**4.8 Upper arms: men and women**

The upper arm area can be combined with chest definition, in selected male cases. In women, the defining process area is the triceps region, often saggy and hanging. It is important in both sexes to define the muscles, for men more the upper section, while in women the lower upper arm portion. The process is similar in both sexes. VENTX ports are placed in the arm pits and elbow region. Taking care that postoperatively scars will be hidden in skin folds, and less visible. Port size should be 3.7 mm, using up to 1 liter of tumescent fluid on each side, with reduced power of VASER device at 50%, using VENTX cannulas for liposuction and if fibrous tissue is present, use the VASER 2–3 grooved cannulas for better extraction of fatty

tissue. Waiting times are similar as previous areas, 10–15 minutes with liposuction time of 20–30 minutes depending on visual achieved results.

#### **4.9 Forearm: men and women**

The forearm area is rarely requested as a corrective area from clients. As such, it is rarely performed. However, in the event this would be necessary to perform tumescent fluid of 200–500 mLs would be used. VENTX ports of a narrower diameter of 2.9 mm would be appropriate and placed in visually conspicuous areas. The VASER device should be at a reduced strength of 50%, using a 3 grooved cannula for liposuction. Waiting times again would be 10–15 minutes, with liposuction time of 20 minutes or more depending on desired results. Great care should be taken to stay away from the skin surface, to avoid breaking through and causing potential scarring.

### **5. Results**

At Polyclinic Bagatin, there have been 409 VASER liposuctions performed in the last 9 years, including combination procedures with surgical resections. In about 15% of the cases, they involved male clients. The most frequent areas treated were the chest, abdominal wall, and lower back area. There were a few double chin procedures, as well. In women, most often VASER liposuction was performed on the abdominal wall, upper back area, hips and lower inside sections of the thighs. Patient postoperative monitoring lasted from 3 months to a year, or even more in certain cases. In both sexes, relatively few complications were encountered. The few seen were slight burns involving areas where ports were positioned, skin color changes, irregularities in the skin as depressions, dimpling or bulges, and some hardness, involving fat necrosis. In two cases, the thermal burns were caused at the ports and usage of over-heated tumescent fluid. Therefore, careful preparation and caution must be used throughout the VASER liposuction process. In 10% of the cases, additional corrections were necessary to achieve the desired results. Adjuncts used to enhance definition and contouring were the non-invasive Med2Contour, Zerona cold laser and the Venus Legacy radiofrequency methods. If liposuction was needed for addition touch up corrections, this was performed a year later. This would also include fat grafting to improve results. It was important to wait a year before redoing liposuction to give the body tissues time to heal and settle down into their new positions. This provided a more accurate visual of what needed to be corrected and exactly where to concentrate the liposuction correction. Patient satisfaction is the key. At Polyclinic Bagatin, patient satisfaction surveys show great percentage levels of satisfaction. Clients frequently recommend our clinic to others, as well as, continue their care and use many of our services offered.

## **6. Discussion**

VASER liposuction itself can achieve great results. The combination of other liposuction methods and surgical methods, adds to the enhancement of desired results. Abdominoplasty is often combined with liposuction in correcting the abdominal area. Procedures to be performed depend on what clients prefer and want. It is the role of the plastic surgeon to explain what can and cannot be achieved, and what will yield the best results for individual cases. Patient satisfaction is a key part of what Polyclinic Bagatin strives for. The best commercial is a happy client.

In general, any liposuction technique used should be tapered to each client specifically. Of course, there are standard procedures and preparations to be followed. *VASER Liposuction - How to Get Natural Results with Ultrasound Assisted Liposuction? DOI: http://dx.doi.org/10.5772/intechopen.100154*

Careful selection of port entries, tumescent fluid amounts, duration and extraction times should be used and again modulated for each case. The amount of tumescent fluid used can vary and is tappered to each case, especially if more than one region is being corrected. It is important to take the time to prepare well, and results will usually follow.
