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What is Body Contouring?
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What is Body Contouring?

Episode 42: What is Body Contouring?

This is a term that gets thrown around a lot, so I just wanted to take a little while to go through exactly what body contouring is, and also to describe the various procedures that are available that fall under this bigger umbrella term. So a straightforward definition of body contouring is that a body contouring procedure is a procedure that is designed to change the shape of your body.

There are several categories of body contouring, and these are surgical procedures, minimally invasive procedures, which are surgery but tend to have much less scarring and much less downtime and recovery than surgical procedures, noninvasive procedures. And finally, there are two special categories of body contouring that we'll cover at the end, and those are high definition body contouring and body contouring procedures after massive weight loss.

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What is body contouring surgery?

So surgical procedures are exactly what you are imagining they are. They involve incisions and usually general anesthesia, which means that you are completely asleep and you're breathing with the help of a machine, and you'll wake up a few hours later and you'll have had your procedure performed. Common examples of surgical body contouring procedures include tummy tuck or abdominoplasty, an arm lift, a thigh lift, and also things like a lower body lift. And what all of these procedures have in common is that they tend to be the most powerful option available to change the shape or the contour of the part of the body under consideration. So for example, with a tummy tuck, we can remove a great deal of excess skin, treat excess fat, and also tighten the abdominal muscles to treat a rectus diastasis. Similarly, with an arm lift and a thigh lift, we are removing the most amount of excess skin possible with these surgical procedures. So while they do tend to have the most scarring, the most downtime, and the most cost associated with them, they also tend to be the most definitive options available for a given body area.

Minimally invasive body contouring procedures are technically surgical. However, they require only very small incisions. It's usually three to four millimeters in length. They tend to have a very straightforward, more comfortable recovery, then surgical procedures with a lot less downtime, and they also often are less expensive than their maximally invasive surgical counterparts. The other thing to know about minimally invasive procedures is that they can often be performed under local anesthesia, which is where you're wide awake, but you have numbing medicine, so you are feeling only minimal if any discomfort, and also twilight anesthesia, which is where in addition to numbing medicine, you have some IB medication to relax you, but you really are a lot less concerned with what's going on.

And with these options where you're not completely asleep as with general anesthesia, the process right after surgery, the recovery is often faster and more comfortable. So there are three subsets of minimally invasive body contouring procedures, and they include liposuction, fat grafting, and skin tightening. So liposuction, and we've discussed this in other episodes, is a procedure in which we make a series of very small incisions, insert a long thin instrument called a cannula, instill numbing medication into the treatment areas, and then come back and suction the fat out of the treatment area to achieve the desired shape.

One kind of liposuction that deserves special mention here is Lipo 360 or 360 Lipo. And this is a term that in my opinion isn't a great one to use because it's just too vague. But what it usually implies is liposuction of the entire torso, the front, the sides and the back or all 360 degrees. The reason I don't love this term is that I think that we need to be very specific in talking about the areas that we're treating with liposuction so that the surgeon and the patient can communicate goals and desires very clearly with one another to make sure that we're achieving the desired outcome. So instead of saying liposuction 360, I prefer to break this down into its component parts such as liposuction of the abdomen, liposuction of the flanks, and liposuction of the upper back or the lower back or the axilla or bra roll. So just a little word on terminology there.

The next category of minimally invasive body contouring is fat grafting. And while the goal of liposuction is to remove fat in areas that it's not wanted, the goal of fat grafting is exactly the opposite, and that is to increase volume with that in areas as desired to improve body contour, body shape. And the two most popular areas for fat grafting in body contouring are the breasts and the buttocks.

And fat grafting for the breasts can be used on its own to increase breast volume or in combination with breast implants to achieve certain shapes specifically. Fat grafting is often combined with breast implants to achieve an increase in upper pole volume. And the upper pole of the breast, just as a reminder, is the portion of the breast that is above the nipple-areolar complex, and the lower pole of the breast is the portion of the breast that is below the nipple-areolar complex. So when we put an implant into the breast, unless we're using a teardrop or anatomic implant, and we discussed the differences between these two in an earlier episode, with a round implant where more or less adding equal amounts of volume to the upper and lower pole of the breast. So if we want to selectively add volume to the upper pole of the breast, we can do that with fat grafting.

And then the other very popular area for fat grafting is the buttocks, and this procedure is often called a Brazilian butt lift. And in this procedure, we are taking fat from elsewhere in the body and using it either to enhance the size of the buttocks or to give them a more pleasing rounder shape, or in some cases, to achieve both of these goals.

And fat grafting is a relatively straightforward procedure to perform. And with this procedure, we are harvesting fat with liposuction and then processing it to remove any excess lipids or blood or anesthesia fluid that we don't want to be re-injecting as part of the graft. And then making essentially a paste out of the harvested fat cells that have been purified and then reintroducing that fat into the treatment area. And while fat grafting is relatively technically easy to perform, there is a lot of nuance and artistry that goes into achieving truly excellent results with this procedure.

The last category of minimally invasive body contouring that I'd like to cover is skin tightening, and skin tightening technology is important because liposuction really is only a fat reduction procedure. It does not do anything to shrink the skin itself.

And an analogy that I like to use here is that of a balloon. So if we think of the treatment area that we're targeting with liposuction as a balloon, if we go and remove a small amount of air from a balloon, the outside of the balloon, that plastic shell, will contract to a certain degree and everything will look just fine. But if we go and remove a lot of air from that balloon, the outside of the balloon will not be able to keep up in terms of how much it contracts and it'll start to look rippled and wrinkled and may start to droop.

