Beyond the Shape

AMI delves into the surgical and non-surgical methods to reshape and enhance a patient ’s body.

The journey of body shaping requires precision, dedication and understanding of the procedures. Body contouring or body sculpting involves getting rid of extra skin, eliminating excess fat or reshaping the area in question. A broad variety of techniques have been established by body contouring to address the various needs of patients looking for both surgical and nonsurgical options.

Available modalities

A variety of techniques are used in body sculpting to reshape and contour the body.

Dr Anuya Manerkar, Consultant Dermatologist and Director, Panache, classifies these into “surgical and non-surgical”.

Dr Pornima Mhatray, Medical Director, Angel Health, adds, “Non-surgical approaches include treatments such as cryolipolysis and ultrasound-assisted lipolysis, both of which have shown promising results. On the surgical side, options like liposuction, tummy tuck, and even breast augmentation or reconstruction are common.”

Dr Umang Kothari, FounderDirector, The Hair and Shape Clinic, introduces a more detailed classification based on what tissue or component is being addressed, “be it skin laxity, fat, muscle, or bone. Non-invasive procedures like radiofrequency-assisted body contouring or laser-assisted contouring can effectively tighten the skin, while fat reduction can be achieved through methods like deoxycholic acid injections or more invasive techniques like liposuction.” He also mentions the rising trend of fat transfer and body fillers for those seeking volume addition (inflation) rather than reduction (deflation).

The ideal candidate

Identifying the right candidate for body sculpting procedures calls for realistic expectations and intrinsic motivations.

Dr Umang emphasises that as opposed to having surgery to satisfy the expectations set by someone else, an ideal client wants to feel more comfortable in their skin. “If you are happy with yourself, there is no need to undergo a procedure,” he stresses, underscoring the psychological aspects of body modification.

On her part, Dr Purnima relates a story from her practice about a 19-year-old patient who was insistent on getting her breast augmentation surgery. She was of the professional opinion that the patient should wait since she was too young, but the girl and her mother insisted on having the treatment done, even threatening to go somewhere else if it was not done. This emphasises the significance of the patient’s will, which, in Dr Purnima’s opinion can occasionally take prominence over expert counsel.

Determining surgical vs. non-surgical routes

Determining whether the patient is better suited for a non-surgical or surgical approach is a crucial step in the bodysculpting process.

According to Dr Purnima, liposuction is frequently recommended for patients who are morbidly obese, particularly if they have extensive abdominal fat accumulation and skin drooping. She mentions that patients who weighed between 85 and 90 kg and had BMIs over 35 were usually good candidates for surgery because non-surgical treatments would not provide them the noticeable outcomes they wanted. However, she also acknowledges that for patients with BMIs between 25 and 35, non-surgical methods like Cryolipolysis can be effective. The challenge, however, lies in patient compliance. Many individuals seek quick results, which often leads to opting for surgical interventions over slower, non-invasive options. Dr Purnima uses comprehensive methods to treat these problems, combining diet and fitness routines with surgery to guarantee long-term success.

Despite the benefits of surgery, many people are hesitant to have it done due to widespread misconceptions and concerns about the process. It is a common problem for Dr Purnima in her practice to convince patients that surgeries like liposuction are safe and beneficial. She explains how surgery is a preventative health plan that can improve overall heart health and metabolism.

Even though surgery is usually safe and beneficial, there are some absolute contraindications where the treatment should be avoided.

“Patients with morbid obesity fall into this category,” says Dr Medha Bhave, Plastic Surgeon, Director, Param Hospital and ICU, Laser Cosmetic.

According to her, treating these people frequently calls for a “broad approach involving physicians, bariatric surgeons, dermatologists, and endocrinologists.”

Furthermore, Dr Medha emphasises that individuals who suffer from mental illnesses, particularly body dysmorphic disorder, or who are emotionally unstable should not undergo surgery. They can have irrational expectations or serious psychological issues, which could make it more difficult for them to recover from the treatment and feel satisfied overall.

Dr Anuya adds that contraindications can also include patients with significant cardiac issues or those with pacemakers.

However, Dr Medha notes that “with proper physician supervision and a well-equipped surgical environment, even highrisk patients with conditions like cardiac problems, diabetes, or hypertension can undergo a surgery procedure safely.”

