High Definition Liposuction (HD Lipo)

HD lipo, also known as high-definition liposuction, HD liposuction or high-definition lipo, is an advanced body contouring technique used for precise delineation of the muscular contours in men. Technical advances in liposuction have parallelled advances in HD lipo. Abdominal etching originally emerged as a differential liposuction technique to enhance the appearance of the abdominal musculature in male patients by removing fat with liposuction at different levels. Although liposuction remains the most popular cosmetic surgical procedure performed in men, patients are increasingly asking for results that are beyond the correction of areas with excess fatty tissue. HD lipo, or HDL for short, is designed to sculpt the muscular anatomy of the torso to achieve results that far exceed anything attainable with liposuction.

RELATED: What is High Definition Liposuction?

Abdominal etching is performed with liposuction in the superficial fat plane. The advanced abdominal etching technique slowly gained acceptance and popularity among surgeons for the treatment of patients seeking well-toned bodies with muscular definition. High-definition liposculpture (HDL) is an evolution of the abdominal etching technique and involves several techniques designed to emulate athletic and attractive surface anatomy. HD lipo is a multistep liposuction procedure that debulks the deeper fatty tissues, whereas more superficial liposuction highlights the natural surface grooves. HDL is now a unique subspecialty in its own right and quite separate from traditional liposuction. HDL is an integration of art and science to deliver results that are very highly regarded by plastic surgeons and patients alike.

At Centre for Surgery, HDL uses PAL technology to achieve both deep fat layer debulking and superficial fat layer sculpting to demarcate and highlight the regional musculoskeletal anatomy of our male patients. Our surgeons utilise precise intraoperative techniques to ensure a smooth postoperative experience, including recovery, satisfaction, and minimising complications.

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All our surgeons are on the GMC specialist register for plastic surgery. The Royal College of Surgeons of England has an excellent information resource on cosmetic surgery.

RealSelf Top Doctors

RealSelf top doctor status is awarded to less than 10% of the RealSelf doctor community.  This status is earned by achieving consistently high patient satisfaction (from RealSelf reviews), getting excellent feedback on expert answers to patient questions, and investing significant time in Q&A and other doctor activities. RealSelf top doctors are rated among the very best surgeons in the UK.

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• Our HD lipo surgeons are on the GMC specialist register for plastic surgery.
• Full membership of the UK and the European association of plastic surgery
• Aesthetic fellowships in body contouring surgery
• A strong background in reconstructive surgery
• Highly skilled plastic surgeons who specialise in high-definition liposculpture
• HD lipo certified surgeons having completed the world-famous Barcelona PAL® Master’s Course

Our surgeons are full members of:

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Our board-certified plastic surgeons have between them many years of performing expert liposuction. They have used all the liposuction techniques over the years, including LASER lipo, VASER lipo, BodyJet lipo and Tickle Lipo and PAL lipo.

Our surgeons agree that PAL lipo is the GOLD standard method of HD lipo with the best long-term overall results.

PAL is an advanced evolution of traditional suction-assisted liposuction (SAL) that involves a rapidly reciprocating cannula tip, which replicates the “to-and-fro” motion of the operator’s arm but at a lower amplitude of 3 mm. There are two main components to PAL’s mechanism of action: firstly, a “jackhammer” effect that breaks down fat tissue into parcels of fat cells; and, secondly, the alternating suction of fat globules that are avulsed by the reciprocating cannula. The advantages of PAL are treatment speed, the economy of motion, effectiveness in fat removal, and reduced surgeon fatigue.

Benefits of HD liposuction

All prospective patients must be assessed for their suitability by one of our surgeons. Ideal patients are men aged between 25 and 39 years, with a body mass index (BMI) of <30 kg/m², an absence of abdominal hernia or abdominal muscle bulging, no history of massive weight loss, no contraindication for TIVA general anaesthesia, and without any significant medical conditions. Other variables taken into consideration in the physical examination are skin quality (tone and elasticity), pinch test (to evaluate subcutaneous vs intra-abdominal fat), and scars from previous surgeries.