And the same thing is true in liposuction. So in that analogy, the air that we're removing from the balloon is fats and the rubber shell of the balloon is skin. And just like the balloon, if we remove a small amount of fat from the treatment area, the skin can contract and you'll do just fine. But if we're moving large amounts of fat, the skin sometimes can't keep up. It can't contract enough. So you will get this kind of wrinkled or rippled or even deflated appearance.

And really the amount of fat that we can remove without having that skin appearance largely depends on the skin elasticity, which has to do with a lot of individual health factors that range from age to smoking status. And this is a really important part of your evaluation with a body contouring expert. They'll be able to help you decide if you will have good enough skin elasticity to have liposuction without a skin tightening procedure at the same time, and they'll do that based on physical exam and also taking your health factors into account.

So if it is decided between you and your surgeon that you're someone that if you remove a significant amount of fat, your skin may not be able to contract enough to get a great result, then you will be looking at these minimally invasive skin tightening procedures. And there are several of these available that we've discussed in other episodes, but the moral of the story here is that in general, they involve the introduction of some kind of instrument through one of the tiny liposuction incisions and using that instrument to pass some kind of energy to the skin to generate heat, which causes skin contraction.

And as I mentioned in the past, of all the available devices, the one that I think works the best and that I use very frequently in my practice is BodyTite, which is a bipolar radio frequency skin tightening device. And I find that this does deliver very consistently excellent results for skin tightening in conjunction with liposuction. So that wraps up our discussion of minimally invasive body contouring techniques.

What is noninvasive body contouring?

So we can now move into noninvasive procedures, and noninvasive body contouring procedures can more or less be divided into fat reduction procedures and muscle building procedures.

The fat reduction procedures have been around for a bit longer than the muscle building procedures. And the basic principle with the noninvasive fat removing procedures is that they use an applicator that will apply some kind of external stimulus that will pass through the skin and selectively affect fat cells to cause them to die, resulting in a reduction fatty volume. Of all of these fat reduction procedures, the most widely known is probably CoolSculpting. And for reasons that I went through in an earlier episode, I do think that of the noninvasive fat reduction procedures, CoolSculpting is the best.

However, these noninvasive fat reduction procedures really in general don't hold a candle to minimally invasive fat reduction procedures as they just don't have the same kind of precision or efficacy as these procedures. But for individuals that either can't have surgery or are just very opposed to having surgery, these noninvasive fat reduction procedures like CoolSculpting can be a reasonable option as long as these treatments are designed by a true body contouring expert that understands the limitations of this technology and the best way to apply it.

In terms of the other category of noninvasive body contouring procedures, we have muscle building treatments, and these are a bit newer to the scene. And the original noninvasive muscle building procedure is Emsculpt. And this is really the noninvasive muscle building procedure by which all other technologies in this genre are judged. And what Emsculpt does is use HIFEM, H-I-F-E-M or high intensity focused electromagnetic energy, to create super maximum muscle contractions or muscle contractions that are much more powerful than anything you could produce through voluntary exercise.

And it induces up to 20,000 of these contractions in a 30 minute period, and this causes muscle growth by both hypertrophy and hypoplasia. So in hypertrophy, the muscle cells themselves are getting larger, whereas in hyperplasia, you're actually creating new muscle cells. So as a byproduct of this treatment, you actually do burn a little bit of fat in the local treatment area, but the main goal of Emsculpt in these noninvasive muscle building procedures is to build muscle.

And before we get to the end of this episode, I wanted to touch on two special categories of body contouring. The first is high definition body contouring or high definition lipo, and the second is body contouring after massive weight loss. In brief, high definition lipo or hi def lipo or hi def body contouring is essentially a marketing term that was developed to describe the use of liposuction instruments to create the appearance of specific anatomical contours as part of a liposuction procedure. So instead of just reducing fatty volume, with high definition lipo in addition to reducing that fatty volume will often attempt to create the cuts or lines that are associated with muscle development.

High Definition Body Contouring and Body Contouring After Massive Weight Loss

So high definition liposuction can actually be used to create the inscriptions in the rectus diastasis to give the appearance of a well-developed six pack. And while a true expert at this technique can create something that approximates the appearance of a well-developed six pack using high definition liposuction, in my opinion, it usually looks unnatural even at rest. And then as soon as you start to move your abdomen, if you bend at your waist or otherwise exert your core, I do think the appearance of these results of high def liposuction do you tend to look a bit unnatural.

So it's important before you embark on one of these procedures that you look at a lot of before and after pictures to make sure that the result that can be achieved is something that is in line with your aesthetic goals.

The second special category of body contouring that I wanted to touch on here is body contouring after massive weight loss. And massive weight loss by most plastic surgeons is considered a decrease in weight by at least a hundred pounds. And this is often accomplished with the use of bariatric surgery procedures, like a gastric bypass or a gastric band, but sometimes can be achieved with diet and exercise. And with massive weight loss, there is a dramatic decrease in the volume of fat. And just like with our balloon analogy from earlier, the skin has a very hard time contracting enough to keep up with this decrease in fatty volume.

So individuals that succeed in losing a great deal of weight often have a lot of skin excess, and this degree of skin excess far exceeds anything that can be treated effectively with the minimally invasive skin tightening methods that we discussed earlier and really require not only the standard surgical techniques that we went over earlier, like a tummy tuck, but they often require a truly advanced surgical skin excision procedures. And these might include things like extended arm lifts and various kinds of thigh lift or lower body lift, or a fleur-de-lis abdominoplasty, which is a tummy tuck that involves both a vertical and horizontal incision to allow for skin excision in multiple dimensions. So before I'm considering having body contouring after a massive weight loss, it's important that you go to someone who is truly expert in these procedures.

Hopefully this overview of body contouring has been helpful, and it allows you to make more informed decisions as you embark on your own body contouring journey.

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  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD

All photos are of models except before and after images.

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