**4.1 Double chin: men and women**

Double chin sagging correction, regardless of sex, can be performed by placing ports of under 2.9 mm in locations under the chin and laterally on both sides under *VASER Liposuction - How to Get Natural Results with Ultrasound Assisted Liposuction? DOI: http://dx.doi.org/10.5772/intechopen.100154*

the ears. Tumescent fluid infiltration should be with about 200–300 mL. The VASER device strength should be set between 20 and 40%, a stronger strength can cause the cannula probe to break. Following tumescent fluid insertion, a 5–6-minute waiting time is needed. For a more pronounced double chin and neck region, this can be increased to 9 minutes. Liposuction duration can be up to 10 minutes, until desired results. This region is very delicate and a baby VENTX cannula is used, to prevent injury and for ease of suctioning and movement. Flat cannulas up to 5 mm can also be useful to use. It is important not to feel any resistance while the VASER converts larger pieces of fat into smaller ones. A large quantity of fat is rarely present, in this area, as compared to other areas of the body. It is also important to postoperatively check neurological facial mimicry functions (smiling, whistling, frowning) to assess possible peripheral nerve injury, which can be common. However, with exercises and anti-inflammatory medications this will resolve in time.

#### **4.2 The back area: men and women**

The back can be defined as the upper, middle and lower areas. Each section can be combined with lateral side areas for liposuction. The upper and middle are often combined with the areas under the armpits and lateral sides of the rib cage – posterior part of chest girth. While the lower back is combined with love handles and buttocks. Differences among the sexes varies only in liposuction definition sections. Women often prefer the lower back with buttocks defined, while men prefer the love handles [16]. However, most opt for a thorough combination of a more complete coverage. Liposuction preparation is the same for both. Ports are regularly distributed, usually 3 to 5 of them, to adequately cover each area for various movement directions of the cannulas. Infiltration is performed with 2–3 liters of tumescent fluid, the amount used depends on coverage area. The VASER device strength should be set at 70–80%, with a waiting duration time of 10–15 minutes. The liposuction duration can last between 15 and 30 minutes, for each area, using VASER probe cannula and VENTX cannula with a diameter of 3.7 mm. The continuous mode is used depending on fibrous tissue (**Figures 5**–**7**).

#### **4.3 Buttocks: men and women**

Liposuction of the buttocks often includes the lower area and sides. This procedure is reserved for specific cases and deformities. If VASER is performed, it should be at 50% VASER device strength, with a waiting time of 10–15 minutes, and tumescent fluid of 1–2 liters. However, instead of liposuction of the buttocks, fat grafting is preferably used. In practice, it is a much better defining and contouring procedure, with more natural results, where the surrounding excess buttocks fatty tissue is removed. The process starts by first emptying the supragluteal region, followed by the infragluteal region. The upper thigh area, lower side areas, and lower buttock area, on both sides, are evaluated for appropriate reduction. Once these areas are defined and reduced, sculpturing of the buttocks can begin [17, 18]. Depending on the sex of the client, certain specific areas are chosen for enhancement. For women, higher side segments are applied, while in men the central and upper areas with concaving sides is defined. Women prefer more of a curvature effect, while men prefer a more athletic figure, with an emptying effect of the lateral sides. Performing the contouring and defining in this area with the cannulas, extreme caution of the tip is needed since it can be easily punctured through the surface, leaving scarring. Gentle in-out motions should be used, and a significant amount of quality fatty tissue should be used to instill when space is created, using

**Figure 5.** *Before and 3 months after VASER liposuction.*

about 200–300 mL. In some cases, more can be used, such as in more obese clients, while more slender clients will need less volume to achieve adequate results.
