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  • The demand for a sculpted and defined body over one that is just flat has required surgeons to make advances in techniques and approaches to surgical body shaping that not only remove large volumes of fat in multiple locations at one time but also use this fat for muscular defining and body revolumization, while also addressing the desire for skin tightening and cellulite reduction.

  • Patient expectations are significantly higher than in the past, as outstanding results are now expected in the consumer-driven, competitive aesthetic environment.

image Beginner Pearls

  • Combining traditional liposuction techniques with modern technologies such as VASER (vibration amplification of sound energy at resonance) ultrasound enables the surgeon to be a sculptor in which multiple steps are used to obtain a contoured and defined body that matches the underlying anatomical landmarks.

  • Patients with significant loose or lax skin with or without stretch marks, higher BMI (>10 lb over expected weight), poorly defined or toned underlying musculature, and extreme cellulite are not ideal candidates for HDBC.

image Expert Pearls

  • To treat the superficial fat layer you must have (1) water-assisted (BodyJet) pressurized tumescence, (2) small (2–3 mm) rotary cannulas, and (3) VASER ultrasound multi-ringed probes.

  • One component to the HDBC procedure is fat grafting to areas that require more muscular definition such as the male chest and shoulders or increased size and projection such as the female buttock and breast.

image Don’t Forget!

  • Traditional power-assisted devices vibrate back-and-forth and extract fat by creating tunnels, increasing the ability to see irregularities and step-offs. Rotary power-assisted devices vibrate side-to-side in a rotational fashion physically shearing the tissue, allowing the surgeon to physically strip down on the thickness of the fat layer-by-layer without any tunnels.

image Pitfalls and Cautions

  • In the past, over-resection of the inner and outer thigh gave a smaller appearance, but also one that was flat and straight, more masculine, and ultimately unattractive.

  • It is therefore common for an HDBC surgeon to add fat volume to the lateral buttock and thigh while removing fat of the upper buttock/lower back and inner thigh.

image Patient Education Points

  • Caucasian and Asian patients often desire a less-defined and curvy thigh, and want it to be as “stick thin” as possible, with a much less laterally projected buttock.

  • In contrast, Latin/Hispanic and African-American patients desire much more prominent lateral thighs, larger buttocks, and very thin waists, often giving a less proportionate appearance.


The desire for improvement in body shape has increased dramatically in the past few years, mainly due to significant improvements in surgical techniques and reduced downtime as well as advances in nonsurgical approaches that not only reduce body fat but also tighten skin and improve cellulite. The demand for a “sculpted” and defined body over one that is just “flat” or “improved” has required surgeons to ...

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