Circumferential Body Contouring

Techniques and Applications of Lower Extremity Feminization and Masculinization

Background

Significant differences exist between feminine and masculine lower extremities, and this region contributes to gender dysphoria in transgender and nonbinary individuals.

Methods

A systematic review was conducted for primary literature on lower extremity (LE) gender affirmation techniques as well as anthropometric differences between male and female lower extremities, which could guide surgical planning. Multiple databases were searched for articles before June 2, 2021 using Medical Subject Headings. Data on techniques, outcomes, complications, and anthropometrics were collected.

Results

A total of 852 unique articles were identified: 17 met criteria for male and female anthropometrics and 1 met criteria for LE surgical techniques potentially applicable to gender affirmation. None met criteria for LE gender affirmation techniques specifically. Therefore, this review was expanded to discuss surgical techniques for the LE, targeting masculine and feminine anthropometric ideals. LE masculinization can target feminine qualities, such as mid-lateral gluteal fullness and excess subcutaneous fat in the thigh and hips. Feminization can target masculine qualities like a low waist-to-hip ratio, mid-lateral gluteal concavity, calf hypertrophy, and body hair. Cultural differences and patient body habitus, which influence what is considered "ideal" for both sexes, should be discussed. Applicable techniques include hormone therapy, lipo-contouring, fat grafting, implant placement, and botulinum toxin injection, among others.

Conclusions

Due to lack of existing outcomes-based literature, gender affirmation of the lower extremities will rely on application of an array of existing plastic surgery techniques. However, quality outcomes data for these procedures is required to determine best practices.

Gluteal Region Reshaping of Massive Weight Loss Patients—A Decision-Making Strategy

Background  Massive weight loss (MWL) is a very common presentation that you may face as a plastic surgeon. Each patient has his own individual criteria, so, you should work according to a well-organized plan, especially when such cases have concerns about their gluteal area contour that were neglected before by many surgeons. A decision-making strategy was used to give a personalized treatment for targeting gluteal region reshaping of MWL patients.

Methods  This study considered all patients with MWL subjected to buttock reshaping. There was no randomization in treatment; there was a case-by-case assessment. We analyzed the features of the buttocks, the type of surgery performed, the outcomes, and the complications.

Results  Fifty two patients were included (41 females and 11 males), ages ranged between 21 and 66 years. Demographic data, preoperative body mass index (BMI), duration of surgery, type of surgery, and postoperative complications were collected. Statistically significant improvements were observed in gluteal ptosis and patient satisfaction grades.

Conclusion  Aesthetic improvement of the buttocks involves either augmentation or contouring that may be obtained by liposculpture, surgical lifting, or combination. Patients with MWL have high expectations and are often treated with multiple procedures. Thus, an easy strategic approach personalized on each patient to treat multiple adjacent areas in one operation is necessary. Adipose tissue distribution, gluteal skin status, and BMI were the main factors that can forcefully affect our plan to guarantee reduction of unpleasant results and complications and improve patient satisfaction.

Photogrammetric Anthropometry to Determine the Female Waistline

Background: In this study, we attempted to develop a reference guide to determine the female waistline based on the golden ratio for waist sculpting in females, which may help in waist sculpting by liposuction or non-invasive techniques.

Material and methods: To understand the anatomy of the waist, we studied the 60 photographs of females and measured the distances between important anatomical landmarks. The different values and proportions obtained were compared between different groups of heights and two groups of BMI using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY) through analysis of variance (ANOVA).

Results: There is a golden ratio in the distances between xiphoid to waist and waist to the abdominal crease that is close to 1:1.66, and the waist is at the junction of the upper 2/5th and lower 3/5th of the height from xiphoid to abdominal crease. The location of the waist is at one-third of the whole length of the abdomen (the whole length of the abdomen being the length from the xiphoid to the pudendal cleft).

Conclusions: We observed in our study that there is a definite mathematical relationship between the length of the abdomen and the waist position, which may be applied for female waist sculpting.

Enhancing Masculine Features After Massive Weight Loss

BACKGROUND

Whereas body contouring surgery after massive weight loss in women emphasizes sculptured adipose and broader lower torso, little attention has been devoted to accentuating the male physique.

OBJECTIVE

To determine if boomerang excision pattern correction of gynecomastia with J torsoplasty combined with an abdominoplasty with oblique excisions directly over bulging flanks provide effective and safe optimizing of muscle visibility and upper torso dominance.

METHODS

A description of comprehensive body contouring through an abdominoplasty and a series of obliquely oriented ellipses of the male torso is followed by review of 19 consecutive patients.

