The Surgeon Minute

Advancing the Female Silhouette

Advancing the Female Silhouette

For the average women who is a bit thick through the waist and hips, liposuction can slim down those areas of the body by removing excess fat deposits and improving body contours and proportion. For that same average woman who has had multiple pregnancies, there may also be loose, bulging skin in the abdominal area. A tummy tuck can flatten and firm the belly by tightening muscles while removing excess skin and fat. Doing either liposuction or a tummy tuck will yield dramatic results. Doing them in combination? Well, that would be the veritable “holy grail” when it comes to rejuvenating the torso, right? “Not quite,” say Drs. Simeon and Holly Wall of the Wall Center for Plastic Surgery in Shreveport, Louisiana.

At the recent meeting of the American Society of Aesthetic Plastic Surgeons (ASAPS), the Walls moderated a panel discussing the most recent advancements in improving the female silhouette. It turns out there is a third step to the combination “lipo”/tummy tuck procedure that makes all the difference and the objective is more about shape than size.

by Isabel Bolt
and Holly Wall, MD and Simeon Wall, Jr., MD

An Evolution in Re-sizing

According to Dr. Holly Wall, years ago, liposuction and tummy tucks were considered “either/or.” “Depending upon the patient…in the evolution of body contouring we used to either do only lipo or only tummy.” The problem with that approach was that in the case of “only lipo,” skin and muscles were not addressed. Conversely, tummy tuck alone would yield an unnaturally flat tummy accompanied by pockets or rolls. “15 years ago,” says Dr. Holly “the combination of liposuction and tummy tuck greatly improved the silhouette.” Dr. Simeon Wall Jr. likens it to “…contouring and shrink wrapping the entire trunk circumferentially.” Both surgeons agree that despite the benefits of combining these procedures, the outcomes were a step below perfection. Liposuction techniques at the time could potentially leave behind a rippled, uneven appearance. Dr. Holly adds a 3 dimensional concern. “If you really shrink wrap…you must think about the hips, thighs and buttocks which could now be totally out of proportion to the reduced torso.”

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A Revolution in Reshaping

Several years ago, Dr. Simeon Wall Jr. developed SAFELipo® to address revision liposuction procedures which are primarily performed to correct contour deformities. He soon learned that his unique process could produce dramatic, smooth and natural contours in all his body contouring patients–not just those seeking a revision. SAFELipo® has since been adopted by surgeons worldwide, eager to sidestep the most common complication of lipo. They’ve been able to replicate consistently beautiful results the first time, every time. But that solves for the first intervention–subtracting fat. What about the 3 dimensional concern? According to Dr. Simeon knowing how and where to add fat is the other side of the equation. “Whereas we used to have hip rolls and depressions on the buttock, and maybe a wide saddlebag area….Instead of having to really reduce saddlebag, which may not be the best approach, why not augment the upper part of the buttock (with fat) for a better shape and less wide saddlebags?”

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Since SAFELipo® incorporates contour augmentation, redistribution and reduction into a single procedure it is changing the way plastic surgeons are looking at fat. Fat is very fragile to “recycle” and must be meticulously stored and processed for best results. Special canisters designed by Dr. Wall Jr. and colleague, Dr. Dan Del Vecchio purify and optimize fat without damaging it. A technique called Expansion Vibration Lipofilling (EVL), also created by Dr. Wall Jr. is used to inject the collected fat to augment areas for a soft fullness and natural appearance.  “We can augment or reduce little parts of the body for subtle changes in shape that make a dramatic difference.  EVL took many years of research but it changed everything.”

From Rock Carvers to Sculptors

Dr. Simeon describes surgeons at the inception of lipo as “rock carvers.” “We would chop away at hips and saddlebags and waists. We knew how to do small waists. But now shaping hips and making the buttocks and thighs integral…these shapes are prettier and rounder, more youthful and athletic.” Drs. Holly and Simeon Wall have learned in over 100 cases how to add and subtract until the best shapes emerge.  At first some patients are hesitant to add too much volume especially to the buttocks. They don’t want “big wide butts,” says Dr. Simeon. “They don’t understand I’m not talking about Kim Kardashian. More like Cameron Diaz or Jessica Biel. It’s about integrating the buttock shape without making it wider. Now we can make a great butt almost every time.”  Both surgeons mourn the days of “throwing away all that fat…such a missed opportunity.”

Dr. Holly is amazed at all the advances influencing these procedures even after decades. Dr. Simeon agrees. “I think the most important advancement is now we can routinely incorporate more predictable fat grafts and shaping with the tummy tuck and lipo procedures for a truly sculpted outcome.”

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