The definition of the ideal body has changed tremendously throughout the centuries, and concepts of beauty undergo ever-changing connotations in today’s world, where the Internet and social media influence people’s vision of beauty, and current trends emerge constantly. Especially fashion, with an increased focus on body image, has fueled a greater interest in evaluating and defining ideal morphometric proportions.
Although beauty lies in the eyes of the beholder, it is also influenced by the individual’s geographic, ethnic, and cultural background and characteristics. However, to what extent these demographic factors influence the aesthetic sense remains unknown.
Such knowledge has significant implications for patients and surgeons performing cosmetic and reconstructive surgery. I must acknowledge cultural differences and international variability when new techniques and aesthetic outcomes are defined and published.
Analyzing female physical attractiveness has gained much attention in the past. Besides certain facial features, the focus is on three beauty determinants: waist-to-hip ratio, body mass index, and curvaceousness. Of all body parts, the buttocks have endured as a critical body element of female beauty across many cultures and times, and buttocks lift or gluteoplasty is now one of the fastest-growing procedures in plastic surgery.
Universal ideals of beautiful buttocks
As in any aesthetic surgery, the surgeon must understand the patient’s requests and any universal ideals of proportions and contours that create the impression of beauty and youth. Singh has proposed that there is one female body shape (full buttocks, narrow waist) that men universally find most attractive.
He states that the attractiveness of the female torso is related to the proportions of the waist and the buttocks (waist-to-hip ratio, or WHR). Specifically, the ideal female has full buttocks that are 1.4 times the circumference of the waist or, inversely, a waist-to-hip ratio of 0.7. He observes that men always have a higher WHR at the maximum prominence of the buttocks. Although most cultures find a woman with a waist-to-hip ratio of about 0.7 most attractive, there are different ethnic ideals of buttocks shape.
How to Best Obtain the Ideal Buttock Shape
Exercise can never accomplish the dramatic changes that patients want. Contrary to popular opinion, exercise (even when focused on the “gluteal’) will not increase buttock size and only minimally improve shape. Body fat is reduced when aggressively pursued exercise, and the buttocks become smaller. This can be confirmed by looking at any bodybuilding magazine.
As with breast enlargement, this fact leaves surgery as the only option. Regarding how to best obtain the ideal buttocks shape, the above discussions lead to two important conclusions: (1) creating the most beautiful female torso usually requires not only augmentation of the buttocks but the reduction of the waist and low back to obtain the ideal WHR of approximately 0.7
To meet the expectations of many of our patients, we must be able to augment not only the medial two-thirds of the buttocks but also the lateral buttocks and the lateral thighs.
Only autologous fat grafting can accomplish these goals; implants cannot, for two primary reasons: (1) sculpting the waist and lower back requires aggressive liposuction of the presacral area to create a very feminine inward sweep of the lower back and to create cleavage where the upper buttocks separate superiorly.
This is routinely done at the time of autologous fat grafting but cannot be done at the time of buttocks implants because it would increase the already elevated risk (20% to 30%) of dehiscence of the midline low sacral incision and increase the risk of seroma (3% to 19%) associated with implants.
(2) No implants can augment the entire lateral buttocks or the lateral thighs, nor is there a feasible anatomic possibility for using implants in these areas. (There is no muscle or fascia available here for implant coverage, and subcutaneous placement of implants has universally been abandoned due to multiple problems). Of course, implants are the only choice if a patient has inadequate fat available and is unwilling to gain weight despite their inherent limitations.
Beyond these important aesthetic and technical limitations, implants have several disadvantages and problems.
- 1. Ideal proportions of the female torso universally include full buttocks that are 1.4 times the waist circumference or, inversely, a waist-to-hip ratio of 0.7.
- 2. While all ethnic groups find a WHR of .7 to be most attractive, there are significant differences in the perception of the ideal shape of the buttocks among Asians, Caucasians, Hispanics, and African Americans. The parameters on which they differ are (1) the size of the buttocks, (2) whether the lateral buttocks should be complete, and (3) whether fullness of the lateral thighs (trochanteric area) is desirable.
- 3. The technique of autologous micro fat grafting (low vacuum harvesting, small particle size, separation of viable fat by centrifugation, drop-by-drop deposition of fat, careful anatomic placement, appropriate antibiotic usage, and prolonged protection of the grafted area from compression and shear) results in the predictable long-term survival of most of the grafted fat.
