer-reviewed publications in the American Academy of Cosmetic Surgery

Journal, Plastic and Reconstructive Surgery Journal, Aesthetic Surgery Journal, Journal of Plastic Reconstructive and Aesthetic Surgery, Journal of Cutaneous and Aesthetic Surgery, Indian Journal of Plastic Surgery, and the prestigious Clinics of North America and 9 chapters in various textbooks. This publication is

part of a 6 Volume Manual of Cosmetic Surgery and Medicine. Dr. Mohan Thomas is a past member of the board of trustees of the prestigious American Academy of Cosmetic Surgery (AACS) and a current member of the World Academy of Cosmetic Surgery (WAOCS) which are known for their commitment towards the development of the eld of cosmetic surgery that delivers the safest patient outcomes through evidence-based information. As part of a Global task force he is committed to developing keyhole surgery, raising the safety standards with reduced operative times, innovative techniques, and superior results. He has a special interest in the very challenging Revision Cosmetic Surgery/Multiply operated patients.

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JamesD’silva is a Board-Certied Plastic Surgeon who has been

in practice as a consultant at the Cosmetic Surgery Institute and Breach Candy Hospital in Mumbai. He practices the full scope of cosmetic surgery ranging from hair transplants, nose surgeries, face rejuvenation, male and female breasts, all types of body contouring including lifts and has a special interest in secondary cleft lip surgery, facial correction in facial palsy, and treatment of scars.

He is part of the teaching faculty of the Cosmetic Surgery

Fellowship program through the D.Y.Patil University. His innumerable publications on cosmetic surgery and medicine are noteworthy and appear in most of the international peer-reviewed journals including the prestigious Clinics of North America and PRS. He along with Dr. Mohan Thomas with inputs from the world community has provided safety guidelines to be incorporated during Body Contouring and Brazilian butt lift which have benetted the surgeons globally.

Contributors

Rania Agha, MD Dermatology, Summit Dermatology and Aesthetic Surgery, Oakbrook Terrace, IL, USA

Editors and Contributors

EhabAkkary, MD Akkary Surgery Center, Morgantown, WV, USA

Akkary Surgery Center, Bridgeport, WV, USA

GregoryAlouf, MD Cosmetic Surgery, Salem, VA, USA

KulwantBhangoo, MD Cosmetic, Plastic and Reconstructive Surgery, Buffalo, NY, USA

Guido Blugerman, MD B&S Center of Excellence in Plastic Surgery, Buenos Aires,

Argentina

GuillermoBlugerman, MD Aesthetic and Plastic Surgery, Buenos Aires, Argentina

B&S Center of Excellence in Plastic Surgery, Buenos Aires, Argentina

ReneCalderon, MD Universidad Autonoma de Baja California (UABC), Tijuana, Mexico

Cosmetic and Aesthetic Surgery, Tijuana, Mexico

JamesD’silva, MS, MCh, DNB Cosmetic Plastic Surgery, Breach Candy Hospital and D.Y. Patil University, Mumbai, Maharashtra, India

JulianDuran, MD Corpo D’oro, Bogota, DC, Colombia

GiovanniP.Ferrara, MD University of Nottingham, Nottingham, UK

JoachimFinckenstein, MD Starnberg, Germany

MichaelGadayev, B.Sc. (Biology) Arizona State University, Tempe, AZ, USA

MarioGioia, Degree in Medicine, Specialist in General Surgery, MD Day Surgery Studio

Nice, Napoli, Italy

GrantHamlet, MB, ChB Hamlet Clinic, London, UK

WaqqasJalil, MD Toronto Cosmetic Surgery Institute, Toronto, Ontario, Canada

Shahin Javaheri, MD Plastic, Reconstructive and Cosmetic Surgeon, San Francisco, CA,

USA

Editors and Contributors

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xix

MartinJugenburg, MD Toronto Cosmetic Surgery Institute, Toronto, Ontario, Canada

JulieKesserwani, BS Bachelor of Science, Natural Resource Plastic Surgery, Scottsdale, AZ,

