**4.5 Chest area: men and women**

Shaping the chest area is obviously significantly different in males and females. In males, this tends to be the most performed liposuction procedure. Excess fatty tissue under the nipple-areolar complex is the most common problem seen. However, this can be spread out wider, covering more of the breast plane. Correcting excess just under the areolar areas is usually not sufficient. Full redefining of the chest region is often necessary to achieve satisfying results. In performing reduction in this area, the sides and lower chest areas, underneath the nipple areolar complex are reduced. Providing a wider reduction area covered. This provides more definition and enhancement of the large chest muscles. Fat grafting is usually not performed in males in this area, since they usually prefer a slender leaner look, with minimal scarring. Preparation for this area include, performing incisions for ports

*VASER Liposuction - How to Get Natural Results with Ultrasound Assisted Liposuction? DOI: http://dx.doi.org/10.5772/intechopen.100154*

**Figure 8.** *Before and 6 months after VASER liposuction – Front view.*

using the method Alfredo Hoyos uses [20], placing then directly under the nipple and in the peripheral armpit region, as to minimize visual scarring postoperatively. These incision areas also allow for easier access to all areas needed reduced. Again, VENTX ports are used from 2.9–3.7 mm diameter. Previously, larger diameter of 3–4 mm, when "Byrone" cannulas (wide diameter) for liposuction were used. However, now the more reduced diameters are preferred, especially in more sensitive delicate regions [21]. VASER device strength can be set from 70 to 90% depending on the presence of scar tissue, increasing strength if present. Tumescent fluid infiltration should be about 1–2 liters for each breast side. The waiting time is 10–15 minutes after application and liposuction should last 20–30 minutes, for each side performed. The combination of surgical tissue removal can be necessary, to achieve desired results. It is important to explain to patients that some loss of touch sensation can occur in the nipple region. Sometimes, this can be permanent.

**Figure 9.** *Before and 3 months after VASER liposuction – Front view.*

Drains are usually not placed, however at the side regions they can be placed to aid overflow in some selected cases.

For women, rarely isolated tissue reduction using VASER liposuction is performed. Instead, VASER is used for defining and contouring the lateral breast and chest areas. This method in combination with surgical reduction achieve very good results, in specific cases. If performed, 3.7 mm diameter VENTX ports are used. Tumescent fluid can be up to 1 liter per side, VASER device strength setting between 70 and 90%, waiting time of 10–15 minutes, and liposuction for 20–30 minutes. Mercedes cannulas with 3 openings can also be used. (For surgical breast reduction, incisions are made under the breast or through horizontal and vertical incisions (inverted T). More often fat grafting is a method used, providing supplement to the procedure on the breast [22]. Small incisions are made, only a few millimeters long in the areolar area, using cannulas of 2.1 mm in diameter for application. This reduces visible scarring postoperatively.

*VASER Liposuction - How to Get Natural Results with Ultrasound Assisted Liposuction? DOI: http://dx.doi.org/10.5772/intechopen.100154*

**Figure 10.** *Before and one year after VASER liposuction.*

### **4.6 Thighs: men and women**

Corrective thigh area procedures are rarely sought by men, this is a more problematic area for women. The upper thighs area is more pronounced, visually with clusters of fatty tissue, cellulite, forming distortions of the skin and contour. The procedure here is to reduce the volume in the front and side areas [4]. Tumescent fluid ordinarily used is 1–2 liters on each leg. VENTX Port diameter size is 3.7 mm, while the VASER device should be set at 50% at a continuous fluid injection stream. Port incisions are made at the groin and knees, medially in the inner thigh area. One placed at the groin, while two are placed lower halfway down towards the knee and at knee level. Liposuction time is again 20–30 minutes per side. Careful care should be taken, to avoid excessive liposuction in this area, because it can lead to the onset of "cutis marmorata" (marbled skin) [23]. Attention should be directed to sagging skin, and in selected cases surgical reduction may be required to tighten the area. Ordinarily, the knees are concurrently defined when the thighs are performed (**Figures 11** and **12**).