To this, Dr Purnima recounts a successful case involving a patient with a cranial peritoneal shunt. “Despite the complexity of the patient’s condition, thorough preoperative screening, including various CT and MRI scans, and a team of specialists ensured a safe and successful procedure.”

In terms of preand post-procedure care, Dr Umang emphasises the importance of “adhering to updated Standard Operating Procedures (SOPs). This includes ensuring physician fitness, limiting procedure time, focusing on one area at a time, and using energy-based devices for better recovery.” He further categorises his patients into three main groups: “The first includes those who have lost significant weight and seek to eliminate stubborn fat. Often, these are younger individuals who follow health-oriented practices like keto diets or intermittent fasting and want to see immediate results to motivate further lifestyle changes. Second consists of those starting their journey toward a healthier lifestyle but struggling due to urban constraints, seeking positive reinforcement to boost their efforts. Third includes patients who do not prioritise a healthy lifestyle and expect the procedure to compensate for poor habits.” He emphasises that a healthier lifestyle complements, rather than replaces, the benefits of cosmetic procedures.

Dr Purnima and Dr Umang emphasises the need for thorough preoperative counselling and adherence to safety protocols. Dr Umang outlines the modern safety standards, which include “detailed checklists and energy-based devices for better recovery.” Dr Purnima adds that “lifestyle modifications are crucial both before and after surgery to optimise results and prevent complications.”

Legal and medical considerations

Dr Medha brings an important legal and medical aspect into the discussion, specifically about breast augmentation. According to FDA guidelines, breast augmentation and the use of breast implants are approved only for individuals 21 years or older. This legal requirement underscores the need for surgeons to carefully assess the age and health of patients before performing any procedure. She cautions that ignoring these legal boundaries can lead to significant consequences if anything goes wrong.

Addressing BMI guidelines, Dr Medha also emphasises that nonsurgical modalities work best for patients with lower BMIs. She points out that patients with BMIs of 27–28 or higher, particularly women of childbearing age, often struggle to see results from non-invasive techniques. In her experience, hormonally accumulated fat in women is particularly resistant to non-surgical interventions, making liposuction the best solution for such cases.

From age-old myths to modern realities

Cosmetic surgery has historically been linked to older persons, especially women going through menopause and the hormonal changes that accompany it. But Dr Purnima shares a change that she noticed in the last few years. “Young people, including men, are increasingly open to cosmetic procedures like liposuction,” she continues. This shift reflects a rising awareness of the advantages cosmetic modifications can provide beyond standard age-related demographics and a broader acceptance of these procedures by society.

A crucial element of cosmetic surgery that is frequently disregarded is the patients’ psychological health. Dr Medha stresses how crucial it is to identify psychological contraindications, such as body dysmorphic disorder. It may not be appropriate for patients to have a surgery if they have severe body dysmorphia or unstable temperament.

Adherence to safety protocols and comprehensive preoperative counselling is crucial as well. The journey begins long before the medical team encounters the patient. Dr Medha believes that the pre-procedure stage is crucial. “Counselling is important,” she says. “We must make sure patients realise the value of leading a healthy lifestyle and set reasonable expectations.” She stresses the value of routine follow-ups to track development and quickly resolve any problems.

Dr Purnima emphasises that lifestyle changes are necessary. “Patients are advised to minimise sugar intake, refrain from strenuous exercise, and make any dietary modifications that are required.”

Post surgery, the attention changes to healing and regular upkeep. To speed up their recovery, patients are encouraged to start walking the same day. But only with the surgeon’s permission can one restart vigorous exercise or particular activities.

Dr Umang emphasises that patients should stay away from foods heavy in sugar, chocolate, and some supplements that may raise their risk of bleeding. He says, “Patients must adhere to these instructions to guarantee a seamless recovery and the best possible outcomes.”

Evolving acceptance

A wider acceptability of body-contouring procedures among a variety of demographic groups can be seen in the changing attitudes toward cosmetic surgery. Men and younger people are becoming more and more interested in cosmetic modifications because they want to fit in and be accepted by society. The future of body sculpting will continue to be shaped by meeting clients’ physical and psychological demands, upholding safety regulations, and adopting an all-encompassing viewpoint as the industry evolves.

The above article has been extracted with excerpts from the panel discussion on ‘Optimising body shaping: Patient Cases that define challenges and successes’ that was held at the Aesthetic Medicine India Conference 2024.