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G. Blugerman
11.11 Bleeding [14–22]
Bleeding is one of the most important risks during the body
contouring surgeries. Use of tumescent anesthesia, the use of
tranexamic acid, coagulation of bleeding vessels during surgeries, etc. are very important preventive factors. One of the
rst symptoms of hypovolemic shock is thirst. The thirsty
patient should indicate an undiagnosed blood loss. Once
hypovolemia is diagnosed, it should be corrected by plasma
expansion, transfusions, and surgical reintervention to look
for the bleeding vessel in the case of postoperative bleeding
in open surgeries. In post-liposuction bleeding, inltration
into the area of tumescent anesthesia with double doses of
adrenaline and compression is usually sufcient to stop
bleeding as damaged vessels are not usually of a large diameter. The patient should be diagnosed and treated urgently to
avoid major complications. Residual anemia commonly
present in this type of patient should be treated in the postoperative period.
11.12 Anemia [2, 14–20]
It may occur due to excess blood suction during liposuction
caused by improper tumescent technique or a poor response
of the patient to vasoconstrictors. Waiting for a minimum of
7minutes after inltration for the vasoconstriction effect is
important before starting liposuction. Another cause of anemia may be the removal of excess fat volume. In our experience, it is not advisable to extract more than 5 or 6L in a
single session. Another cause of postoperative anemia is usually the patient’s constitutional capillary fragility, resulting
in increased bruising or ecchymosis.
11.13 Hematoma [14–18]
Bruising is often the result of damage to medium-sized vessels such as a perforating artery in the abdomen. Correct
diagnosis through the use of diagnostic ultrasound and early
treatment is very important to prevent the formation of brosis and retractions in the late postoperative period. Once
diagnosed, the liquid part of the hematoma should be drained.
The use of external ultrasound usually helps in liquefying the
hematoma and facilitates its removal early and preventing
serohematoma and brosis (Fig.11.8).
The rupture of capillary vessels usually manifests as more
supercial bruises whose treatment will be performed with
creams containing heparin.
Some bruises may require immediate surgical treatment
to avoid hypovolemic shock, but in most cases, they are selflimiting or requiring diagnosis and treatment during immediate postoperative care. Ultrasonic diagnostics are very useful
and are used in the rst week to diagnose high-volume
bruises that deform the treated area, but the smaller ones will
be diagnosed later when the clot is liqueed. In the case of
diagnosing a high-volume hematoma, the use of threemegahertz external ultrasound should be used to speed up
clot liquefaction. Once such liquefaction has occurred, the
liquid must be drained either by using cannulas or 16G or
18G thick needles. In many cases, it is advisable to wash the
cavity with saline or tumescent solution.
If we notice that the hematoma is already in the process of
brosis, inltration of the brous area may be performed
with a mixture of 5FU and triamcinolone. The use of physiotherapy or kinesiology through manual lymphatic drainage,
circular massage, external ultrasound, and carboxytherapy
will help a less prolonged evolution of this complication.
11 Complications inBody Contouring
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203
Fig. 11.8 (a, b) 1week post
liposuction surgery a hard non
resolving lump is seen in the
lower abdomen. Ultrasound
assessment showed that it is a
hematoma which is lysing. (c,
d) Surgical evacuation was
carried out using liposuction
and a tube drain. (e) Post
evacuation compression in the
area (f) Final result
a
c
b
d
e
11.14 Seroma Prevention, Diagnosis,
andTreatment [23, 30–34] (Fig.11.9)
Seromas usually occur as a result of rupture of lymph vessels, or as a result of reabsorption of bruises, and should be
properly diagnosed and drained to avoid scarring and encapsulation. Seroma treatments will depend on their extent and
volume. The best way to diagnose and treat them is to incorporate the use of diagnostic ultrasound into your practice that
greatly facilitates the monitoring of their evolution until they
disappear. There are also pseudo seromas that are actually
f
fatty cysts caused by necrotic fat due to devascularization or
by encapsulated fat grafts. These have a more yellowish and
oily liquid and should be treated differently.
The onset of seromas is a common problem in the postoperative body contouring surgeries. It is very important to be
able to make an early diagnosis of their presence and the
treatment of them in order to avoid major complications.
There are two types of seromas and evolution and sequalae of both is completely different. It should not be confused
further with cyto-steato necrosis caused by the lysis of
adipocytes.