USA

SandraKnight, MD Harmonyhealth cosmetic clinic, Kingston, Jamaica

E. Antonio Mangubat, MD Director- La Belle Vie Cosmetic surgery Center, Tukwila,

Seattle, WA, USA

CarlosMata, MD, MBA, FACS Plastic and Reconstructive surgery, Scottsdale, AZ, USA

ArianMowlavi, MD, FACS Long Beach Memorial Hospital, Hoag Presbyterian Hospital,

Laguna Beach, California, USA

ErikJ.Nuveen, MD, DMD, FAACS Cosmetic Surgery Afliates, Oklahoma City, OK, USA

JavierPalacios, MD Cosmetic Plastic Surgery, Veracruz, Mexico

AldoPerez, MD Aesthetic Plastic surgery, Cuernavaca, Morelos Mexico

Department of Plastic Surgery, Universidad de Ciencias Medicas de la Habana, . Cuba

Aesthetic Plastic Surgeon, Cuernavaca, Morelos, Mexico

SoaSantareno, MD Plastic Surgery - The Dr Pure Clinic, Lisbon, Portugal

DiegoSchavelzon, MD B&S Center of Excellence in Plastic Surgery, Buenos Aires, Argentina

Victoria Schavelzon, MD B&S Center of Excellence in Plastic Surgery, Buenos Aires,

Argentina

Peter M. Schmid, DO, FAACS Institute of Aesthetic Plastic Reconstructive Surgery, Longmont, CO, USA

TarickSmiley, MD California Surgical Institute, Beverly Hills, CA, USA

Mauro Dalmiro Soriano, MD Plastic Surgeon at Parque Sanatorium, Rosario, Santa Fe,

Argentina

Jeffrey A. Swetnam, MD, FACS, FAACS General Cosmetic Surgery, Facial Cosmetic Surgery and General Surgery, Fayetteville, AR, USA

MohanThomas, MD, FAACS Cosmetic Plastic Surgery, Breach Candy Hospital and D.Y. Patil University, Mumbai, Maharashtra, India

J.HowellTiller, MD Board Certied Aesthetic Plastic Surgeon, Pensacola, FL, USA

CesarVelilla, MD Evolution, Miami, MD, USA

FranciscoVillegas, MD. Plastic Surgeon Private Practice at Clínica San Francisco, Tuluá,

Colombia

Plastic Surgery Unit, Universidad del Valle, Cali, Colombia

EdwinZara, MD Cosmetic Surgery, Salem, VA, USA

Ivonne Žgaljardić, MD Plastic, Reconstructive and Aesthetic Surgeon, Opatija/Zagreb,

Croatia

Zoran Žgaljardić, MD, PhD Maxillofacial Surgeon, Head and Neck Plastic Surgeon, Opatija/Zagreb, Croatia

Part I

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Introduction to Body Contouring

The Art andScience ofBody Sculpting:

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Sculptor’s Perspective

PeterM.Schmid

The quintessential inspiration to mankind is the beauty of the human body. In our work as cosmetic surgeons we are entrusted by our patients to be the Michelangelo’s of Beauty, the master sculptors of image, emotion, and form. To artists and surgeons alike, the human body provides extraordinary possibilities for them to exhibit aesthetic nesse. To the unartistic template-reliant technician, the body’s complexity will impair outcomes. Working with a contemporary audience of heightened idealizations, patients today present with preconceived perceptions and place a priceless value on physical beauty. These expectations reect the times with technology and savvy social media self-reconstructions of personal beauty that may be imagined but may or may not be achievable [1, 2]. Creating harmonious visual and emotional outcomes distinguishes the cosmetic surgeon from other surgical subspecialties. It is our love affair with human body that we are called as surgeons to discover new truths to deepen our understanding of the aesthetics of human form (Fig.1.1).

Aesthetics is the formal study of art and relationship to beauty. Since the Renaissance, the gold standard for training in the gurative arts has been through intense study of the antique, the live model, and anatomy [3].