- 4. In many cases, buttock implants cannot obtain ideal proportions in one operation because of inadequate projection of the implants and the inability to sculpt the upper buttocks and presacral area at the same time as the implant surgery.
- 5. Buttocks implants can never meet the patient’s desires for fullness in the lateral buttocks or the lateral thigh, therefore cannot fulfill the requests of almost half of the patients.
- 6. Although buttocks implants can augment limited areas of the buttocks to a limited degree, the rate of significant complications (15% to 35%) and the patient’s dissatisfaction with inadequate size make them a second choice to be used when adequate donor fat is not available.
- 7. There can be significant complications with buttocks augmentation by autologous fat grafting. By meticulously following the technique described above and limiting the graft to less than 1000 cc/side (adequate for most patients), I can keep significant complications at less than 3%, the lowest of all augmentation methods.
- 8. Only augmentation by autologous fat grafting with liposuction can create the universal ideal proportions of the female torso in one operation and meet the specific ethnic ideals of beautiful buttocks. Except for the patient with advanced aging, all the patients presented met these goals.
- 9. Autologous fat grafting with liposuction can significantly restore a more youthful appearance to the female buttocks and lower torso affected by aging and the effects of menopause.
Classification System for Gluteal Evaluation
Four different anatomic variables influence the overall shape of the buttock:
- Underlying bony framework
- Gluteus maximus muscle
- Subcutaneous fat topography
The interaction of these four variables gives the buttock its individualized shape. With the muscle out of the way, we must understand how the variables that compose the frame (bone, skin, and fat) interact to create a particular shape.
- The underlying bony framework influences the shape, but since I cannot surgically change this structure, it does not play a significant role in our classification system other than to refer to it as a tall, short, or intermediate pelvic height.
- The skin plays a role when determining whether an upper buttock lift, inferior gluteal crease excision, or inner gluteal fold excision is needed.
- Fat topography is the most critical component of the frame and the easiest to modify. The subcutaneous fat has the most significant impact on establishing the overall shape of the frame that the gluteus muscle rests on.
How to identify the different frame types
This is done by comparing the amount of fat present in three zones. The most protruding point in the upper lateral hip is marked point A, the most protruding point in the lateral thigh is marked point B, and the lateral mid-buttock is point C.
The connection of points A and B on each side (left and right) of the body leads to identifying the four basic frame types: A-shape, V-shape, square, and round.
Point C has two functions. The first is to help differentiate a round versus a square buttock. Point C’s second and most crucial function is to help assess the degree of depression present at point C in the square, A-shaped, or V-shaped buttock. This depression is categorized as none, mild, moderate, or severe.
The clinical significance of point C is that mild to moderate depressions usually do not require fat transfers because tremendous contour improvement is obtained through liposuction of the upper buttock, outer leg, or both. With severe depression, however, one should consider fat transfers to this area.
Characteristics of the four frame types of Buttocks
The square buttock is the most common shape in about 40% of patients. Equal volumes characterize the square-shaped buttock at points A and B, so a square shape emerges when these points are connected. Point C can have varying degrees of fat deficiency.
This shape is the most malleable of the four types because any variations at points A, B, or C can turn it into a different shape. This shape is unique in that it can be tall, intermediate, or short.
The round shape buttock is seen in about 15% of patients. The round shape is characterized by having excess fat at point C. A gentle C-shaped curve becomes apparent when all 3 points (A, B, and C) are connected. Point C is crucial since it differentiates around from a square shape. As point C diminishes, the buttock takes on a square shape.
Patients with round-shaped buttocks tend to be heavier than those with a square shape. In the round shape, the gluteus maximus muscle may have a wide or average gluteal base width; however, it often has a narrow base. The height-to-width ratio of the muscle is usually a 1:1 relationship. This shape may also have a deformity consisting of excess fat or skin in the lower inner gluteal fold area. This fullness gives the buttock a “dirty diaper” look that is not aesthetically pleasing.
A-shape (pear shape)
The A-shape buttock is present in about 30% of patients. An ” A ” shape is apparent when points A and B are connected; an “A” shape is apparent. This shape has more fat in the lateral upper thigh (point B) and less in the lateral upper hip area (point A). Ideally, point A should protrude more than other hip areas. As the fat at point B diminishes, the buttock takes a square shape. Point C can be severely deficient, but in most cases, the depression is mild to moderate.