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Fig. 11.9 Seroma seen in the lower abdomen with uid collection
marked by circles
G. Blugerman
11.15 Pulmonary Thromboembolism (PTE)
[23, 35–38]
The prevention of PTE is mainly based on a good presurgical risk assessment, through the use of anti-thrombotic
elastic stockings, pneumatic boots, early mobilization, and
the use of low molecular weight heparin. Early diagnosis of
deep vein thrombosis, which is usually the leading cause of
PTE, is based on proper postoperative examination, observation of edema or pain in the lower limbs, and diagnosis
through vascular two-dimensional Doppler. Treatment is reference to the hematological clinic and most of the time
requires the implementation of prolonged preventive
anticoagulation.
11.16 Death [35–38]
Pure seroma is caused by rupture of lymph vessels in
treated areas often caused by lateral moving of the cannula.
Its treatment consists of multiple punctures with thick needle
aspiration. Punctures should be performed as far as possible
daily, noting that after each puncture the removed volume
should be less. The drainage function is to prevent the formation of a capsule that will lead to chronic seroma. When the
aspirated volume is more than 100 milliliters, Shiffman’s
technique of replacing the extracted liquid with equal volume of atmospheric air can be used. If the seroma has already
become chronic, percutaneous drainage may be attempted
using a cannula such as those used to supply endovenous
solutions. Through this cannula, products that irritate the
pseudoendothelium present on the inner surface of the capsule can be infused to produce an obliteration of the capsule.
Hydrogen peroxide, hypertonic saline, vascular sclerosing
agents, or acidic solutions of different types may be used as
an irritant material.
Seromas following the presence of bruises have been discussed above.
Cytosteatonecrosis is characterized by the uid extracted
being cloudier and more yellow than seroma. The risk of
infection is higher in this case as cell debris serves as a
breeding ground for microbes. For this reason, it is important
to perform the aspiration procedures under perfect antiseptic
standards and maintain antibiotic coverage.
The lack of correct diagnosis of the presence of seroma
can cause sequelae at the skin level causing unevenness and
irregularities on the surface, as well as movement of the aps
when the patient changes position.
This is the most serious complication of body contouring
surgery. Statistically, the most common causes of death of
patients undergoing body contouring surgeries are caused by
anesthetic action resulting from the use of general anesthesia, adverse reactions to anesthetic medication, pulmonary
edema, over-hydration, lidocaine toxicity, hypovolemic
shock, pulmonary thromboembolism, septic shock, and viscera perforation. Its prevention and treatment exceed the
scope of this surgical manual.
11.17 Safety Factors [1–5, 23, 39]
– Limit the number of areas treated. There is not a limit in
amount of areas; we measure the volume of overnatant fat
removed. There is no nal consensus, but the limit for a
safe surgery is 5000ml in patients with a maximum body
mass index (BMI) of 26.
– Dosing of lidocaine mg/kg bodyweight should be between
35 and 45mg/kg of weight.
– Duration of the surgical procedure should be less or equal
to 4hours.
References
1. Klein JA.The tumescent technique for liposuction surgery. J Am
Acad Cosmetic Surg. 1987;4:263–7.
2. Klein JA.Tumescent technique for local anesthesia improves safety
in large-volume liposuction. Plast Reconstr Surg. 1993;92:1085–98.
11 Complications inBody Contouring
https://t.me/medicina_free
205
3. Klein JA, Jeske DR.Estimated maximal safe dosages of tumescent
lidocaine Jeffrey A.Anesth Analg. 2016;122:1350–9.
4. Klein JA, Kassarjdian N.Lidocaine toxicity with tumescent liposuction. A case report probable drug interactions. Dermatol Surg.
1997;23:1169–74.
5. Jaydeep Yadav K, Korzekwa S. Improved predictions of
drug-drug interactions mediated by time-dependent inhibition of CYP3A. Nagar chemistry, medicine. Mol Pharm.
2018;15(5):1979–95.
6. Xu M, etal. Regional anesthesia and lipid resuscitation for local
anesthetic systemic toxicity in China. BMC Anesthesiol. 2016
Jan;4(16):1.
7. Sagir A, Goyal R.An assessment of the awareness of local anesthetic systemic toxicity among multi-specialty postgraduate residents. J Anesth. 2015 Apr;29(2):299–302.