In addition to the above criteria, patients must adhere to a strict postoperative protocol, which includes regular clinic visits, medical photography at predetermined postoperative time intervals, compliance with compression garment use as instructed by the surgeon, massage therapy for lymphatic drainage and demarcation, staged return to work, and staged return to physical activity (which includes exercising and working out at the gym). All patients are encouraged to start a healthy, protein-rich diet postoperatively and adhere to exercise habits as soon as the compression garment is removed.

The importance of having realistic expectations

Your surgeon will explain the procedure in detail during the preoperative visit. With HD lipo, the results depend on many factors (including the patient’s personal anatomy, the volume of excess fat, exercise habits, etc.) and cannot simply be replicated from a photograph which is shown to the surgeon during your consultation.

Trust a body contouring plastic surgeon

A body contouring plastic surgeon is trained to undertake aesthetic surgical procedures on the breast and body region. They are dedicated sub-specialists. Compared with general plastic surgeons, body contouring plastic surgeons are inherently better trained to perform advanced breast and body procedures. The extra years of surgical training by body contouring specialists focused on the breast and body region results in an exceptionally high degree of skill.

Regarding HDL, our surgeons have noticed that the short-amplitude reciprocation of the cannula tip, coupled with the aspiration, helps to penetrate the dense superficial fat layer precisely, helping the surgeon achieve a fine and detailed sculpture of the fat. Moreover, the use of mechanical energy avoids the side effects and tissue injuries associated with thermal energy, such as VASER, including deep tissue and skin burns, increased seromas, and painful recovery. In addition, the extent of the definition can be well controlled by taking advantage of the fine reciprocation while turning the suction power on and off.

HD lipo is performed at our state-of-the-art Baker Street clinic in Marylebone as a day case procedure. This means you will be admitted and discharged on the same day, thus allowing you to recover in the comfort of your own home.

HD lipo comprises the treatment of:

• Abdomen and flanks
• Chest
• Upper arms

Preoperative marking for HD lipo

Immediately before the procedure, patients are always marked in the preoperative area while in a standing position. The underlying bony and muscular anatomies are the guidelines for skin marking at all times. The surgeon starts by marking the chest anatomy following the inferior horizontal and oblique lines of the pectoralis muscle; the upper part of the chest is evaluated to assess whether a fat transfer is required. The abdominal inscriptions are examined and carefully marked to delineate the underlying rectus abdominis anatomy. The pelvic bones and ligaments are marked. The groove between the deltoid and the biceps anteriorly and deltoid and triceps posteriorly are marked. In the lower back, the surgeon marks the lateral border of the thoracolumbar fascia, the inferior border of the latissimus dorsi, and the superior border of the gluteus maximus muscle.

HD lipo is performed with the PAL system (power-assisted liposuction). Fat harvest and superficial liposculpting are done by means of bent, and straight 5-mm exploded tip cannulas. Fat is collected and processed with a fat grafting system. Fat transfer to the chest is performed with a 4-mm single-side-hole injection cannula. HD lipo is performed under TIVA general anaesthesia.

Step 1:

After induction of general anaesthesia, the surgeon starts by turning the patient into a prone or face-down position. The gluteal area, back, and arms are prepped and draped. Two 5-mm incisions are made just above the gluteal region and two 5-mm incisions in the back of the armpit fold. Tumescent local anaesthetic solution is injected into the fat compartments to be treated. Our surgeons use the SAFElipo technique for lipo-aspiration. After the deep fat compartments in the lower back are aspirated, superficial fat compartments are treated to mark the lower back lines (lower border of the latissimus dorsi muscle following along the lateral thoracolumbar fascia and the lateral vertical line of the erector spinae muscle caudally). The back of the upper arms is marked by suctioning the superficial fat layer between the deltoid and the triceps.

Step 2:

Patients are then turned into a supine or face-up position, and 5-mm incisions are made in the following sites: groin region (bilaterally), belly button, below both nipples, and armpit crease on both sides. SAFElipo technique is used for extraction of the deep medial and lateral abdominal compartments (below and above the umbilicus) and the deep fat compartment in the armpit. This is followed by treatment of the superficial fat compartments along the preoperatively marked lines on the abdomen and chest. Abdominal inscriptions overlying the rectus abdominis are marked through the belly button and the areola region without the need for additional incisions. This is accomplished with the use of both straight and curved cannulas. The front of the upper arms is treated through the armpit incisions by aspirating the fat between the deltoid and biceps.