The A-shape buttock is usually improved with liposuction of point B and occasionally of point A. Point C may require fat transfers depending on the degree of depression.
V-shape (apple shape)
The V-shape buttock is seen in about 15% of patients. A ‘V” shape can be appreciated when points A and B are connected, illustrating gluteal base width. Most fat is in the upper lateral hip area (point A) and minor in point B. Deficiency in point C is rarely a problem. As point A diminishes, the buttock takes on a squarer shape.
This shape is unique because patients tend to have a tall pelvis, skinny legs, and a tendency toward central obesity. The pelvic anatomy is worth mentioning since a tall pelvis with a V-shape gives a deceptively long appearance to the buttock; however, the muscle lies low on the pelvis and is often short, with a 1:1 height-to-width relationship.
The intergluteal crease line also appears to be short and low-lying. Two factors create this appearance: (1) there is no gluteal volume above the top of the intergluteal fold, and (2) the sacral height is two to three times taller than the intergluteal crease length.
In the ideal buttock, the sacral space—defined as the area between the L5/sacral junction and the upper end of the intergluteal crease length—should be 50% to 100% of the intergluteal crease length. The intergluteal crease length is ideally considered half the gluteus muscle height, with one-fourth to one-third of the gluteal volume above the upper end and one-fourth to one-third of the volume below the low end the line.
The low end of the intergluteal crease is the take-off point where the infra-gluteal fold deviates from the intergluteal crease. In patients with a V-frame, the gluteus muscle’s height seems comparable to the short intergluteal crease, which creates the illusion that the upper half of the gluteus muscle is missing.
The clinical significance of the V-shaped buttock is that this shape is the hardest to re-contour. The V-shape is not very attractive, but I can improve it with the liposuction of point A and the flank area. Implants and secondary fat transfer to the upper inner muscle areas are often required to improve the V-shape.
The main reason for assessing skin quality is to determine if an upper buttock lift or an excision of excess skin in the infra-gluteal fold is needed to recontour the buttocks. A buttock lift may be indicated if skin wrinkling is present at points C or B. Skin laxity is seen most often in the massive weight loss patient.
Another indication for a buttock lift is severe depression at point C, but fat transfers may also be required to correct a depression deformity. Remember that the greater the depression at point C, the higher the patient’s likelihood of benefiting from an upper buttock lift.
The last step of the buttock evaluation is determining if any buttock ptosis exists. To make this assessment, the lateral view categorizes buttock ptosis into No Ptosis and Ptosis groups, which have three classes or subcategories. This categorization is essential for choosing the best buttock reshaping procedure to perform.
No Ptosis categories
In patients with No Ptosis, the buttock volume is above the infragluteal fold, and there is no drooping skin below the fold. However, the location of most of the buttock volume will vary and assist in categorizing patients with no ptosis into Class A, B, or C, as illustrated in Fig. 25.
No Ptosis—Class A
Class A is the ideal shape, with aesthetically pleasing proportions, when viewed laterally. Most buttock volume is centrally located in this class, with equal fat distribution in the upper and lower buttock zones. No ptosis or depressions are evident on the lateral view, and the contour has a smooth C curve shape. Patients with No Ptosis–Class A require augmentation only.
No Ptosis—Class B
In the typical appearance of this class, there is no ptotic skin below the infragluteal fold, but there is a deficiency or depression in the lower part of the central buttock zone. For this class, buttock augmentation should be accompanied by fat transfers to the depression, although an anatomic implant also helps in some cases.
Fat transfers can be done at surgery or as a second-stage procedure. A patient with No Ptosis—Class B would be ideal for surgeons who prefer placing implants in the subfascial plane since a subfacial implant directly impacts this zone. Limited, conservative liposuction is another possibility for improving the contour of the lower gluteal area.
No Ptosis—Class C
Augmentation is usually sufficient for patients with No Ptosis—Class C. The fat has well distributed throughout the buttocks, and no depressions are seen on the lateral view. The skin does not droop below the infragluteal fold in the Class C category, but neither is the fold appreciated.
The Ptosis classification applies when skin droops over the infragluteal fold, and a skin fold is appreciated. The degree of overhang will be divided into Grades I, II, and III.