8. Picard J, etal. Guidelines and the adoption of ‘lipid rescue’ therapy
for local anaesthetic toxicity. Anaesthesia. 2009;64(2):122–5.
9. Elin S, etal. Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning. Clin Toxicol (Phila).
2016;54(10):899–923.
10. Neal JM, etal. American Society of Regional Anesthesia and Pain
Medicine checklist for managing local anesthetic systemic toxicity:
2012 version. Reg Anesth Pain Med. 2012;37(1):16–8.
11. Kucera IJ, Lambert TJ, Klein JA, Watkins RG, Hoover JM, Kaye
AD.Liposuction; contemporary issues for the anesthesiologist. J
Clin Anesth. 2006;18:379–87.
12. Rodriguez Testal JF. Alteraciones de la imagen corporal (body
image alterations). Madrid: Ed Sintesis; 2013.
13. Bolton MA, Pruzinsky T, Cash TF, Persing JA. Measuring
outcomes in plastic surgery: body image and quality of
life in abdominoplasty patients. Plast Reconstr Surg.
2003;112(2):619–27.
14. Swedenhammar E, Stark B, Hallstr AH, Ehrstrom M, Gahm
J. Original scientic report. Surgical training and standardised
management guidelines improved the 30-day complication rate
after abdominoplasty for massive weight loss. World J Surg.
2018;42:1647–54.
15. Jabaiti SK.Risk factors for wound complications following abdominoplasty. Am J Appl Sci. 2009;6(5):897–901.
16. Vastine VL, Morgan RF, Williams GS, Gampper TJ, Drake DB,
Knox LK, Lin KY. Wound complications of abdominoplasty in
obese patients. Ann Plast Surg. 1999;42:34–9.
17. Van Uchelen JH, Werker PM, Kon M.Complications of abdominoplasty in 86 patients. Plast Reconst Surg. 2001;107:1869–73.
18. Grazer FM, Goldwyn RM.Abdominoplasty assessed by survey, with
emphasis on complications. Plast Reconstr Surg. 1977;59:513–7.
19. Blugerman G, Schavelzon D.Intralesional use of 5-FU in subcutaneous brosis. J Drugs Dermatol. 2003;2:169–71.
20. Rogliani M, Labardi L, Silvi E, Maggiulli F, Grimaldi M, Cervelli
V.Smokers: risks and complications in abdominal dermolipectomy.
Aesthet Plast Surg. 2006;30:422–4.
21. Manassa EH, Hertl CH, Olbrisch RR.Wound healing problems
in smokers and nonsmokers after 132 abdominoplasties. Plast
Reconstr Surg. 2003;111(6):2082–9.
22. Khajuria A, Charles WN, Dutt A, Hoyos A. The 100 Most-cited
articles in abdominoplasty: A bibliometric analysis. Plast Reconstr
Surg Glob Open. 2021;9:e3426.
23. Dutot M-C, Serror K, Al Ameri O.Improving safety after abdominoplasty: a retrospective review of 1128 cases. Plast Reconstruct
Surg. 2018;142(2):355–62.
24. Lipp MB, Butterwick K, Angra K, Chunhara C, Goldman
MP. Evaluation of long-term outcome and patient satisfaction
results after tumescent liposuction. Dermatol Surg. 2020;46(Suppl
1):S31–7. https://doi.org/10.1097/DSS.0000000000002498.
25. Dayan E, Chia C, Burns AJ, Theodorou S, et al. Aesthet Surg J.
2019;39(Suppl_3):S112–9. https://doi.org/10.1093/asj/sjz055.
PMID: 30958550; PMCID: PMC6460431
26. INFORME TÉCNICO. Consenso SADI-SAM-SAD- CACCVE.
Guía para el manejo racional de las infecciones de piel y partes
blandas– Parte I.Rev Panam Infectol. 2009;11(3):49–65.
27. INFORME TÉCNICO. Consenso SADI-SAM-SAD- CACCVE.
Guía para el manejo racional de las infecciones de piel y partes
blandas– Parte II.Rev Panam Infectol. 2009;11(3):47–62.
28. INFORME TÉCNICO. Consenso SADI-SAM-SAD- CACCVE.
Guía para el manejo racional de las infecciones de piel y partes
blandas– Parte III.Rev Panam Infectol. 2010;12(1):60–74.
