Introductory Chapter: New Horizons in Body Contouring

1. Introduction

The history of humanity and its scientific evolution cannot be described without pointing out the innate desire of our species to observe our surroundings, accompanied by the need to achieve better and consistent results through the invention of new technologies and devices. In the present days, these advances have come along also with the evolution of how patients see themselves, being more demanding than before, looking for less inflammation, shorter recovery periods, and natural and long-lasting results, following a modern vision of beauty mostly influenced by social media and ethnic parameters.

Regarding body contouring surgery, we have witnessed a massive change in the last few years, not only because of the cultural change in how patients see themselves and what types of bodies they are looking for, but also because of the new techniques and devices that have helped achieve those type of results modern patients want, and also because of a change of our own mentality we as surgeons have [1].

2. Cultural influence and patient expectations

First of all, the cultural changes have been very important to get us where we are standing nowadays. In the past, the type of results the patients often wanted was massively influenced by TV shows, movies, and magazines. With the boom of silicone breast implants, patients wanted to go as high in volume as they could, without considering the final shape and how they fit their general body contour as a whole, nor the effect of the weight will have in the breast, with the natural descent that comes in the following years. Nowadays, our patients have become more aware of their own bodies, looking for more natural and athletic looking results that can relate to the type of body of each patient, shifting our main vision in breast surgery influenced also with the type of activities modern female patients do, and looking for better shape and long-lasting results rather than just volume [2].

The same happened with their expectations from other body contouring procedures such as abdominoplasty and liposuction. From my point of view, this is one of the areas in plastic surgery with the most evolution in recent years. The general idea of the patients was just to take out volume from some areas, without volumizing others, or in other instances just remove the skin excess generated by pregnancies or by important changes in weight [3].

3. New technologies

Secondly, there has been a very important development in new technologies and devices. Practically each year we see a new console, a new machine that comes out to the market promising the best results. We as surgeons have to be very well informed on what effects those new technologies will produce in our patients, selecting which ones are best for them with consistent results and scientific evidence supporting them [4]. First, with the introduction of power-assisted liposuction, we as surgeons got less fatigued, with less movements we could extract a lot more of fat from a particular area, thus enhancing the results. Secondly came the ultrasonic liposculpture, helping us liquify the fat, eliminating the adipose tissue, facilitating the extraction, and helping us with the postoperative recovery with less inflammation and quicker recovery times. Finally, what we are using nowadays is operative radiofrequency helping us with a much better skin retraction, less inflammation, stimulation of collagen and elastin production, and with so, better skin quality and better results, enhancing negative areas and accentuating lights and shadows that make our results even better. The last piece in the puzzle has been the postoperative therapy that has helped the patient in a reduced swelling, less seromas formation, and better skin redraping to the areas where fat was extracted [5].

4. Surgeon’s mindset

Finally, our mentality as plastic surgeons has also experienced an important change, focusing our practice in patient safety first, and with the support of the new technologies and advances previously described, the type of results we are looking for. In the past, previous procedures were even considered dangerous, where patient safety was not a priority, resulting in dangerous side effects and very poor results. The second part of our mentality change is influenced also by cultural changes and the current definition of beauty, combined with a much better understanding of the male and female anatomy which in combination with the current technologies have helped us in achieving not only more natural results, but in selected patients high-definition results where we can enhance abdominal and back muscles, and even get athletic arms and legs, pectoral definition in men, treatment of gynecomastia, and in general a better body contour fit with the types of bodies we want (Figure 1).

Figure 1.

A): Preoperative markings (in black we outline midlinemidline and lateral borders of rectus abdominis muscle in blue we outline the negative spaces to totally get rid of the fat in those compartments, and in red we outline the areas of fat transfer to enhance the pectoralis). B): Preoperative frontal picture. C): Postoperative picture after 6 months.

In conclusion, there is a three-way responsibility in achieving better results, patients, new technologies, and surgeons. We need to have a better understanding of our patients’ desires but also educate them on what can be done and what cannot, keep preparing ourselves in learning how to apply these technologies having in mind our patient’s safety and how we can help them achieve the results they are looking for, helping them as we can with a better recovery period, less painful procedures, and quick return to their normal activities.