Adipose Tissue Transfer in Dynamic Definition Liposculpture—PART I. Back: Latissimus Dorsi and Trapezius Muscles

Abstract

Background: The aesthetics for the male posterior torso remain a topic not fully studied in body contouring surgery, neither the lipoinjection of its muscles have been considered before. As a result, we carried out a retrospective cohort study including patients who underwent fat grafting of either the trapezius or the latissimus dorsi muscles as part of dynamic definition liposculpture (HD2). Methods: We performed cadaveric dissections to support the fat grafting technique for both the trapezius and the latissimus dorsi muscles. We also searched our records for patients who underwent fat grafting of these muscles in addition to HD2 from January 2016 to November 2021 at a single center in Bogotá, Colombia. Results: Thirty-five consecutive patients met the inclusion criteria. In total, 22 (63%) and 7 (20%) of 35 underwent fat grafting at the trapezius and the latissimus dorsi muscles alone, respectively, and 6 out of 35 (17%) of both. Mean age is 39 years (range = 22–63). All patients were men. No complications were recorded related to fat grafting. Almost all patients were satisfied with the procedure (97%). Follow-up period ranged from 2 to 48 months. Conclusions: Liposuction might not be enough to achieve the ideal V-shape of the men’s back in some cases; hence, fat grafting of the power muscles becomes the best option. Recognition of the main neurovascular pedicle, proper preoperative markings, and a correct surgical technique ensure both the safety and the reproducibility of the technique.

Adipose Tissue Transfer in Dynamic Definition Liposculpture Part II. The Lower Limb: Gastrocnemius, Vastus Medialis, Vastus Lateralis, and Rectus Femoris Muscles

“…In recent years, both women and men have shown an increasing interest in the appearance of their thighs and calves, which has run along with the increasing demand of aesthetic procedures of this area. 2–22 In the US in 2018, there were 10,100 thigh lifts performed, 9614 in women (95.1%) and 486 in men (4.8%), and also 655 calf augmentations, 377 in men (58%) and 278 in women (42%). 23 Surprisingly, our population showed a different distribution, as men required less calf augmentations compared with women, and women actually sought the appearance of stronger legs and more voluminous thighs compared with men.…”

“…All patients were subject to protocols for safe large-volume liposuction including those for thromboembolic event prevention, blood conservation, and hypothermia prevention. 18 …”

“…event prevention, blood conservation, and hypothermia prevention. 18 IV medications used were antibiotic prophylaxis with cefazolin (2 gr IV, 60 minutes before incision); dexamethasone, 8 mg; metoclopramide, 10 mg; diclofenac, 50 mg; and ranitidine, 50 mg. Photographic records were taken before and during follow-up at 2 days and 1, 3, 6, and 12 months after surgery.…”

Ultrasound-guided Fat Graft of the Obliques–Serratus Complex

“…This creates an inexpensive and readily available product for lipografting, which is the application of liposuctioned material. In recent times, there is the precedent of muscle fat grafting in body contouring surgery, initially with Viaro, Manzaneda, Danilla, and Hoyos 5,7,12,17 Therefore, muscle fat grafting in surgery is an essential part to complement body contouring surgery, which has evolved sharply in recent years, with big contrasts between the standards of care that were used in earlier times for traditional liposuction and those that we use today for high-definition liposuction involving the principle of "all or nothing" in which all body and muscle surfaces are intervened, following the aesthetic and natural concept of results. 18 In a specific search carried out in databases (PubMed, ScienceDirect, Ovid, ClinicalKey), this issue related to volume increase using fat grafting of the external oblique-serratus anterior muscle complex was not found; however, as already mentioned, there is the history of volume increase in other muscle groups.…”

Adipose Tissue Transfer in Dynamic Definition Liposculpture PART III. The Arms: Biceps, Triceps, and Deltoids

“…All patients were subject to protocols for safe large-volume liposuction including those for thromboembolic event prevention, blood conservation, and hypothermia prevention. 16 IV medications used were antibiotic prophylaxis with cefazolin (2-g IV, 60 minutes before incision) or clindamycin 600-mg IV (if allergic to beta-lactams), dexamethasone 8 mg, metoclopramide 10 mg, diclofenac 50 mg, and ranitidine 50 mg. Photographic records were taken before surgery and during follow-up appointments at 2 days and 1, 3, 6, and 12 months.…”