The senior authors, Dr. Emil Bisaccia and Dr. Dwight A. Scarborough, are authors of the textbook The Columbia Manual of Dermatologic Cosmetic Surgery. Since its development, liposuction has evolved from bulk removal of subcutaneous fat to a means for contouring and sculpting the body. Liposculpting is at the forefront of liposuction techniques. It allows for targeted resculpting of the body and dramatically improves the contour and definition of muscular areas such as the abdomen and chest.1-3 We use liposculpting to enhance the appearance of abdominal musculature to create what is known colloquially as a “six-pack.”
Our Technique
To enhance the appearance of the abdominal musculature, grooves of subcutaneous fat are removed to mimic the natural definition of the rectus abdominis muscle. The rectus abdominis is a paired muscle separated by a band of connective tissue along the midline called the linea alba. Fibrous bands, known as transverse tendinous intersections, cross the rectus abdominis in a horizontal fashion.The goal is to selectively thin the subcutaneous layer at these junctures while achieving an overall volume reduction of abdominal fat. Marking the Patient • The linea alba, the midline groove extending from the xiphoid to the umbilicus, is marked while the patient is standing to ensure accurate placement of grooves. (See Figure 1, left.) • Horizontal lines are then marked, corresponding with the transverse tendinous intersections of the rectus abdominis (See Figure 1, right). The Procedure • Once the patient is appropriately marked, tumescent anesthesia is infiltrated into the area under conscious sedation. • Stab incisions are made at the midline just superior to the umbilicus and on the lateral abdomen corresponding to the transverse tendinous intersections. Volume reduction of abdominal fat is accomplished in the usual manner.4 • Using a 4-mm cannula, subcutaneous fat is then removed along vertical and horizontal planes to create the appearance of well-defined abdominal musculature (See Figures 2 and 3). Aftercare • The patient is placed in a constrictive corset for 7 days.
Complications
Misplacement of grooves can result in an unpleasing and asymmetrical appearance of the abdominal musculature. It is important to take care to mark the patient while in a standing position to ensure accurate placement of grooves. Fat removal at the level of the umbilicus has been reported to result in an exaggerated groove that is difficult to correct,3 so it is not advisable to treat this area.
Discussion
The art of liposuction has continually evolved since its introduction in the 1970s. Liposculpting is at the forefront of current liposuction techniques and is an excellent option for those seeking to enhance definition of abdominal musculature. n Dr. Bisaccia is a practicing dermatologist and Clinical Professor of Dermatology at the Columbia University of Physicians and Surgeons in New York City. Dr. Lu is a Fellow in an ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologic Surgeons in Morristown, NJ. Dr. Rogachefsky is a practicing dermatologist and is the Program Director of the ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologist Surgeons in Morristown, NJ. Dr. Scarborough is a practicing dermatologist and Assistant Clinical Professor of Medicine, Division of Dermatology, at the Ohio State University Hospital in Columbus, OH. Disclosures: Drs. Bisaccia, Lu, Rogachefsky and Scarborough disclose that they have no real or apparent conflicts of interest or financial interests or arrangements with any companies or products mentioned in this article.
The senior authors, Dr. Emil Bisaccia and Dr. Dwight A. Scarborough, are authors of the textbook The Columbia Manual of Dermatologic Cosmetic Surgery. Since its development, liposuction has evolved from bulk removal of subcutaneous fat to a means for contouring and sculpting the body. Liposculpting is at the forefront of liposuction techniques. It allows for targeted resculpting of the body and dramatically improves the contour and definition of muscular areas such as the abdomen and chest.1-3 We use liposculpting to enhance the appearance of abdominal musculature to create what is known colloquially as a “six-pack.”
Our Technique
To enhance the appearance of the abdominal musculature, grooves of subcutaneous fat are removed to mimic the natural definition of the rectus abdominis muscle. The rectus abdominis is a paired muscle separated by a band of connective tissue along the midline called the linea alba. Fibrous bands, known as transverse tendinous intersections, cross the rectus abdominis in a horizontal fashion.The goal is to selectively thin the subcutaneous layer at these junctures while achieving an overall volume reduction of abdominal fat. Marking the Patient • The linea alba, the midline groove extending from the xiphoid to the umbilicus, is marked while the patient is standing to ensure accurate placement of grooves. (See Figure 1, left.) • Horizontal lines are then marked, corresponding with the transverse tendinous intersections of the rectus abdominis (See Figure 1, right). The Procedure • Once the patient is appropriately marked, tumescent anesthesia is infiltrated into the area under conscious sedation. • Stab incisions are made at the midline just superior to the umbilicus and on the lateral abdomen corresponding to the transverse tendinous intersections. Volume reduction of abdominal fat is accomplished in the usual manner.4 • Using a 4-mm cannula, subcutaneous fat is then removed along vertical and horizontal planes to create the appearance of well-defined abdominal musculature (See Figures 2 and 3). Aftercare • The patient is placed in a constrictive corset for 7 days.
