4. Surgeon ability in shaping

The introduction of vaser allows efficient and safe emulsification of fat in superficial and deep layers while preserving vascular and neural structures.

This is a new chisel in surgeon hands to sculpture the body as a work of the artist, working in all subcutaneous planes, by adding and subtracting fat with delicate instruments and refined techniques. The subdermal plane is no longer a taboo area; controlled deformities are desirable, and muscular definition is attainable through lipoplasty by revealing the underlying anatomy.

Figure 4. Muscle anatomy.

The full understanding of muscle anatomy is essential to try to recreate a muscle-shaped body and enhance definition and contouring (Figure 4).

The lines of body are described as natural curves which are defined by muscle, bone frame, and fat deposit. Posture is another component to assess the natural body appearance, and man and woman are different of course. Lipoplasty can address only subcutaneous tissue and is not a solution for abdominal protrusion secondary to muscle weakness or intraabdominal fat. This will require muscle exercise and diet to compensate. The achievement of symmetry and proportion is the goal of any body contouring procedure. The man of Vitruvio, designed by Leonardo da Vinci, remains the golden reference of human proportions. In the recent age, new trends in fashion have defined new more athletic figure, more toned, even in woman, answering to the so popular attended gym all over the world.

The surgeon view and sense of artistry are essential in planning a good shaped body. He must create in his mind a tridimensional view of the new body to shape: ideally must thin the subcutaneous tissues as much as to display and reveal the superficial musculature, removing fat and highlighting major muscle groups. The salient features of the muscular anatomy relevant to body contouring are outlined such as origin, insertion, orientation, form created, and relationship to adjacent muscle groups.

Main muscles involved are the rectus muscles, the oblique muscle, the pectoralis in the front appearance, the latissimus dorsi, the lumbaris, and the gluteus in the back.

The muscle edges and the intermuscular digitations must be outlined to better define an athletic abdomen, together with the linea alba and linea semilunaris recreation.

Lines of transition between muscles must be obtained with more suction in a superficial manner. The main concept is removing and revealing what is underneath in normal-weighted patient, while traditional liposuction focuses in removing fat in overweight patient. The sculpturing surgeon tries to reveal the underlying musculature and body anatomy; shaping is a combination of removal to reveal what is underneath and adding in areas of deficiency to give more curvature.

It is a mixture of light and shadow and depression and concavities to give the impression of more defined and toned body. In man, fullness is desirable in the upper pectoral region, deltoid, and biceps, and frequently, fat is grafted to augment the pectoralis and deltoids. In woman, the buttocks and breasts often require augmentation to improve fullness and increase curves.

An example of this high-definition surgery in man is given:

Figure 5. Planning high-definition frontal view.

#### Figure 6.

Planning of lateral side. Margin of the oblique muscle outlined, edge of latissimus muscle, the inguinal ligament, and in red the outer medium gluteus zone to be grafted with fat to increase roundness.

Figure 7. Preop appearance.

Figure 8. Postop appearance at 3 months.

Figure 9. Preop oblique view.

Figure 10. Postop oblique view.

Figure 11. Pregluteal definition and torso contouring.

32-year-old athletic body, looking for definition (Figure 5).

The areas of biceps muscle are marked, the area of male gland reduction is circled, the area of superficial fattening of male breast is marked, and the area of fat transfer to pectoralis muscle to add volume is marked as well.

#### Figure 12. Postgluteal definition and torso contouring.

The linea alba is marked in the central abdomen; the outer margin of the rectus muscle and the interdigitations of the muscle area are marked as well.

The margin of the oblique muscles, the inguinal ligament to create a marked depression, and the extra fat surrounding the navel are circled, and finally, the lateral flanks are lined where fat needs to be removed (Figure 6) [3, 4].

Result of definition of an athletic young body is shown, after linea alba and linea semilunaris deepening and oblique muscle and inguinal ligament being enhanced.

Note the concavities and shadows created with false deformities to give more power and more density to muscle areas (Figures 7–10).

The gluteal region is approached in a distinct way: lateral flanks are reduced in an aggressive way; the inguinal ligament is enhanced and glutes' prominence reduced, while the outer medium gluteus muscle is filled to improve athletic definition (Figures 11 and 12).
