Lipocontouring: Recipe for Esthetic Feminine Silhouette

*Sherif Wasief*

### **Abstract**

This chapter discusses the different types of procedures for augmenting body shape and size, including liposuction, lipoinjection, lipocontouring, and others. It presents a history and literature review of liposuction and details the author's personal techniques with accompanying figures and photographs. The chapter also discusses safety and common complications of body contouring techniques.

**Keywords:** lipocontouring, liposculpture, lipoinjection, hip-to-waist ratio, Brazilian butt lift (BBL), VASER, laser-assisted liposuction, expansion vibration lipoinjection (EVL), cellulite, buttock augmentation, thread lift

### **1. Introduction**

The influence of social media on how people view their bodies is undeniable. Increasingly, many people consider an hourglass body shape with a narrow waist and round buttocks to be "ideal." This is true across many cultures and ethnic groups. Nowadays, there is a focus on buttock aesthetics, with many people wanting full, round buttocks free from cellulite and a small hip-to-waist ratio (**Figure 1**).

#### **1.1 Liposuction, lipocontouring, and new concepts**

Liposuction is one of the most frequently performed procedures in plastic surgery, accounting for 15–20% of all cosmetic procedures. In the last 5 years, it has been among the top three most requested procedures [1].

Contributions from researchers like Sterodimas, Coleman, Klein, Gasparotti, Zocchi, Apfelberg and others are the cornerstone for all current lipocontouring procedures performed [2–7].

Alfredo Hoyos and Peter Prendergast's book on high-definition liposculpture details advanced techniques in lipoplasty and autologous fat grafting [8]. The authors describe augmentation of muscular curves by lipoinjection over muscles and intramuscularly for an athletic body shape.

A meta-analysis by Hector Lázaro Cárdenas-Camarena et al [1] focused on safety and reducing fatal complications in liposuction. This study found that thromboembolic disease, fat embolism, pulmonary edema, lidocaine intoxication, and intraabdominal visceral lesion are the most serious complications when performing liposuction.

**Figure 1.** *a, b, c and d are images of patients who have undergone lipocontouring; from different ethnicity.*

Danilla described the rectus abdominis fat transfer (RAFT) technique, which involves transfer of fat directly to the rectus abdominis muscle after flap elevation during lipoabdominoplasty [9]. Gonzalez et al. investigated incorporating the ultrasound-guided rectus abdominis fat transfer (UGRAFT) technique after highdefinition liposuction in one patient [10].

### **1.2 Gluteal fat augmentation**

Strong et al. contributed to the refinement of the fat grafting procedure with their review of harvesting, processing, and injection techniques [11].

Luiz Toledo invented the "Brazilian Buttock Technique" for transferring fat to the buttocks [12].

Mendieta [13] published his classification of the liposculpture of the gluteal units for better understanding of the area; gluteal fat augmentation became a threedimensional body contouring technique more than just a simple buttock augmentation; Mendieta described a gluteal esthetic unit classification system involving 10 units (see **Table 1** and **Figure 2**).

In Mendieta's classification system, six esthetic zones contribute to the buttock frame/shape: zones 1–5 and 8. The mid-lateral buttock (zone 8) is unique in that it


**Table 1.** *Gluteal esthetic units.*

*Lipocontouring: Recipe for Esthetic Feminine Silhouette DOI: http://dx.doi.org/10.5772/intechopen.108936*

**Figure 2.** *Gluteal esthetic units.*

often requires fat transfer to improve contour. Additionally, this area does not contain muscle and thus requires special attention and precision when fat grafting. All approaches involve liposuction of zones 1–4 in all patients. It is important to note that excessive liposuction of zone 5 can also lead to an unnatural transition zone between the buttock proper and the lateral thigh [14].

Expansion vibration lipofilling (EVL), first described by Del Vecchio and Wall, is a more efficient alternative to syringe-based injection in large-volume fat transplantation to the breast and buttock, employing basket cannulae and vibration through recipient site tissue. By utilizing 4-mm large-bore tubing, the authors demonstrated that large-volume fat transplantation procedures such as Brazilian butt lift (BBL) can be performed more expeditiously, free the operating hand from fatigue, and allow for more focus on cannula tip location and anatomic cannula depth [15].