Contemporary training for the cosmetic surgeon is the Surgical Fine Arts in a structured, stimulating, and supportive environment. Art academia broadens the intellectual palate and renes the senses, expanding visual thinking and perspective, observation, ne motor skills, and performance. Human aesthetics is intricately composed of geometrics, contour, shape, volume, and form. Sculpting explores these qualities of beauty and serves an aesthetic bridge to cadaver dissection, surgery, and technology.

Sculpting for Surgeons™ provides a learning platform from which the aesthetic sculptural arts and cadaver labs serve as a pillar for intellectual, conceptual, and personal growth. The physician learns the nuances of corporeal beauty and develops a delity in form while producing the anatomical human body in drawing or in clay. This aesthetic intelli-

Supplementary Information The online version contains supplementary material available at [https://doi.org/10.1007/978- 981- 19- 4997- 5_1].

P. M. Schmid (*) Institute of Aesthetic Plastic Reconstructive Surgery, Longmont, CO, USA e-mail: drs@iaprs.com

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P. M. Schmid

gence enables surgeons to develop unique vision and innovative artistic direction from which to deliberately sculpt their patients and advance one’s surgical art, acumen, and outcomes.

1.1 Surgeon andSculptor

To effectively integrate artistic principle into cosmetic practice, training in the sculptural arts requires divergent thinking in a stimulating learning environment (Fig.1.2). In cosmetic surgery, the latest technology and aptitude in standard techniques does not assure favorable aesthetic outcomes, and this is where aesthetic prowess becomes the game changer.

Aesthetic intelligence cannot be learned from one lecture, read in a book, or learned through social media. It is the continued scrutiny and analyzation of the live model, sculpting from skeleton to surface, emphasizing the aesthetic unity of form, connecting translations to the human patient, correcting surgical planning, and unfolding the infrastructural anat-

omy. The sculpted human gure is the unequivocal model for studying human anatomy, as it emphasizes the interplay of three-dimensional concepts of mass, weight, and solidity, three-dimensional space (volume and depth), compositional three-dimensional modulations, and details of anatomical form [4]. It exercises a constructive “inside-out” performancebased experience touching on aesthetic landmarks, geometry, gender dichotomy, cultural aesthetics, dynamics, and harmony. Sculpting in clay explores natural convexities, concavities, transition zones, bony and adipomyofascial patterns, soft and hard forms, and the qualities of volume creating the values of light and shadowing.

These aesthetic tools hone artistic perspective and transfer to the cadaver lab where one rethinks and rediscovers human anatomy and aesthetics. This exercise renes aesthetic judgment, while expanding mental constructs and proposals through conceptualization so relevant to the cosmetic surgery [5]. The experience accordingly promotes further passion for artistic discipline and renes aesthetic prociencies in work. Art become a means to the end.

1 The Art andScience ofBody Sculpting: Sculptor’s Perspective

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1.2 Cadaver andModel

The study of the human cadaver, our “Silent Teachers,” is abiding and invaluable [6]. The quest to understand the disposition of structures under the skin has inspired artists to undertake unconventional human dissections on corpses since the sixteenth century. Renaissance artists Leonardo da Vinci and Michelangelo took these studies further. Having acquired structural knowledge through anatomical dissections, they were determined to understand anatomy (Fig.1.3). This knowledge, combined with exceptional discipline, artistic aptitude, and style, advanced their artistic skills and representations of the human gure, setting them apart from others in their eld [7–9]. The Greek sculptors, infamous for canons and iconic human form, did not dissect, but displayed profound observational skills as sculptors of the living human body.