Grade I ptosis is similar to No Ptosis—Class C, but some buttock volume and skin fall slightly below the infragluteal fold. A skin fold is apparent as a horizontal line on the lateral view. In these cases, augmentation is usually sufficient, and an upper buttock lift is rarely needed. In a tiny group of patients with Ptosis—Grade I, excision near the inferior intergluteal crease may be considered, but this is extremely rare. I recommend performing the augmentation and then reevaluating the contour after 3 to 6 months.
The infragluteal fold is apparent in Grade II ptosis, and skin droops below it. Whereas a Grade I gluteal fold is horizontal, a Grade II ptosis fold is more angular. There is typically a depression in the upper portion of the lower gluteal zone with Grade II. Other characteristics include a loss of skin elasticity and the presence of stretch marks. If skin wrinkling exists at points C or B, an upper buttock lift would be indicated; however, most cases with Grade II ptosis receive sufficient improvement with augmentation alone.
These patients also may require excision near the inferior intergluteal crease. I recommend performing a gluteal augmentation first and then waiting 3 to 6 months to see if excision is indicated.
Grade III ptosis has the most skin laxity, with the skin drooping well below the infragluteal fold on the lateral view. The fold extends laterally toward the middle of the thigh, and its angle is more significant than 30º. Also typical is a depression at the lower portion of the central gluteal. Skin wrinkling is typical at point B, and the skin has poor elasticity with a fair amount of stretch marks. Treating Grade III ptosis requires an upper buttock lift, an infragluteal fold excision, and a gluteal augmentation. Which procedure is performed first will be the surgeon’s preference?
Putting it all together
To achieve the best aesthetic buttock shape, we must concomitantly address buttock contouring and gluteal augmentation since both are interrelated. When approaching these patients, surgeons should think about contour first and augmentation second.
For simplicity, look at the buttock as two separate removable structures: the frame and the detachable gluteus maximus muscle. Then divide the evaluation into four tasks.
Task 1: Evaluate the frame
- 1. Determine if the pelvis is tall, intermediate, or short.
- 2. Determine the frame type as round, square, A shape, or V shape. The frame type will help identify which areas may benefit from liposuction.
- 3. Determine whether the degree of depression at point C is none, mild, moderate, or severe. The amount of depression will determine if fat transfers are warranted. Currently also evaluate the presence and amount of skin wrinkling at points A, B, and C.
- 4. Identify the sacral height as compared with intergluteal crease length. Suppose the sacral height is equal to or greater than the crease length. The sacral height should be less than one-third of the crease length. The intergluteal crease may need to be visually lengthened by adding volume to the upper inner buttock or defining the V zone with liposuction.
Task 2: Evaluate the gluteus muscle
- Determine whether the patient has a tall, intermediate, or short gluteus maximus muscle. This will help in implant selection: if the muscle is tall (2:1 ratio), use an intramuscular anatomic implant; if the muscle is short (1:1 ratio), use a round implant.
- Most patients will have a muscle that falls between tall and short (between 1:1 and 2:1 ratio); in these intermediate cases, a second criterion is needed. Using the lateral photographic view, identify where most of the gluteal volume lies (upper, middle, or lower buttock zone). An anatomic implant is best if most of the volume is in the upper buttock.
- If most of the volume is central, an oval, round, or anatomic implant may be used. A round implant produces the best results if most of the volume is in the lower zone.
- Evaluate the inferior base width of the gluteus muscle to determine whether it is narrow, standard, or wide.
- Evaluate the four quadrants of the muscle (upper inner, upper outer, lower inner, and lower outer) and determine whether each volume is sufficient or deficient.
Task 3: Evaluate the four junction points between the muscle and the frame
- 1. The upper inner gluteus/sacral junction (upper gluteal cleavage) often requires some definition to look aesthetically pleasing. If the area appears flat and blunt, there may be excess fat in the V zone (intergluteal/sacral space) or a lack of gluteal volume (or both).
- 2. The infragluteal fold/thigh junction (lower gluteal cleavage) also requires definition. If too much fullness exists, the area that should be a diamond-shaped space is a straight line, which is much less appealing. Also, evaluate the angle of the infragluteal fold. Does it have a downward 45º angle, run horizontally, or have an inverted upward slope? If excess fat exists, consider liposuction of the inner thigh and inner gluteal fold. Excision of infragluteal fold skin may also be beneficial if there is a skin excess in this area.
