Male High Definition Liposuction Preoperative Markings are far more extensive than typical liposuction. As you can see from the pictures at the bottom and the descriptions below, a detailed surgical plan is esssential for superior, natural looking results.
Abdominal markings
- Linea alba (vertical line that separates two sides of ab muscles)
- Slightly wider than females
- Extends down to the belly button only
- Wider as it gets lower
- Sculpt after inscriptions done in order to avoid over defining
Inscriptions
- 3 instead of 2 for females 3rd 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; superficial Ultrasound and use of thumb to define
- Sculpt lower inscription from belly button
- Sculpt upper inscription from infrareolar crease
- Sculpt middle inscription using perpendicular sculpting with Power X and curved cannula from infrareolar crease
- Curved around laterally at the semilunaris line and up (curved up)
Packs
- 6 pack versus 4 pack
- Highest pack weakest and smallest may not even be present
- Middle and lower pack the largest and most prominent
- More linear and concaved up laterally (at the upper aspect)
- More concaved up starting earlier (especially lower pack)
- Must debulk fat (mark as blue)
- Lipo: start with 4.6, then 3.7 as you get close to the end, then 4.6 to bring down the whole region.
Chest Proper (Pecs)
- Must define the lateral aspect of the pec (linear – creates medial aspect of lateral chest diamond)
- Must remove more fat over inferior aspect than upper aspect
- Must debulk superficial fat (make as blue)
- Must define muscle shape (gentle concave at bottom/may have linear component at mid mammary line; medially curves up the muscle attaches along the clavicle and laterally to the humerus.
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
- May even not be contiguous (broken up by serratus anterior fingers)
- Sculpt from top down using lateral infra-areolar port(1st) and then from pubic tubercle from bottom up (2nd)
- Associated with negative triangles (2 to 3): triangles become wider as move down the abdomen.
External oblique
- Must be debulked minimally and be more prominent than its adjacent neighbors (superiorly the serratus anterior), medially the semi-lunaris line, inferiorly the V to the P (the iliac crest) and posteriorly the back
Lateral chest (a diamond shape)
- Medial upper border the lateral pectoralis
- Medial lower border the subcostal border (extends from lateral infra-areola)
- Lateral Posterior border the latisimuss
- Superior border the armpit
- Inferior border the external oblique muscle
- Base: serratus anterior muscle and rib cage
- Inferior base: demonstrates serratus fingers (lowest two fingers extend inferior oblique onto the upper and upper middle packs of the abdomen); extend just below the rib cage
- Etch inferior diamond from belly button port and from posterior port
- Etch superior diamond from anterior axillary port
Axilla
- Anterior etching minimal make smooth with pec contour
- Posterior etching more aggressive and can create a cavity
Inferior lateral abdomen
- Referred to as a V to P
- Area below the iliac crest
- Negative space concavity just under the iliac crest/lip
Central lower abdomen
- Avoid debulking in zone of adherence (may fat graft)
- May have to fat graft to complete infra-areolar pack;
Arms:
- Use anterior and posterior axillary ports (must provide access yet be hidden)
- Etch deltoids from ports (use 3.0 cannulas)
- May also create slight triceps and biceps accents
- Leave more fat at mid triceps in males to give it more bulk
- Posterior axilla may create more of a crater give triceps more definition.
Back
- Lower back debulk completely (create a hole as Hamlet says -no transition zone)
- Buttocks shelf desirable (in comparison to female)
- Latisimuss definition inferiorly;
- Central lower back(diamond in females) must be minimally debulked.
- Buttocks shape more square
- Define central vertical line (along the spine)
- Define the lateral paravertebral muscle lines (extend from ports over the pit dimples)
Buttocks
- Buttocks shelf desirable (no transition zone)
- Upper aspect more square; mid buttocks more horizontal (not rounded)
- Central inferior back upper buttocks minimally debulked and linear shaped
- Buttocks proper more square