Complications
Misplacement of grooves can result in an unpleasing and asymmetrical appearance of the abdominal musculature. It is important to take care to mark the patient while in a standing position to ensure accurate placement of grooves. Fat removal at the level of the umbilicus has been reported to result in an exaggerated groove that is difficult to correct,3 so it is not advisable to treat this area.
Discussion
The art of liposuction has continually evolved since its introduction in the 1970s. Liposculpting is at the forefront of current liposuction techniques and is an excellent option for those seeking to enhance definition of abdominal musculature. n Dr. Bisaccia is a practicing dermatologist and Clinical Professor of Dermatology at the Columbia University of Physicians and Surgeons in New York City. Dr. Lu is a Fellow in an ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologic Surgeons in Morristown, NJ. Dr. Rogachefsky is a practicing dermatologist and is the Program Director of the ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologist Surgeons in Morristown, NJ. Dr. Scarborough is a practicing dermatologist and Assistant Clinical Professor of Medicine, Division of Dermatology, at the Ohio State University Hospital in Columbus, OH. Disclosures: Drs. Bisaccia, Lu, Rogachefsky and Scarborough disclose that they have no real or apparent conflicts of interest or financial interests or arrangements with any companies or products mentioned in this article.
The senior authors, Dr. Emil Bisaccia and Dr. Dwight A. Scarborough, are authors of the textbook The Columbia Manual of Dermatologic Cosmetic Surgery. Since its development, liposuction has evolved from bulk removal of subcutaneous fat to a means for contouring and sculpting the body. Liposculpting is at the forefront of liposuction techniques. It allows for targeted resculpting of the body and dramatically improves the contour and definition of muscular areas such as the abdomen and chest.1-3 We use liposculpting to enhance the appearance of abdominal musculature to create what is known colloquially as a “six-pack.”
Our Technique
To enhance the appearance of the abdominal musculature, grooves of subcutaneous fat are removed to mimic the natural definition of the rectus abdominis muscle. The rectus abdominis is a paired muscle separated by a band of connective tissue along the midline called the linea alba. Fibrous bands, known as transverse tendinous intersections, cross the rectus abdominis in a horizontal fashion.The goal is to selectively thin the subcutaneous layer at these junctures while achieving an overall volume reduction of abdominal fat. Marking the Patient • The linea alba, the midline groove extending from the xiphoid to the umbilicus, is marked while the patient is standing to ensure accurate placement of grooves. (See Figure 1, left.) • Horizontal lines are then marked, corresponding with the transverse tendinous intersections of the rectus abdominis (See Figure 1, right). The Procedure • Once the patient is appropriately marked, tumescent anesthesia is infiltrated into the area under conscious sedation. • Stab incisions are made at the midline just superior to the umbilicus and on the lateral abdomen corresponding to the transverse tendinous intersections. Volume reduction of abdominal fat is accomplished in the usual manner.4 • Using a 4-mm cannula, subcutaneous fat is then removed along vertical and horizontal planes to create the appearance of well-defined abdominal musculature (See Figures 2 and 3). Aftercare • The patient is placed in a constrictive corset for 7 days.
Complications
Misplacement of grooves can result in an unpleasing and asymmetrical appearance of the abdominal musculature. It is important to take care to mark the patient while in a standing position to ensure accurate placement of grooves. Fat removal at the level of the umbilicus has been reported to result in an exaggerated groove that is difficult to correct,3 so it is not advisable to treat this area.
Discussion
The art of liposuction has continually evolved since its introduction in the 1970s. Liposculpting is at the forefront of current liposuction techniques and is an excellent option for those seeking to enhance definition of abdominal musculature. n Dr. Bisaccia is a practicing dermatologist and Clinical Professor of Dermatology at the Columbia University of Physicians and Surgeons in New York City. Dr. Lu is a Fellow in an ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologic Surgeons in Morristown, NJ. Dr. Rogachefsky is a practicing dermatologist and is the Program Director of the ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologist Surgeons in Morristown, NJ. Dr. Scarborough is a practicing dermatologist and Assistant Clinical Professor of Medicine, Division of Dermatology, at the Ohio State University Hospital in Columbus, OH. Disclosures: Drs. Bisaccia, Lu, Rogachefsky and Scarborough disclose that they have no real or apparent conflicts of interest or financial interests or arrangements with any companies or products mentioned in this article.