Step 3:

After harvested fat is washed and filtered in the fat grafting system, transfer to the chest area is achieved through the areolar and armpit incisions. Low-volume fat grafting is performed in the subcutaneous pectoral area with a 4-mm single-side-hole cannula. There is no need for the placement of surgical drains after HD lipo.

After the wounds are closed and dressings have been applied, specialised compression foam (Epifoam) strips are applied over the superficially marked areas. Patients are then placed in compression garments before finally being woken up from TIVA general anaesthesia.

Courtesy of Dr Ahmed Saad

Patients are discharged home later in the day once they have met all the discharge criteria.

Patients will have scheduled postoperative clinic visits on days 3, 7, and at six weeks, three months, six months, and one year. Manual lymphatic massage needs to be scheduled for two sessions during the first postoperative week. More sessions are scheduled if found necessary. Manual lymphatic massage, which is performed in our practice by our specialist massage therapists, includes draining areas of swelling to the closest lymph nodes, as well as drainage of superficial fat areas that are treated to avoid the development of fibrosis and loss of definition. All patients are given documents to complete postoperatively detailing their intake of pain medication, number and dates of massage sessions, compression garment use, return to work, return to full activity and physical exercise, and their satisfaction score (1-10, with one being extremely bad and ten being outstanding) at 1.5, 6, and 12 months. Photographs are taken in a standardised fashion, with the same light settings being used preoperatively and during all postoperative visits.

All patients are prescribed paracetamol and ibuprofen for postoperative pain control on an as-required basis. Patients are completely off their pain medications, typically by day 8 (paracetamol) and day 9 (ibuprofen). After day 9, we found none of our patients to be on pain medication for surgical pain treatment.

Skin retraction after HD lipo

With the skin in the treated areas, a significant retraction is often noticed as early as day 3 when the compression garment is first removed. This concept has been well described in the past with liposuction of the superficial fat layers as well with thermal energy–emitting technologies like VASER. Our surgeons agree that skin retraction continues to progress over the first few months after surgery.

Our surgeons have noticed that the two massage therapy sessions during the first-week help accelerate the recovery time and diminish the risk of fluid collection. Another benefit of these sessions is the drainage of the marked areas in the superficial fat layer, as failure to do so for a prolonged time could produce fibrosis and diminished definition.

Compression foam is used for only 3 or 4 days after surgery (it can be removed during the first massage therapy session), and there is no need for reapplication for longer periods.

Our surgeons recommend only three weeks of compression garment use; with longer periods of wear, the risk of contour deformities from the garment folds outweighs the benefit. Furthermore, at three weeks, patients should be ready to return to their regular physical activity, and garment removal should help with this process.

HD lipo has been performed with an impressive safety record for over 15 years and is considered by our plastic surgeons to be a very safe procedure when performed correctly. All procedures at Centre for Surgery are performed by fully qualified and experienced plastic surgeons to get the best possible results. Although complications with HD lipo are generally rare, they can still occur. Your surgeon will discuss with you in detail at your face-to-face consultation all the potential risks and complications associated with the HD lipo procedure.

Potential risks of HD lipo

• Anaesthesia risks
• Seroma or haematoma
• Numbness which can temporary or permanent
• Bruising and swelling
• Poor wound healing
• Stretch mark development
• Exacerbation of cellulite
• Surgical site infection
• Visceral perforation
• Asymmetry
• Contour irregularities
• Skin laxity
• Kidney or liver problems
• Fat embolism
• Skin laxity – In some patients, liposuction may exacerbate pre-existing skin laxity, requiring skin removal in a second procedure.

Reducing the risk of surgical site infection

Preventing Venous Thromboembolism (VTE)

Several factors will determine the overall cost of the HD lipo procedure, and the final quotation will be given after your face-to-face consultation with your specialist plastic surgeon.