29. S.A.D.I.Clara, L; Angeleri, P; Blugerman, G; Biondi, H; Carbone,
E; Chattas, A; Colombini, A; Cornistein, W; Daciuk, L; Del Castillo,
M; Fernández Garcés, A.GUÍA DE PROFILAXIS ANTIBIÓTICA
QUIRÚRGICA. EDITORIAL OCÉANO ARGENTINA
S.A.Actualización 2017.
30. Seroma: How to Avoid lt and How to Treat It AESTHETIC
SURGERY JOURNAL ~ NOVEMBER/DECEMBER 1998.
31. Di Martino M, Nahas F, Kimura A, etal. Natural evolution of seroma
in abdominoplasty. Plast Reconstr Surg. 2015;135(4):691e–8e.
32. Bercial ME, Sabino Neto M, Calil JA, Rossetto LA, Ferreira
LM.Suction drains, quilting sutures, and brin sealant in the prevention of seroma formation in abdominoplasty: which is the best
strategy? Aesthet Plast Surg. 2012;36(2):370–3.
33. Alexander L.An uncomplicated and cost-effective solution to large
seromas after liposuction. J Cutan Aesthet Surg. 2021;14(2):260–2.
https://doi.org/10.4103/JCAS.JCAS_185_20. PMID: 34566375;
PMCID: PMC8423210
34. Salari N, etal. The global prevalence of seroma after abdominoplasty: a systematic review and meta-analysis. Aesthet Plast Surg.
2021;45:2821. https://doi.org/10.1007/s00266- 021- 02423.
35. Cárdenas-Camarena L, Durán H, Robles-Cervantes JA. Critical
Differences between Microscopic (MIFE) and Macroscopic
(MAFE) Fat Embolism during Liposuction and Gluteal
Lipoinjection. Plast Reconstruct Surg. 2018;141(4):880–90.
36. Rosique RG, Rosique MJF.Augmentation gluteoplasty: a Brazilian
perspective. Plast Reconstruct Surg. 2018;142(4):910–9.
37. Cárdenas-Camarena L, Bayter JE, Aguirre-Serrano H, CuencaPardo J.Deaths caused by gluteal Lipoinjection: what are we doing
wrong? Plast Reconstr Surg. 2015 Jul;136(1):58–66. https://doi.
org/10.1097/PRS.0000000000001364.
38. Rohrich RJ, Mendez BM, Afrooz PN.An update on the safety and
efcacy of outpatient plastic surgery: a review of 26,032 consecutive cases. Plast Reconstruct Surg. 2018;141(4):902–8.
39. Vieira B, Chow I, Sinno S, Dorfman RG, Hanwright P, Gutowski
KA.Is there a limit? a risk assessment model of liposuction and
lipoaspirate volume on complications in abdominoplasty. Plast
Reconstruct Surg. 2018;141(4):892–901. https://doi.org/10.1097/
PRS.0000000000004212.
Part III
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Hi-Denition Body Contouring
Hi- Def Liposuction- My Technique
https://t.me/medicina_free
CarlosMata, MichaelGadayev, GiovanniP.Ferrara,
andJulieKesserwani
12
12.1 Introduction [1–3]
In the 1983 meeting of the American Society of Plastic
Surgeons, Yves-Gerard Illouz introduced his technique of fat
aspiration. The term “Liposuction” was rst used by Pierre
Fournier when referring to his technique of using a syringe to
remove fat and reintroduce it into specic areas to increase
contour. Liposuction has come a long way from the early
1980s. High-denition (HD) liposuction combines traditional lipoplasty techniques with a more accurate understanding of how this relates to the natural musculature
throughout the body. Modern techniques combine a myriad
of methods, including: ultrasound-, power-, laser-, and
manual- assisted liposuction; abdominal etching; as well as,
radio frequency devices which have been shown to tighten
the skin and yield more desirable and “smoother” results.
As the accessibility to social media increases, views on
what constitutes an ideal body are shaped through the lenses
of “inuencers.” A predominant feature of the ideal body
seen on social media are pronounced abdominal muscles; in
males this may be recognized as the “six-pack abs”; and, in
women a “pilates body.” Abdominal etching is an advanced
branch of lipoplasty that aims to accentuate the natural
underlying anatomy of the patients through strategic removal
Supplementary Information The online version contains supplementary
material available at [https://doi.org/10.1007/978- 981- 19- 4997- 5_12].
