High Definition Liposculpture: Combining art, medicine and science

Featured image
Peter Paul Rubens, Venus in front of the Mirror, 1614/1615. Oil on panel, 123 x 98 cm. The Princely Collections, Lichtenstein.

Okay, so you’ve done your time on Peloton and sweated to Beachbody, but stubborn pockets of fat still persist, obscuring the hard-won muscles underneath. If you’re looking to eliminate this troublesome adipose tissue, but feel that liposuction is a step too far, and invasive, then high definition liposculpture may be the answer for you.

“The results are simply astonishing,” says renowned Colombian plastic surgeon, Dr. Alfredo Hoyos, about this technique which he pioneered. This is not the liposuction of yore which merely aimed to slim. Don’t get me wrong, “thin is always in and for patients who don’t exercise a lot — you just slim them down. But for our fitness friends who really want to see the muscles, we offer this procedure,” says Dr. Ryan Neinstein.

“A year ago, we’d probably get one call a month for hi-def lipo and now we get five calls a day. We’re getting more because it took time to evolve the technique to where it’s less invasive with less downtime. That is important, especially in Manhattan and the New York area, because people work and people have busy lives,” says Dr. Ryan Neinstein.

In essence, liposcultping is liposuction using energy to melt fat and tighten skin, explains the New York City plastic surgeon. “We call it liposculpting because anyone can kind of just remove fat. But what Dr. Hoyos and I are doing is using technology to bring the best version of the body out, not just simply remove fat.”

According to Dr. Alfredo Hoyos, “High definition liposculpture has expanded the demographics of liposuction because it works very nicely in slim people, in athletic people and it also works in people who tend to be chubby.”

The ideal patient for this procedure is someone who is close to their optimal body weight and committed to exercise and fitness because a good muscle foundation is necessary to achieve great results. A bonus is that the effects are long lasting — seven to ten years according to South American studies and even 20 years according to Dr. Hoyos’ experience. One reason may be that it actually seems to increase metabolism. Another is that patients tend to stay motivated. They like what they see in the mirror and want to maintain the results.

I wanted to know how this level of precision is possible.  There are two layers of fat, explains Dr. Hoyos – a deep layer and a superficial layer. Traditional liposuction removes only deep fat tissue. It cannot shape and sculpt the body like hi-def lipo can. But new techniques and technology have made the removal of superficial or intermuscular fat possible. And equally important is the plastic surgeon’s understanding of anatomy.

The tumescent liposuction technique, for instance, whereby a cocktail of lidocaine, epinephrine, sodium bicarbonate and saline solution is injected into the targeted sites, is more effective, safer and less painful than traditional liposuction. Not only does this method, which uses microcannulas, result in less bleeding, swelling and bruising, but it allows for greater accuracy by causing the fatty subcutaneous tissue layer to swell and become firm. This firming action permits more precise removal.

Technologies such as ultrasound imaging and lasers have also transformed liposuction. VASER (Vibration Amplification of Sound Energy at Resonance), for example, a third generation ultrasound-assisted liposuction tool, delivers pulsed energy to liquefy fat, allowing the surgeon to target specific areas of the body without damaging surrounding tissue. “By melting the fat, we can selectively remove more in one area than another which allows us to create those hills and valleys, bringing out the definition of the muscles, giving women that athletic, sexy look,” explains Dr. Neinstein.

How high definition liposculpture is performed:

1. A tumescent solution is delivered to the fatty tissue.

2. The high frequency vibration of VASER ultrasonic probes causes the fat cells to break apart and liquify.

3. Liquified fat is removed via a small cannula.

4. During the healing process, the skin will retract. Images: South Florida Plastic Surgery

But beautiful results will not be achieved no matter how advanced the technology without great skill, knowledge and even artistry on the part of the surgeon. “We literally have to become anatomists,” says Dr. Hoyos. “We have to see right through the skin to locate the patient’s muscles.” That’s because everyone’s musculature is different. For example, not everyone has a six-pack. Some have a four-pack while others have an eight-pack.

