Abstract

The art of body shaping has changed in the last decade, with the new philosophy of superficial sculpturing and fat removal and fat adding in combination. Vaser ultrasound device allows a superficial undermining of the skin all over the body; deeper fat removal allows precise contouring. Fat harvesting with new device allows harvesting and concentrating high-quality fat, which is added in zones to enhance curvature and balance of body shape.

Keywords: vaser liposuction, fat harvesting, fat transfer, superficial sculpturing

#### 1. Introduction

The evolution of body shaping techniques in the last decades has affected new technologies as well as vaser ultrasound liposuction; new blunt and narrow cannulas, which replaced sharp, larger diameter ones; and wet and superwet infiltrations which have replaced aggressive dry liposuction. Moreover, the art of fat harvesting and fat transfer, combined with the new studies of stem cell and their capability of generating new tissues, has led to a more sophisticated way to intend the art of body contouring. The new vision has a more artistic impact on the tridimensional sculpture of body frame. Another fundamental issue has been the understanding of the skin retraction capabilities enhanced by new technologies and the importance of full understanding of the anatomy of body muscles to help define and shape the body.

#### 2. Heading section

New technologies have entered the market in the last decade, as power-assisted technology, ultrasound technology, and laser technology, in order to facilitate fat removal, reduce trauma, and improve skin retraction. I have personally been one of the pioneers of ultrasound-assisted liposuction since they appeared in the early 2000s and contributed to the realization of the new vaser device, more advanced and safer than previous ultrasound-assisted devices in commerce 20 years ago. In vaser technology (Figure 1), vaser is an acronym of vibration amplification sound at resonance and is a third generation of ultrasound-assisted liposuction that uses ultrasound energy to melt fat tissue, ultrasound technology emulsifies the fat for removal in such a delicate way that preserves as much of the tissue of the matrix as possible while emulsifying the desired amount of fatty tissue. Special titanium

probes deliver the ultrasound energy to fat tissue, after proper infiltration with tumescent solution, allowing the selective destruction of only the fat tissue through three mechanisms: (1) cavitation, (2) mechanical, and (3) thermal.

In cavitation effect (Figure 2), the vaser probes vibrate at ultrasonic frequencies creating compressive and rarefactive forces around the grooved tip; cavitation microbubbles expand and then implode, releasing energy that disrupts the adipocyte architecture until an emulsion of fat and fluid is formed.

Figure 1. Vaser system.

Figure 2. Cavitation.

Mechanical disruption of fat occurs at the tip of the probe, where the vibrating metal surface comes in contact with the adipocytes. Cavitation and mechanical disruption of adipose tissue occur due to relative fragility of this tissue compared to other tissues such as vessels, muscle, and nerves. This is why this process is safe and effective, spears the connective and vascular network of the skin and subcutaneous tissue, allows a safe subcutaneous superficial undermining of the skin, and is thus a major skin retraction of tissue. The thinnest is the dermal tissue, the highest is the skin retraction, and liposuction is the term to define vaser smoothening of the fat. Careful emulsification, not an aggressive fat removal, is selective where needed in two different layers: subcutaneous for superficial definition and deep dermal for volume removal.

Minding the advantages of this technology, the plastic surgeon must be able to achieve superior results in terms of definition and shaping.


All those potential weapons must be utilized by surgeon to better define the body shape and achieve better contouring [1, 2].

### 3. Fat anatomy

The subcutaneous tissue is divided into three layers: a superficial adipose tissue layer, an intermediate membranous layer, and a deep adipose tissue.

The thickness and proportion of those layers vary throughout the body depending on the anatomic region: the abdominal has a prominent fascial plane, making it easier to distinguish between the two fatty layers.

In the leg, there is an attenuated fibrous membrane which separates from the muscle fascia. In the trunk, the adipose tissue is similar, as in gross appearance and density and structure (Figure 3).

Figure 3. Fat anatomy.

In the thighs and gluteus, the subcutaneous fascia fuses with the gluteal crease and intergluteal fold [3].