C. Mata (*)
Plastic and Reconstructive surgery, Scottsdale, AZ, USA
e-mail: drmata@nrpsaz.com
M. Gadayev
Arizona State University, Tempe, AZ, USA
G. P. Ferrara
University of Nottingham, Nottingham, UK
J. Kesserwani
Bachelor of Science, Natural Resource Plastic Surgery,
Scottsdale, AZ, USA
of fat deposits in order to mimic what is portrayed. Some
surgeons advocate the use of a combination or all of the
aforementioned technologies while others prefer to use only
manual cannulas to achieve these remarkable results. We will
provide a brief description of the most commonly used
devices and techniques in order to achieve the highlights and
contours that most have come to call HD liposuction, abdominal etching, or four-dimensional liposuction.
12.2 Ultrasound-Assisted Liposuction [3–6]
Ultrasound-assisted liposuction (UAL) is a technique in
which ultrasonic energy is transmitted through a specialized
cannula in order to emulsify fat cells for easier extraction.
UAL necessitates the introduction of a water medium to conduct the ultrasonic energy. This is usually achieved by inltration of normal saline with lidocaine, epinephrine, and
sodium bicarbonate to the desired areas of liposuction prior
to the initiation of UAL. The dispersed ultrasonic energy
forms cavitations that expand or coalesce to form bubbles
from an average size of 5–10μm–180 μm. This expansion
allows the air to traverse in between the fat cells and separate
them, causing the cohesive units to be emulsied for ease of
removal. Of the UAL devices used today, vibration amplication of sound energy at resonance (VASER) is the most
prominent. The ultrasonic soundwaves produced by VASER
serve a dual purpose: emulsication of the fat to assist in
aspiration; as well as, skin tightening due to the thermal
effects contracting the dermis.
12.3 Radiofrequency Devices [2, 4, 6]
Other than the removal of fat, the most sought-after result of
high-denition liposuction is skin tightening. This is the
“holy Grail” of cosmetic surgical procedures. The primary
company responsible for leading the frontier in the treatment
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022
M. Thomas, J. D’silva (eds.), Manual of Cosmetic Surgery and Medicine, https://doi.org/10.1007/978-981-19-4997-5_12
209
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C. Mata et al.
of loose skin is Apyx Medical Corporation Renuvion (formerly known as J-Plasma). Their device generates heat by
passing helium gas over an energized electrode which results
in a change in state to plasma. Suggested temperature ranges
for Renuvion vary from 60–100°C, at 85°C energy delivered
from the handpiece into the bro-septal network causes
denaturation and subsequent reorganization of collagen proteins which ultimately leads to skin tightening. Final results
can be seen at the 6–9 months mark postoperatively once the
body has fully completed its healing and neocollagenesis
process.
12.4 Laser Lipolysis
The advent of laser lipolysis in 1992 by Dr David
Apfelberg entailed delivering laser energy through a minimally invasive applicator. The cellular structures of the
small surrounding lipocyte deposits are disrupted through
thermal energy generated by the laser. In doing so, the fat
is melted into a liquid consistency that can be then aspirated via suction. Typically, the best candidates for laserassisted liposuction would be those who are not overweight
and wish to correct small to medium sized areas. Optimal
areas to treat are the neck, upper arm aps, and lower
torso. Laser lipolysis is better suited for patients who wish
for a shorter recovery with minimal downtime (circa 1–2
days), whilst other forms of liposuction usually require
5–7 days. However, there is a greater risk of thermal damage if a novice is performing the procedure and is not cognizant of the energy that laser is delivering. These
differences can be attributed to increased aggressiveness
as well as greater fat aspiration associated with non-laser
liposuction modalities.
12.5 Patient Selection forHigh-Denition
Liposuction
Patient selection is probably the single greatest factor in
obtaining a stellar result. When selecting a patient, the following criteria must be evaluated. The patient’s body mass
index (BMI) needs to be between 18 and 27; the patient
should already have a good underlying muscular anatomy; as
well as adequate bony landmarks in order to achieve the best
possible outcome. The next most telling characteristic in
achieving a spectacular outcome rests with the patient’s skin
tone and skin elasticity. A “pinch test” looking for a minimum of 2cm thickness between the two ngers should be
performed over all areas where contouring and highlighting
are planned. This will provide an adequate idea of possible
and predictable outcomes. Stretch marks, indicating tears in
the dermis, should not be overlooked as these can lead to a
false sense of a predictable outcome.