- 3. Evaluate the other two attachment zones: the lower lateral gluteal/thigh junction and the lateral mid-buttock/lateral thigh junction. Is there a smooth transition, moderate demarcation, or sharp demarcation? If there is a moderate or severe demarcation, consider fat transfers.
Task 4: evaluate ptosis (lateral view)
- 1. If ptosis exists, what grade is it: I, II, or III? This information—along with the information obtained from the PA view evaluation of skin laxity or wrinkling at points A, B, or C—will help you inform patients if they need either an upper buttock lift (helpful for Grades II and III) or an after excision of the inferior intergluteal crease.
- 2. If no ptosis is present, determine whether the buttock is Class A, B, or C. This information will help identify whether fat transfers to the mid/lower gluteal area (Class B) or liposuction of the infragluteal area is needed. Ptosis class also is a significant factor in deciding whether to use an anatomic or round implant. (An anatomic device will fill in this area better.) Finally, evaluating the lateral view helps determine if liposuction of the sacral area is indicated.
- Buttock-in-shape techniques for improving the buttock’s region’s appearance are essential elements in body contouring. In all cultures and communities, this physique aspect holds a special place among the elements comprising the ideals of physical beauty. Recent studies described the aesthetics of the gluteal region in terms of shape, volume, and projection.
- There is a growing interest in aesthetic surgery of the bottoms and posterior body contouring with severe weight loss. However, Prof Moawad noticed ten years ago the accumulation of fat at the supra-gluteal, lower paralumbar, infra-gluteal, or trochanteric areas often disturbed the natural shape of the butt. He decided to enhance the gluteal region by liposculpture of places around the buttocks and, when needed, lipo-injection to give volume and projection.
- Weight loss often produces flat buttock deformities, which push the need for butt lift surgery. Like breast surgery, buttock surgery can be performed with several techniques to make an aesthetically pleasing shape in or out of clothing. There is no single butt-lifting technique capable of solving all aesthetic problems.
- Choosing the correct procedure, combining techniques, or even adding an implant or fat, is common. The treatment or combination of suitable approaches for each patient is discovered through consultation that focuses on understanding a patient’s goals and unique anatomy. It is essential to realize that the buttock reshaping surgery must address the whole back, flanks, hip, and thigh as one unit. It is fundamental to understand the differences between female and male butt.
What is Buttock In Shape Surgery
It is essential to realize that the butte shaping surgery must address the whole back, flanks, hip, and thigh as one unit. It can be considered a back, buttock, and thigh remodeling procedure. No procedure should be carried out on the buttock area or the posterior contour without a full assessment and complete understanding of its complexity.
Patients seeking treatment should be aware of the potential risk factors associated with any surgical procedure. The high phenomenon in severe weight loss has increased the demand for body contouring. This has extended to buttock contouring. Weight loss often produces flat buttock deformities, which pushes the need for butt enhancement surgery.
It is fundamental to understand the differences between female and male butt. A woman’s butt is characterized by curvy lines, round volumes, and prominent projection, while a man’s butt is characterized by straight lines, square volumes, and side depressions.
Sagginess of the butt should not be present, nor the entire gluteal crease which may indicate early ptosis. Suppose there is any fatty fullness under the crease (also known as banana deformity), cellulite, contour irregularity, or saddlebags. In that case, I must also address these. Butt contouring surgery should address the above points to produce desirable results that match the patient’s expectations.
Who is a Good Candidate?
- Flattened buttocks (developmental or post-weight loss)
- Small buttocks
- Saggy buttocks
- Disproportionate buttocks.
- Large buttocks and thighs
- Large flanks
- No waste definition
Below are the Procedures We Offer at MSI:
- 1-Buttock lift
- 2-Buttock Augmentation
- 3-Buttocks reduction/reshaping with or without liposuction: for large buttocks patients.
- 4-Liposuction on the love handles: for fatty accumulation under the waist
- 5-Saddle Bag correction: for fat accumulation on the sides of the thighs
- 6-Banana fold deformity treatment
- 7-Gluteal retraction Treatment: for irregularity, depression, and hollows on the buttock surface caused by conditions of the subcutaneous tissue, fascia, or muscle.