RESULTS

Seventeen patients were performed in a single stage. Nine of the last ten cases included J torsoplasty and oblique excision extensions over the flanks. Of the 17 patients responding to a ten-question survey, 15 were satisfied with chest improvement. One of the first eight patients with a transverse lower body lift was satisfied with the flank bulges. All of the last eight cases with direct oblique flank excisions were satisfied with their lower body. Five patients (26 %), having a total of 74 operative procedures, had significant complications of chest hematoma, persistent hip and buttock seromas, superior NAC edge necrosis, and distal necrosis of the fleur de lis abdominoplasty. One boomerang correction underwent minor revisions. One transverse lower body lift underwent major revision. No complications occurred in the last ten patients, having oblique flank excisions instead of transverse lower body lifts.

CONCLUSION

Comprehensive excisional body contouring surgery of a central high tension abdominoplasty with a series of obliquely oriented ellipses throughout the torso appears to provide low risk improved body contour for the muscular male.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Physical attractiveness: analysis of buttocks patterns for planning body contouring treatment

BACKGROUND

As buttocks region is one of the most characteristic features of the ideal female body figure, the popularity of gluteal region contouring is on the rise. Perception of body form is influenced by its shape and size. Interventions to modify the form of this region are often difficult due to influence. The aim of this study is to investigate the attractiveness of various buttock shapes with the aid of a dedicated software.

METHODS

Standard personal photographs of the lower body were obtained from 200 healthy volunteers. Linear analyses were made and anatomical perception was calculated according to reference points.

RESULTS

Compared to males, all measurements concerning buttock dimensions were a significantly greater in females. Proportional assessments revealed that in females, the most attractive buttock waist-to-hip ratio was 0.75 from the posterior view. This ratio was 0.85 in males. From the lateral view, the most attractive buttocks have a waist-to-hip ratio of 0.70 in females. Positioning of the lateral prominence at the inferior gluteal fold was rated by 25% of the respondents as the most attractive in males from the posterior view. From the lateral view, the most prominent portion positioned at the midpoint (a 50:50 vertical ratio) was considered the most attractive for females.

CONCLUSIONS

These results suggest that utilizing digitalized reference values for a given body region may be an invaluable tool for determination of the correct fat volume, thus individualization of body contouring procedures. With the help of certain software, this research has shown that it is possible to measure the parameters of buttock, which may in turn be used to offer the best solution for any individual in quest for an improved buttocks form. New ideal waist-to-hip ratios of 0.7 update the previous standards.

Rectus Abdominis Fat Transfer (RAFT) in Lipoabdominoplasty: A New Technique to Achieve Fitness Body Contour in Patients that Require Tummy Tuck

OBJECTIVE

To describe a new technique to achieve a fit-look in lipoabdominoplasty patients through liposculpture and rectus abdominis fat transfer (RAFT).

METHODS

Patients with a body mass index under 26 and of both genders scheduled for abdominoplasty or body lift were selected for this procedure. Fat was transferred directly to the rectus abdominis muscle after flap elevation during lipoabdominoplasty.

RESULTS

A total of 26 patients were operated on with this technique. No complications attributable to the fat grafting were noticed. All patients had a high satisfaction level with the procedure. Demonstrative cases are shown.

DISCUSSION

The RAFT technique is a useful and effective technique to improve results in standard lipoabdominoplasty. Its main limitation is the adequate selection of the patient. The RAFT technique can be incorporated easily to common day practice.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Enhancing Masculine Features After Massive Weight Loss

Background

Whereas body contouring surgery after massive weight loss in women emphasizes sculptured adipose and broader lower torso, little attention has been devoted to accentuating the male physique.

Objective

To determine if boomerang excision pattern correction of gynecomastia with J torsoplasty combined with an abdominoplasty with oblique excisions directly over bulging flanks provide effective and safe optimizing of muscle visibility and upper torso dominance.

Methods

A description of comprehensive body contouring through an abdominoplasty and a series of obliquely oriented ellipses of the male torso is followed by review of 19 consecutive patients.

Results

Seventeen patients were performed in a single stage. Nine of the last ten cases included J torsoplasty and oblique excision extensions over the flanks. Of the 17 patients responding to a ten-question survey, 15 were satisfied with chest improvement. One of the first eight patients with a transverse lower body lift was satisfied with the flank bulges. All of the last eight cases with direct oblique flank excisions were satisfied with their lower body. Five patients (26 %), having a total of 74 operative procedures, had significant complications of chest hematoma, persistent hip and buttock seromas, superior NAC edge necrosis, and distal necrosis of the fleur de lis abdominoplasty. One boomerang correction underwent minor revisions. One transverse lower body lift underwent major revision. No complications occurred in the last ten patients, having oblique flank excisions instead of transverse lower body lifts.

Conclusion

Comprehensive excisional body contouring surgery of a central high tension abdominoplasty with a series of obliquely oriented ellipses throughout the torso appears to provide low risk improved body contour for the muscular male.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.