The human cadaver provides a realistic anatomical model

for dissection and education during implementation of surgi-

cal specialty techniques, bereft of complications in a safe working environment [6, 10]. Current teaching of surgical skills and anatomy has evolved into a romance with state-ofthe-art educational simulators from videos and digital cadavers to virtual dissection platforms (i.e., Visible Human Project) by the click or swipe of a nger [11, 12]. These learning platforms lead to a “focus on academic knowledge at the expense of manual training and craftmanship,” undermining the development of critical thinking, tactile muscle memory, and surgical skills (Roger Kneebone, MD, Imperial College, 2020). Though providing a safe environment for learning, there remain deciencies inherent to the cadaver dissection lab. Death in the rst hours distorts the body, disguring surface form, as the convexities of vitality become stiff and attened. Dissection in itself is a destructive process to human structure, as one disassembles the body to delve into deeper tissue levels. Artistic training demands exhaustive study of the nude model conditioning the “eyes of the mind” and an artistic intelligence for human anatomy committed to memory.

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P. M. Schmid

1.3 Sculpting andtheSenses

Conditioned observation and the “power of seeing” is an acquired skill. In aesthetic anatomy, this process requires focused conscious practice in visual thinking and scrupulous reproduction of the human gure via drawing or sculpting. These activities detail concepts of line, light, shape, and form taught under the direction of a mentor. The challenge is to suspend one’s existing conceptions and see to understand aesthetics afresh. An unencumbered mind is free of homogenized interpretations, visual discrimination, preconceptions, opinions, and biases; free of the habitual calculating mind [13]. One must release preconceived ideas and judgments of beauty in the visual world, and “not only look at, but for each detail” [14]. Since the eyes see in two dimensions, touch intimately connects vision to three dimensions.

Hands-on training in clay bridges cognitive and visual neural pathways. Representative sculpting incorporates additive and reductive technique utilizing the sculptor’s tools, via deliberate comparative study of “iconic” live female and male models from the head to the toe (Fig.1.4). Working in clay tests hand and eye, and the armature is transformed into

a representational human gure meticulously reproducing bone, muscle, and adipose dispositions dened by a passive pose or suspended animation, challenging artistic skills, visual interpretation, patterning, proportional relationship, scale processing, and critical judgment in reproducing form. The process engages visual thinking by imagining, abstracting, multi-perspective analysis, body thinking, and dimensional thinking processed with and without the measuring caliper [15, 16].

Sculpting and sketching synergistically borrow from both cerebral hemispheres, engaging neuroaesthetic processing areas of brain and the right prefrontal cortex, and can reorganize and reprogram hard-wired hemispheric cortical pathways through neuroplasticity in response to conditioning [17–19]. The artistically inclined surgeon works beyond sci- entic linear thinking by incorporating aesthetic insight, abstract, and ambidextrous thinking into practice [20, 21]. For many surgeons, the creative part of the brain has always been there, but never tapped into due to preconditioned linear thinking. Years of deliberate practice will transform thought and action. “Superior performance extends beyond the power of sight, and the ability to feel resides in touch” [22].

Sculpting and drawing introduces a new language and mental model to decipher anatomical structural relationships and human beauty [23]. Sculpting in clay requires the student to memorize anatomical relationships three-dimensionally in shape and disposition and seek to understand form as related to gesture and function. It strengthens the ability to visualize the human body transparently, imperative to the surgical eye. The sculpting process explores the denition and linear angulations of the male and owing softness of the female body. Practice and time become automatic and unconscious by Fitts–Posner motor skill development, and muscle memory that with time may allow one to enter “in the zone” or ow experience [24, 25]. Over time, the committed student will rene aesthetic sensitivities and nd an inherent “sixth sense” awareness to human form.

1.4 General Body Analysis: Studying

theModel

The chief forms of beauty are order and symmetry and denite-

ness. Aristotle [26]

Instantaneous visual reaction to the physical presence of an another form is called the “blink response” [27], perceiving appearance to be attractive, average, or unsightly. This aesthetically charged visual impulse is inherently hard-wired into our brains in infancy [28]. Cerebral maturation comes later as we develop more sophisticated perceptions and interpretations of beauty.

To physically sense core and pose of the model, the artist should briey mirror and assume the model’s position to

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