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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_577_Библиотеки_им_академика_М_И_Перельмана
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Case 1
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A. Di Giuseppe and F. Giovagnoli
Fig. 20.22 Anterior, posterior, and lateral views. (a, c, e) Pre op, (b, d, f) 6months post op after 3D circumferential thigh VASER
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20 Three-Dimensional Thigh Contouring theRole ofFat Grafting
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Case 2
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Fig. 20.23 Pre op (a, d), planning (b, e), 6months post op (c, f) oblique view
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S curve
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A. Di Giuseppe and F. Giovagnoli
20.7 The Role ofFat Transfer inThigh
Contouring
The analysis of female body gure will reveal the ideal contour lines that enhance the beauty and harmony. C lines goes
from the axilla to the breast and abdomen, with a concavity
at the midline in correspondance with the umbelicus. S lines
are a curvature from lateral thorax, creating a concavity at
the anks and ending at the buttocks and lateral thigh. S lines
does continue with a gentle convexity at the knee-calf junction. R curve denes buttocks projection and shape [8]
(Fig.20.24).
The planning of the ideal body frame of the lateral thigh
includes the marking of the line which goes from the lateral
ank to the outer trochanter and then continous and termi-
C curve
S curve
C curve
R curve
S curve
S curve
Fig. 20.24 C curve, S curve, R curve (Photo taken from VASER Solta
Medical User’s Guide [5]. Courtesy of Bausch, ©2022 Bausch Health
Companies Inc., All Rights Reserved)
nates along the lateral thigh at the knee. This line should be
ideally a gentle S curve, where some areas have to be
removed (lateral ank, trochanter) and some areas have to be
added (lateral gluteal depression) (Fig.20.25a).
So, the nal ideal shape results from a combination of fat
substraction (VASER liposuction) and fat addition (fat
transfer).
All information about technique of fat transfer are forwarded to the chapter named “Breast fat augmentation: stepby- step technique and ultrasound contouring of donor area.”
Surgeon does often encounter asymmetries in body areas
when planning is contouring procedures.
The following patient presents a rather consistent asymmetry in the anks area as well in the trochanter. The right
ank appears more rounded and full, the lateral trochanter
and the lower buttocks are denitely larger than the left side.
At the lateral gluteal depression, there is a more marked
deformity on the left side. The inner thighs do convert and
touch themselves without leaving an ideal “window space”
which should be in the ideal frame of inner thighs. There is a
lack of roundness of the lower buttocks, which are heavy and
saggy. This attitude is mostly due to heavyness of middle
buttocks.
In order to x all those esthetic issues, a liposculpture of
anks, abdomen, buttocks, and thighs has been planned, with
body reshaping by substraction and addiction of fat.
The abdominal region was treated with high denition
VASER in order to reshape and enhance the edges of abdominal muscle (rectus abdominis and oblique muscles). The
anterior lateral thighs were reduced and reshaped with 3D
thigh VASER liposuction. Skin tigthening after supercial
undermining and deeper fat emulsication is a major advantage of the ultrasound technology.
Body proportions of thigh, buttocks, abdomen, and anks
are often part of the same frame study of the female g. I like
to treat all those areas at the same time, in order to give the
best esthetic result and nal ideal frame.
In the case presented (Figs. 20.26 and 20.27), buttocks
and thighs have been reshaped together with anks and anterior thighs. Fat has been transfered to the lateral gluteal
depression, to recreate a natural curvature and the ideal S
line of the body frame. The nal result is a lighter body, a
curved natural shaped buttock-thigh complex, and a thinner
circumferential thigh. Mastering body frame liposculpture is
nowadays a combination of fat removal and fat adding.
Surgeon must be prepared to use both techniques in order
to achieve the best esthetic result as the patients are nowadays more and more demanding: the internet generation has
gured that with the latest technologies, surgeon could
achieve any possible change in the body appearance and pretend perfection without understanding the human limits of a
surgical result, which depends in large part on the initial
condition.
20 Three-Dimensional Thigh Contouring theRole ofFat Grafting
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Fig. 20.25 (a) Pre-op line, (b) planning correction with fat removal and fat addition, arrow indicates fat transfer area, (c) new line after liposcu-
lpture and fat transfer (10days after surgery)
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a
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A. Di Giuseppe and F. Giovagnoli
Fig. 20.26 Pre op (a, d, g, i), planning (b, e), post op 6months (c, f, h, j)
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Fig. 20.26 (continued)
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A. Di Giuseppe and F. Giovagnoli
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Fig. 20.27 Planning ideal curves drawn with concavity (a), convexity, zone of fat transfer at the gluteal depression, nal result (b), pre op (c, f,
i), planning (d, g, j), post op 6months (e, h, k)
20 Three-Dimensional Thigh Contouring theRole ofFat Grafting
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ijk
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Fig. 20.27 (continued)
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A. Di Giuseppe and F. Giovagnoli
3D VASER liposuction is somehow different from threedimentional: as described by Leonardo da Vinci, in order to
respect proper proportions, in the thighs area, the plastic surgeon must not only reduce the dimension circumferentially
but he must also respect the anatomy and sense of beauty of
the thigh. Which means reducing the thickness of the tissues,
in a different way, minding the area where he works. And I
dene it 3D VASER liposuction.
As a matter of fact, VASER lipo allows surgeons to work
as in the deeper layer, to debulk and reduce the volume, as in
the supercial layer to sculpture and better dene the nal
shape.
More it is essential in enhancing skin retraction in difcult area as the inner thigh, or in older skin, saggy skin
(Fig.20.28).
This is a 54-year-old patient: quality of the skin and skin
tone are related to the age of the patient. Likely with a standard liposuction, a proper contouring and retraction of the
tissue would have been impossible. Photos show the 3D contouring of buttocks and thighs. Lateral and oblique views
(Fig.20.28c–h) show the nal result achieved in a difcult
case.
I personally believe those type of patient can be treated
succesfully only with the help of a device, which allows the
surgeon to work in different layer of the tissue: and to my
knowledge, ultrasound liposuction is the only device which
helps. I used 3.7mm diameter probe with 2 or 3 rings: power
is set at 80% of the total.
I work initially on the supercial layers to fully undermine the tissues. Then I approach the deeper layer for
debulking.
As a nal step, I clinically observed the shape achieved,
and I do correct according to the nal proportion required.
Sense of artistry of the surgeon is capital at this point to
properly assess the contour of the thigh.
At the end, I use a 3.7mm cannula with no suction, for
verifying the full untermining of the tissues.
In order to obtain the highest skin retraction, plastic surgeon should be able to harvest a ap with a thin subcutaneous layer in all the areas treated.
Tridimensional thigh contouring is possible also in large
cases. This is a 32-year-old patient, 78kg of weight, and
158cm height.
A large VASER liposuction was performed, removing 5
litres of emulsied fat. Liposuction was extended also to the
abdomen and anks.
In this case, greast attention was devoted to debulk the
deeper layer where the majority of fat was located.
Final result shows that the dimention of the entire thigh
was reduced circumferentially achieving a much better proportion with a good contouring (Fig.20.29).
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Fig. 20.28 This is a 54-year-old patient: quality of the skin and skin tone is related to the age of the patient. Pre op (a, c, e, g, i), 6-month post op
(b, d, f, h, j) oblique view
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