A thorough history and physical should be obtained prior
to surgery and any scars should be examined and investigated for possible hernias. If any doubt persists, a computer
tomography should be performed rather than an ultrasound
examination of the abdominal wall to avoid operator dependent errors in diagnosis.
Finally, scar placement in abdominal etching must be discussed with the patient to ensure that these remain hidden
and nearly imperceptible. Patients typically are physically t
within their own goal weight but often do not wish to display
evidence that they could not get rid of some stubborn areas
that are concealing their underlying musculature.
12.6 Preoperative Markings [7–11]
Preoperative markings are best explained by examples. The
markings for male and female patients will vary slightly as
most females prefer the aforementioned “pilates body” look
while males aspire to the “six pack” or “eight pack” look (see
Figs.12.1, 12.2, 12.3, 12.4, 12.5, 12.6, 12.7, and 12.8). The
following sequence helps identify the patients muscular
anatomy: Begin by identifying the xiphoid process and the
anterior superior iliac spines; Have the patient contract their
abdominal core and feel for the linea semilunaris bilaterally
in order to mark the length of it; Proceed to feel for and mark
the linea alba which is typically the same width as the umbilicus. It is of utmost importance that there are no linear markings below the umbilicus other than the linea semilunaris.
Conrm the placement of your marks by having the patient
expand their abdomen to see if your marks are truly in line
with the muscular anatomy. When striving for the “six pack”
appearance have the patient contract their rectus abdominis
and mark the inscriptions which are either two linear sets of
lines or two asymmetric sets of lines due to some patient
having step off inscriptions. Finally mark the iliac crest to
accentuate the hills and valleys surrounding the bony
anatomy.
Key points to remember are that the borders of the muscles are gradual and not square boxes in order to avoid a
stuck on or pasted appearance. Hills and valleys with gradual
slopes and recesses create a more natural and realistic
appearance. It is important to emphasize that this type of
liposuction must not appear incongruent with the remainder
of the patient’s torso; hence, consider addressing residual
gynecomastia or excess fatty deposits in the surrounding
areas such as anks upper-, mid-, lower back, axillae, and
chest.
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Fig. 12.1 Male 1 Abdominal
etching; preoperative
markings followed by
postoperative result. Patient
was 44years old who had
2.7L of fat aspirated from the
abdominal region via UAL
(VASER) PAL.RF device
known as Renuvion was also
used. A bilateral cumulative
total of 180cc of fat was
transferred to the chest for
visual accentuation of the
pectoralis major
211
Fig. 12.2 Male 2 Abdominal
etching; preoperative
markings followed by
postoperative result. Patient
was 32years old who had
1.4L of fat aspirated from the
abdominal region via UAL
(VASER) PAL.RF device
known as Renuvion was also
used. Additional procedure
includes the removal of
excess glandular breast tissue
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Fig. 12.3 Male 3 Abdominal
Etching; Preoperative
markings followed by
post-operative result. Patient
was 50years old who had
1.2L of fat aspirated from the
abdominal region via UAL
(VASER) PAL.RF device
known as Renuvion was also
used. A bilateral cumulative
total of 115cc of fat was
transferred to the chest for
visual accentuation of the
pectoralis major
C. Mata et al.
Fig. 12.4 Male 4 Abdominal
etching; preoperative
markings followed by
postoperative result. Patient
was 34years old who had
6.5L of fat aspirated from the
abdominal, ank, and back
region via UAL (VASER)
PAL.RF device known as
Renuvion was also used. A
bilateral cumulative total of
220cc of fat was transferred
to the chest for visual
accentuation of the pectoralis
major
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Fig. 12.5 Female 1
Abdominal etching;
preoperative markings
followed by postoperative
result. Patient was 39years
old who had 4.9L of fat
aspirated from the abdominal,
ank, and back region via
UAL (VASER) PAL.RF
device known as Renuvion
was also used
213
Fig. 12.6 Female 2
Abdominal etching;
preoperative markings
followed by postoperative
result. Patient was 37years
old who had 4.0L of fat
aspirated from the abdominal,
ank, and back region via
UAL (VASER) PAL.RF
device known as Renuvion
was also used
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