Furthermore, in women, there are anatomical differences in the oblique muscles.

“It’s that individual combination of the muscles that actually gives the person unique features – like the nose and the eyes. So, if you don’t do it right, if you don’t follow the real anatomy, the patient is going to look very weird,” cautions Dr. Hoyos. “And if the patient starts training, he or she won’t have a six-pack, but a 12-pack. It’s going to look worse if the patient actually exercises more.”

There are other considerations too. Age, lifestyle, past pregnancies and of course, the patient’s own aesthetic preferences. “It’s not one size fits all,” remarks Dr. Hoyos. A very young athletic woman, for example, can have a higher degree of definition whereas a woman who has already had children and has some skin laxity and stretch marks won’t necessarily look good with ripped abs.

It bears mentioning here that older, fit patients can look considerably better than their younger counterparts. “I have to say that some of our 60-year-old women with kids who have been committed to a healthy lifestyle look better than a 21-year-old model who will eat and drink and smoke whatever she wants,” says Dr. Neinstein (whose majority of patients are women).

“The lifestyle people live will really make a big difference in their outcome. I care more about the physiological age than the chronological age.”

Unlike a nose job or eyelid surgery, liposuction is a dynamic surgery, points out Dr. Hoyos. Gaining or losing weight won’t affect the outcome of facial surgeries, “but with liposuction, anything that you do that increases the volume of fat is going to diminish the results.”

It is this dynamic quality which prompts a holistic, whole-body approach among some surgeons. For Dr. Hoyos, this means adjusting other parts of the body if necessary — for example, the arms or back. “It’s not just about the abdomen,” says the renowned surgeon. “If you have a six-pack and you have chubby arms, you’re going to look very awkward. Every single region of the anatomy can be converted to high definition. We can do the arms, the pecs, the back, the thighs. We can combine all these procedures to make people look more athletic.”

But it’s not just about reduction. Judicial additions of the liquified fat can enhance the results. For women, this would be to the buttocks and for men, it’s usually to the pectoral region.

Dr. Hoyos Before Photos:

Dr. Hoyos After Photos:

Dr. Hoyos Before Photos:

Dr. Hoyos After Photos:

For Dr. Neinstein, rather than modifying additional body parts (which he does if requested and if feasible) the holistic approach means enhancing the patient’s nutrition and fitness routine. So, patients partake of a recovery-boosting anti-inflammatory diet designed by a nutritionist and a fitness routine devised by Dr. Neinstein’s wife, Lauren Duhamel Neinstein, a celebrity fitness instructor. Lymphatic drainage massage and nonsurgical muscle building via EmSculpt round out the care.

“Dr. Hoyos and I have a very similar approach, just painted with the cultural and social relevance of the places we live in,” says Dr. Neinstein. “That’s how it should be done. Science is born out of the same element and the brush is painted a little differently based on the local flavor.” Spoken like a true artist.

Dr. Neinstein Before and After Photos:

So how much time and money will all this artistic athletic sexiness set you back? The recovery time varies with the extensiveness of the procedure, but for the abdominal area, it’s about eight to ten days with maximum results appearing in approximately three months. A compression garment is worn postoperatively for three to four weeks. Costs vary depending on the number of procedures performed. The range with Dr. Hoyos is $8,000 – $20,000; and with Dr. Neinstein it’s $14,000 – $20,000.

Expert Beauty tip, Dr. Hoyos: “After hi-def lipo, the body fat distribution will change, so keeping good habits of diet and exercise will help maintain the results. It will be easier than ever!”

Expert beauty tip, Dr. Neinstein: “I have found that becoming more and more plant based in my diet has reduced day to day indigestion, bloating, discomfort and has promoted recovery from exercise.”

For more beauty tips and information, follow Delia on Instagram: @chasingbeautywithdvn

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