The butt area has received much media attention in recent years, which has produced increased patient demand for buttock reshaping. Skin influences the overall shape of the butt. Four different anatomic variables:1. The underlying bony framework, 2. Gluteus maximus muscle,3. Subcutaneous fat topography, and 4.
The subcutaneous fat has the most significant impact on establishing the overall condition of the buttocks. Liposuction, the number one cosmetic surgery performed globally, is a procedure removing unwanted lumps, bulges, and areas of resistant fat deposits from specific areas of the body.
Butt Liposuction is performed using a hand-held instrument (cannula) attached to a vacuum-like machine or a syringe. By pushing and pulling the cannula, fat cells are broken up and sucked out with a vacuum, traditional Buttocks Liposuction. Today, I can use several liposuction techniques to improve the procedure’s ease and enhance outcomes.
Based on the experience of Prof Moawad for the last 20 years, he prefers the tumescent approach assisted with a suction cannula for considerable butt duction. If precise contouring is the goal, he likes syringe liposculpture. Syringe liposuction is necessary when fat transfer is needed. Thorough anatomic analysis, surgical technique, and constant patient communication are encouraged to determine their aesthetic preferences.
Buttocks Lift Surgery
I can drastically improve excess skin and fat from aging, heredity factors, or after dramatic weight loss in the gluteal area. Not to be confused with a “Brazilian butt lift,” which adds volume using fat transfer, this procedure involves only removing skin and fat through surgical excision and liposuction.
A butt lift is a cosmetic surgical procedure to improve the appearance of the buttocks. It may be done as part of a tummy tuck (belt lipectomy) or lower body lift to contour the buttocks, groin, thighs, and abdomen.
A butt lift alone won’t add any volume to the buttocks. But sometimes, a butt lift is combined with an augmentation procedure to alter the shape or size of the buttocks with implants or fat grafts. Excess skin and fat are removed from the butts during a butt lift. The remaining skin is then repositioned to create a more toned look.
Back liposuction applies to individuals with localized fat in the upper and lower back. Liposuction of the back can decrease fullness in the upper back by reducing subcutaneous fat and can result in skin retraction, particularly with power-assisted ultrasound liposuction (U-PAL). Liposuction of the upper back is an excellent complement to the arm breast lifts, while liposuction of the lower back will complement the abdomen, butt, and thigh lifts.
The upper and lower back liposuction secondarily unmasks and enhances the buttock region. The sacrum often has a fatty deposit that responds well to liposuction and helps contour the buttock. Liposuction of the back is not a procedure frequently applied to massive weight loss patients who have achieved a body mass index of less than 30. Their issue is more skin redundancy and lax tissue than subcutaneous fat.
Brazilian Butt Fat Injection
But augmentation can be performed through various surgical techniques, but there are substantial advantages to gluteal fat transfer compared with other methods. Principles of butt augmentation with autologous fat transfer have evolved from butt augmentation to global, whole-body, 360° contouring and shaping, thereby producing an optimal, highly defined body/ buttocks balance without implant-related complications.
Brazilian butt is a specialized fat transfer procedure that augments the size and shape of the buttocks without implants. Excess fat is removed from the hips, abdomen, lower back, or thighs with liposuction, and a portion of this fat is then strategically injected into the butt. A skilled cosmetic surgeon can improve the proportions of the entire lower body with Brazilian Buttocks lift surgery, helping a patient lose fat in common “problem areas” and enhancing the buttocks, lasting many years.
Autologous fat grafting is associated with the lowest rate of complications. It is ideal for correcting finite asymmetries and volume deficiencies. Moreover, I can combine it with liposuction of the waist, lower back, and lateral thigh. Prof Moawad calls it “horseshoe liposuction” to create the universal perfect proportions of the female torso and meet the specific ethnic ideals of beautiful buttocks in one operation.
There is an increasing number of transcutaneous energy delivery devices currently available. They are classified according to the energy they deliver to their target—mechanical (e.g., suction, massage), radiofrequency, ultrasound, cryolipolysis, and laser. Of these, radiofrequency devices are the most popular. Adverse outcomes following noninvasive treatments are uncommon but may include thermal injuries and temporary dysesthesia.
