Lipoplasty (liposuction) continues to be the most commonly performed aesthetic (cosmetic) surgical procedure, with the number of lipoplasty procedures performed in the U.S. up 111% since 1997, according to statistics from the American Society for Aesthetic Plastic Surgery (ASAPS). Lipoplasty first generated wide interest among American plastic surgeons in the early 1980s; since then, ongoing improvements in patient selection, techniques, physician training and credentialing, and facility accreditation, all have contributed to satisfying results for most patients. As aesthetic plastic surgeons continue to strive for even better outcomes, many are finding that, while most patients need only "spot reduction" of the localized fat deposits that cause unsightly bulges, some patients can benefit from the more technically difficult "circumferential" approach to lipoplasty. According to ASAPS Vice President and panel moderator Peter Fodor, MD, panelists will address this advance in lipoplasty technique, focusing on the female silhouette, at ASAPS' Annual Meeting, May 16-21, at the Hynes Convention Center in Boston.

"In order to achieve the best results for our patients, aesthetic plastic surgeons must consider the whole body contour, not just isolated areas," says panelist and ASAPS member Jeffrey Kenkel, MD. The Dallas plastic surgeon says that for properly selected patients, this approach might mean performing lipoplasty around the entire circumference of the thighs instead of addressing just the outer saddlebag area or the inner thigh, for example.

To refine the waist, contouring with lipoplasty may be done not only in the front abdominal area but also on the sides and back. In some patients, this may be combined with a tummy tuck to remove excess skin. Dr. Kenkel says that the training and experience of the plastic surgeon are important to achieving well-proportioned results with maximum safety.

Dr. Fodor also stresses the importance of the "hand that wields the tool." The Los Angeles plastic surgeon, who is a past president of the Lipoplasty Society of North America (LSNA), explains that "while appropriate training and experience are crucial, beyond that, a plastic surgeon's aesthetic sense is harder to define and may be more innate than learned." Dr. Fodor says that a good surgical plan may not always conform to a patient's initial request. "A patient's expressed wish for 'straight thighs' may not produce a result that is in proportion to the natural curves of the body, which must always be respected," he says.

Dr. Fodor notes that the success of lipoplasty ultimately rests with the sculpting finesse that the aesthetic plastic surgeon provides. "Obviously, male and female silhouettes are different," he continues. "In the female, there must be a smooth flow of curves, which is what the skilled aesthetic plastic surgeon strives to achieve through selective removal of fat and actual body sculpting. This is a complex and tricky procedure to do well," he says. "It isn't enough to reduce the fat somewhere either in a spot or even circumferentially. The final result must be shaped and sculpted, and that is where the technical expertise and aesthetic sense of the plastic surgeon come in." 

The images below are of one of my patients that had liposuction of the abdomen, back and hips.  Notice the improved general contour of the back and front.  With one area she would have had an improvement, treating the front and back of the trunk significantly improved her result.