1. Abdominal markings
a. Linea alba (more prominent)
- Slightly narrower than males
- Extends down to the belly button only
- Wider as it gets lower
- Sculpt after inscriptions done in order to avoid over defining
b. Inscriptions (less prominent)
- 2 instead of 3 for males
- 2nd inscription near upper aspect of belly button
- Inscriptions not necessarily straight and at different levels on two sides
- Must mark preoperatively with patient pushing down on your shoulder/head
- Must palpate with fingers the inscriptions
- Sculpt lower inscription from belly button
- Sculpt upper inscription from inframammary crease
- Curve up and around laterally at the semilunaris line
- Create 4 packs versus 6 packs in males
- Highest pack often weakest and smallest
- Lower pack the largest and most prominent
c. Semilunaris line
- Curved down from lateral aspect of areola and around down to the pubic symphysis.
- Not necessarily a straight line especially at the inscriptions
- Sculpt from top down using lateral infra-areolar port(1st) and then from pubic tubercle from bottom up (2nd)
- Associated with negative triangle; located at the point of maximum indentation on the abdomen.
d. External oblique
- Must be maximally debulked as it is the extension of the negative green zone from the back
2. Lower back
a. Central vertical line: define the spine
b. Lateral vertical line: define paravertebral line (much narrower paraspinous muscles than the male)
c. Central inferior diamond – must core out (rounded in comparison to males); make sure to extend onto the back (paravertebral area) so you don’t create a shelf
d. Negative zone extends from dimple superiorly along the costal margin and inferiorly the iliac crest
e. Transition zone extends from dimple superiorly along the iliac crease and inferiorly down to the buttock proper; must debulk once done coring out the negative zone.
f. Use single/double fist under the anterior iliac spine to make sure you core out the negative zone in deep plane
3. Upper/middle back
a. Do not overdo debulking; must debulk to eliminate the mid lateral back crease
b. Do not overdo debulking of the posterior axilla (just make it smooth- 1 to 2 minutes of lipo only)
4. Buttocks
a. Ports: two lateral dimple ports and single central inferior port at apex of intergluteal crease and two inferior ports at the ischial tuberosity.
b. Use port sites (dimple pits) as guide to marking
c. Buttocks proper Shape more rounded superiorly
d. Need to add more volume to superior lateral aspect
e. Need to round out inferior medial buttocks (J shape) – use 3.0 cannulas
f. Fill out lateral buttocks depression/dimple (from posterior and sometimes from the anterior when turn back over)
g. Lifting the buttocks: graft from inferior port and into the muscle
h. Shaping the buttocks: graft from anywhere and into the fat
i. Must lift buttocks with both hands placed under the anterior iliac spine without touching buttocks skin to evaluate shape and symmetry.
5. Thighs
a. Medial thighs (a diamond) must carve out from anterior and posterior aspect; have three separate planes(use palm of hand to create); do not over debulk; use 3.7 cannula
b. Posterior thigh – bordered by lateral and medial diamonds; do not lipo or will lose support of infragluteal crease. May debulk minimally only superficially; do not go deep or will lose buttocks support
c. Lateral thighs (minimize debulking if going for a bubble butt which will require lateral buttocks depression filling)