Nonsurgical Body Fat Reduction
Unwanted local fat deposits negatively affect body shape and image. Diets, exercise, medications, liposuction, or gastric surgeries may effectively control obesity. Surgical or minimally invasive body shaping can dramatically improve the shape and proportion of your body, enhancing your appearance and boosting your self-confidence. For patients who require minor improvement or are unwilling or unable to undergo a surgical procedure, nonsurgical fat reduction is an alternative to surgical procedures.
Nonsurgical and minimally invasive options for fat reduction use various modalities, including freezing, ultrasound, radiofrequency, infrared light, vacuum massage, and injectable medication. Realistic expectations on the part of patients and the appropriate application of technologies by surgeons are the key to achieving patients’ aesthetic goals.
Radiofrequency Skin Treatment
Minimally invasive procedures to tighten and lift skin give natural results with minimal risk and recovery time. Monopolar radio-frequency deliver a high-frequency electric current—tissue resistance to electrical current, resulting in volumetric heating to the deep dermis and underlying tissue. The resulting heat leads to immediate collagen contraction and a delayed wound healing response, with new collagen formation up to 4 to 6-month post-treatment.
The FDA approved monopolar radiofrequency (RF) devices to treat periorbital wrinkles. Since then, they have been used to treat the laxity of the forehead, cheeks, nasolabial folds, marionette, lines, jawline, and neck. Although the results of RF are not as dramatic as a facelift, over 90% of patients obtain noticeable tightening of the treated areas, and it never looks “pulled.” Another benefit of radiofrequency is reducing fat and tightening the skin by directing energy to target collagen.
“Radiofrequency is a versatile procedure that can be used on anybody site – from large areas like the abdomen to minimal regions like the chin – with the same degree of success. For example, a patient with flabby upper arms may have more loose skin than fat in this area. In this instance, Prof Moawad might use radiofrequency to tighten the skin and remove excess fat. However, if he determines that there is fat primarily in an area, he will remove the fat first and then tighten the skin afterward.
Stretch Marks Treatment
Many things change after you have a baby: schedules, sleep time, and a sense of freedom, to name a few. Along with that, there are many physical changes you’ll see. Chief among them is stretch marks. Stretch marks or striae are a form of scarring on the skin with an off-color hue.
Stretch Marks are the result of the dermal tear, which over time may diminish, but will not disappear completely. Stretch marks are often the result of the rapid stretching of the skin associated with rapid growth or weight changes. Stretch marks may also be influenced by hormonal changes associated with puberty, pregnancy, bodybuilding, hormonal replacement therapy, etc.
Stretch marks form during pregnancy, usually during the last trimester. It appears on the belly and commonly on the breasts, thighs, hips, lower back, and buttocks. For red stretch marks, clinicians may consider the PDL, 1,064-nm Nd: YAG laser, and 532-nm KTP laser, improving red stretch marks’ redness (vascular component).
Stretch marks prevention and treatment stay a clinical challenge. Several emerging treatment modalities, including fractionated micro-needling RF, ultrasound, and PRP and micro-needling, have reported good clinical improvement of stretch marks. Physicians should set realistic expectations with patients seeking stretch marks treatment and inform patients that the appearance and texture of stretch marks may improve but will not completely resolve to be an integral part of setting these expectations.
Cellulite Skin Treatment
Approximately 85% of post-pubertal woman has a form of cellulite. The term cellulite refers to the ‘orange peel,’ ‘mattress,’ or ‘dimpling’ appearance on the thighs, buttocks, and sometimes lower abdomen and upper parts of the arms of otherwise healthy women. This appearance is much more common in women than in men because of differences in how fat, muscle, and connective tissue are distributed in men’s and women’s skin.
Although rarely observed in men, those men presenting with cellulite are commonly deficient in male hormones. The lumpiness of cellulite is caused by fat deposits that push and distort the connective tissues beneath the skin, leading to characteristic changes in the appearance of the skin.
The causes of cellulite are not well understood. Theories include genetics, circulatory problems, inflammation, hormonal disturbances, tight clothing, and lifestyle factors. Although being overweight is not a prerequisite for cellulite, excess body fat makes cellulite more visible.
The aging process can worsen the appearance of cellulite, as skin loses elasticity and is less able to resist irregular tension created by the fibrous bands. Despite many treatments available—all of which claim to work somehow—few do work, and many jobs with unpredictable results. The new minimally invasive techniques of power liposuction (without suction) and fat transfer are rewarding to achieve acceptable results.