**2. Evolution of technique**

We have gone through multiple iterations to arrive at our current method of abdominal contouring.

Regardless of the technology used, liposuction technique is of paramount importance. The end point of liposuction should not be viewed as what has been taken away, but what remains. While it is important to note the total volume of fat aspirated from each site, the resulting contour is of greater importance.

Our current method of abdominal contouring combines the SAFE (Separation, Aspiration, and Fat Equalization) technique with VASER for fibrotic areas and Renuvion or BodyTite to assist in skin contraction in patients with more significant skin laxity. In our experience, VASER leads to mild skin contraction, but its main advantage is easier fat removal by facilitating adipose disaggregation in fibrotic areas. We use vaser in almost every liposuction case with the exception of cases where the aspirated fat would be used for fat grafting the breasts and when we are elevating an abdominoplasty flap.

When more profound skin contraction is required, we turn to the Renuvion or InMode devices. The decision for using Renuvion over the InMode devices is based on the surgical area treated. The design and ease of use of the Renuvion device makes it better suited for larger treatment areas. Bodytite can typically target more superficial soft tissue contraction needs while Renuvion can be helpful for large surface area fibroseptal contraction. There are instances where we will combine both Renuvion and Bodytite to achieve maximal contractions. In addition we will often add percutaneous treatment using RF microneedling treatments to improve skin quality and further increase contraction. We prefer the Morpheus 8 devide by InMode. We will typically perform 3 serial treatments separated by 4–6 weeks. We no longer utilize laser-assisted liposuction as we have had superior results with radiofrequency-assisted liposuction.
