Lift & Shape

M s Revathi (namechanged) came to me with the main concerns of hip dip correction and buttock projection along with correction of irregular contours of anterior abdominal wall and grossly asymmetric arms from previous liposuction. She had undergone liposuction of the back and abdomen twice along with BBL (Brazilian Butt Lift). In her last surgery, two years back, she had also undergone arm liposuction She was extremely unhappy with her previous results.

Patient expectations

She desired an hourglass shape with a butt that had both lateral and posterior projection and did not look so flat and disproportionate. Her main concern were her hip dips because of which she could not achieve the smooth S shaped curve between her waist and hips. After her previous liposuctions, she had irregular adherent lower abdominal contours because of which she could not wear anything revealing her midriff. Also she wanted more symmetrical and toned look in her arms which had been left grossly asymmetric with a big difference in size from previous liposuction.

Challenges

Redo liposuction is always challenging. But this case was unique in itself.

• The patient had severe irregularities with adherent fixed anterior abdominal wall.

• There was gross asymmetry in both the arms along with sagging.

• The patient wanted both lateral and posterior projection of buttocks.

• She did not want to get buttock implants as she was apprehensive of having a foreign body inside her.

• After previous liposuctions, donor areas for fat harvest was limited.

Patient counselling

Previous results had made the patient worried about going through them for a third time. But it was also necessary to have it explained to her in detail what could and could not be achieved. Assessing her donor areas, which had already undergone liposuction before (abdomen, upper and lower back and arms), made me realise that the amount of fat harvest would probably not be more than 700-800 cc. And it would be injustice to either area if I tried to improve both the hip dips and also increase the projection of the buttocks. Since her major concern was hip dips, we decided on correcting the hip dips first. Increasing the posterior projection would be decided on table as per availability of donor fat. I assured her that I would do the best in my capability to correct the abdominal deformity. Regarding the arms, I explained that I would achieve near symmetry but could not promise absolute symmetry because after the previous liposuction, I did not have an objective measurement to assess for symmetry.

Surgical procedure

Given my experience with previous redo cases and the use of specialised tools, I was able to break the fibrous adhesions between the abdominal skin and underlying muscle. After proper infiltration of the layer with hemostatic fluid, I broke the adhesions using VASER (Ultrasound Assisted Device) and MicroAire (Power Assisted Device) and then injected some fat between the two layers to prevent future adhesions.

More fat was extracted from the bigger arm and just contouring was done on the smaller arm to achieve near symmetry in both arms. Deltoid grooves were created to give a more toned appearance. Finally, BodyTite (Radiofrequency Assisted Device) was used to tackle the sagging and laxity in the arms.

After completion of liposuction from all the areas, I could, to my relief, harvest 1500 cc of purified sedimented fat. Hip dips were corrected with 300 cc fat each side and the remaining 900 cc fat was used to augment the posterior projection of buttocks with 450 cc fat each side. This procedure of fat grafting was done by a specialised technique called EVL (Expansion Vibration Lipofilling). The subcutaneous space was expanded with the help of vibrations emitted from MicroAire device and fat was filled in this expanded space. This technique is proven to increase the quantity of fat that can be grafted in a given space with increased survival of fat cells and ensures maximum safety for the patient. It also enables a more precise placement of fat cells. The patient had undergone fat injection by the syringe technique in her previous surgeries, which was probably the reason for greater fat absorption and unsatisfactory results in her case. I have been using this EVL technique in all my cases of BBL and achieved consistent results.

Recovery and results

There was some initial discomfort after the procedure. Most of it went away within the first two days, and she could resume her normal activities three days later. She had swelling and bruising, most of which settled by the end of one month. At her two month follow up, her abdominal contours had become absolutely smooth. The fast recovery is attributed to the minimal tissue invasion and trauma caused during the procedure made easier with the help of technologies that I use. She still had some swelling on her back and arms. Her arms, though still had some swelling, appeared more symmetrical. Her hourglass shape had started becoming obvious. Fat absorption takes place in the initial six weeks and whatever fat remains after that, stays lifelong. Her hip dips were gone and she had good projection at the end of two months. The results would keep improving till six months and the patient is yet to come for her six month follow-up.

At her two-month follow up, patient was extremely satisfied and happy with her results. She even gave a video testimonial of her entire journey and experience and a review on her results. She was now feeling more confident in her own body, finally having achieved the hourglass shape she always wanted, with no hip dips and a perfectly projecting butt.

Key message

This patient could have had a much better outcome had she been a primary case. Deficit in the amount of donor fat limited the amount of projection that could be achieved. Yet whatever fat was transferred has given a good result as per the patient’s expectations. It is thus most important to understand patient expectations and try to achieve the best outcome the very first time.

Dr Priya Bansal

MBBS, MS (General Surgery), DNB (Plastic Surgery), is a board-certified cosmetic and plastic surgeon with over a decade of experience. She is well-versed in performing the most complex and precision-driven aesthetic and cosmetic procedures. She has been presented with many awards for her international presentations and has also won gold medal for her surgical skills. She is known for her personalised counselling, compelling results, and unrivalled patient experience. She has been associated with renowned institutes like Rosewalk Healthcare (Delhi) CK Birla (Gurgaon) and Fortis Lafemme (GK, Delhi) as a part of RG Aesthetics.