Preface

Body contouring surgery has evolved greatly in the last decades. Along with cultural changes and new concepts of beauty, medical practice has also evolved following new ideas and patient expectations.

This book describes new techniques and devices, including surgical and nonsurgical procedures, in body contouring. It begins with a description of the evolution of liposuction. In the past, previous procedures were considered dangerous, resulting in poor outcomes and adverse side effects; patient safety was not a priority. As such, new technologies and care were needed, and a new term for liposuction emerged: liposculpture. There are various types of liposuction, ranging from soft or medium to high-definition liposuction, depending on how athletic a patient is and how much fat and skin laxity they have. The book also discusses preoperative markings for liposuction, which involves the surgeon marking the negative areas to work on to completely remove fat deposits, outlining the upper part of the midline, the lateral borders of the rectus abdominis muscle, the oblique and serratus muscles, and the iliac crest.

The second part of the book emphasizes some techniques for body contouring, starting with breast surgery. After the first breast implants became available, the initial trend was to use larger implants without considering the shape and readaptation of skin. Today, breast surgery has dramatically shifted, influenced by the type of activities modern patients engage in and with an eye towards shape and long-lasting results rather than just volume.

In patients who have had pregnancies or experienced weight fluctuations, a breast lift (mastopexy) may be needed, with or without the use of implants. The book describes some variations of the pedicles used in mastopexy in combination with the use of mesh in some instances or other options where the implants can be stabilized using a pre-pectoral pocket.

Next, the book discusses some new devices in body contouring. Power-assisted liposuction is an external device that generates an oscillatory movement in the canulae and hand piece that reduces the surgeon's fatigue, facilitating the extraction of more fat in less time. It is also a good tool for better defining the negative spaces in the abdomen. Other devices discussed include ultrasonic devices and internal radiofrequency devices that dilute fat and make its extraction easier, destroying adipose tissue and helping with the postoperative retraction of the skin. These devices achieve excellent definition of the worked areas with little inflammation and pain in the postoperative period, producing long-lasting results and allowing patients a more rapid return to their regular activities.

Finally, the book discusses skin resection, which is used if the patient has skin laxity and excess. Resection may range from a mini abdominoplasty to a complete or extended abdominoplasty or even a more advanced procedure called fleur-de-lis abdominoplasty, which is used in cases of skin excess and redundancy in the central and upper part of the abdomen. This procedure eliminates excess fat at the back, flanks, and lateral areas, helping to achieve a flat abdomen. The type of procedure used depends on the height and weight of the patient, the amount and extent of skin that needs to be resected, and the patient's general health. The book also discusses some safety specifications as they relate to these new technologies.

There is a promising future in body contouring procedures and it is important for surgeons to be aware of advancements in the field in order to keep up with and meet the needs and desires of patients.

> **Alexandro Aguilera** National Institute of Pediatrics, Department of Peripheral Nerve and Hand Surgery, Mexico City, Mexico

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Section 1

Introduction

Section 1 Introduction

### **Chapter 1**
