Body

BODYContouring
CONTOURING

Aesthetic Surgery Journal

Special Topic 2019, Vol 39(12) 1368–1377
© 2019 The American Society
for Aesthetic Plastic Surgery, Inc.

Abdominal Etching: Past and Present Reprints and permission: journals.

permissions@oup.com
DOI: 10.1093/asj/sjz153
www.aestheticsurgeryjournal.com

Nneamaka Agochukwu-Nwubah, MD; and Henry A. Mentz, MD

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Abstract
Since its inception in the 1980s, liposuction has undergone a tremendous paradigm shift from the simple removal of excess subcutaneous fat to a pro-
cedure of extreme sophistication and elegance where we as surgeons are able to mold and shape a patient’s figure. Plastic surgeons have modified this
procedure with the overall goal of improving the aesthetic results while focusing on maximizing safety and minimizing complications. These modifications
include advanced liposuction technology and techniques, the increasing use of subdermal superficial liposuction, differential liposuction, the advent and
introduction of a wide range of cannulas, and the use of fat grafting simultaneously with liposuction for targeted contour and fat repositioning. In this
article, the authors discuss in detail the introduction and progression of abdominal etching, a procedure first introduced by the senior author (H.A.M.) in
the early 1990s. The authors also present their experience over the past 4 years. In this procedure, the technique of differential liposuction is employed
to enhance the detail of abdominal musculature. The literature on abdominal etching is fairly scarce. Thus, the authors hope that this review will not only
give the provider a thorough review and understanding of liposuction and its evolution over the years but will also provide an overview of the indications,
patient selection, technique, expectations, and complications of abdominal etching as well.

Level of Evidence: 4

Editorial Decision date: May 10, 2019; online publish-ahead-of-print May 20, 2019.

Advanced liposuction is a term to describe liposuction with
the goal that goes beyond the simple removal of fat. It en-
tails liposuction for body sculpting and shaping. Different
types of advanced liposuction that have been described in-
cluding high-definition liposculpture, 3-dimensional (3D)
liposuction, Separation, Aspiration, Fat Equalization lipo-
suction, and differential liposuction. High-definition lipo-
sculpture, 3D liposuction, and differential liposuction are
somewhat interchangeable terms that describe the utiliza-
tion of advanced techniques in liposuction to sculpt and
re-mold a patient’s figure/shape. With these techniques,
the surgeon is able to perform body sculpting of the super-
ficial tissues to define the 3D anatomy and musculature in
a wide range of patients. The idea in these cases is to shape
the body fat in a multilayer and 3-dimensional approach
for contouring based on the principle of the creation of
convex and concave zones. This is in stark contrast to the
simple flattening of areas with basic liposuction principles.
Surgeons are able to attain dynamic definition of several
areas, including the chest, abdomen, upper extremities,
lower extremities, and cankles (the area where the calf
and ankle meet).1-9 In some cases, selective fat extraction
in conjunction with fat grafting is performed to enhance
the anatomical architecture.6,9 This has been described
in the abdomen and arms where surgeons have achieved
the current desired “fit-look” for patients by fat grafting to
the rectus abdominis and arms.6,9 The utilization of these
Dr Agochukwu-Nwubah is an aesthetic surgery fellow at a private
plastic surgical practice in Houston, TX. Dr Mentz is a plastic
surgeon in private practice in Houston, TX.
Corresponding Author:
Dr Nneamaka Agochukwu-Nwubah, The Aesthetic Center for Plastic
Surgery, 12727 Kimberley Lane, Suite 300, Houston, TX 77027, USA.
E-mail: nneagochukwu@gmail.com; Twitter: @dramakaplastics
Agochukwu-Nwubah and Mentz
techniques as adjuncts has also revolutionized the results
surgeons can achieve surgically. This has been most com-
monly described in combination with body contouring pro-
cedures, such as abdominoplasty.8,10-12
With the advent of advanced liposuction, what was
known as “basic” liposuction where surgeons simply
achieved a flatter contour has “morphed” into a procedure
for patients of varying ages, shapes, and sizes including
the already athletic and fit patient who simply desires im-
proved contour or abdominal muscle definition.
ABDOMINAL ETCHING: HISTORICAL
PERSPECTIVE
Abdominal etching was first performed and described by
the senior author (H.A.M.) in the 1990s, with the goal of
enhancing the detail of the abdominal wall musculature.1
In abdominal etching, differential liposuction is utilized to
obtain a rippled “washboard” appearance of the abdom-
inal muscles. To achieve the goal of enhanced muscular
detail of the abdomen, principles utilized include detailed
preoperative markings, superwet technique (1:1), and vig-
orous superficial liposuction in particular areas. Traditional
deep liposuction is done to thin the overall abdominal fat
as needed, followed by superficial liposuction that helps
delineate the grooves and furrows that separates the mus-
cles. This creates the sharp convexities and concavities
typical of a washboard abdomen.
The literature on abdominal etching is fairly scarce,
with 3 focused reports to date on the topic.1,2,7 The first
report of abdominal etching reported on 8 male patients.1
In this report, the patient population consisted of male ath-
letes who sought consultation to obtain a washboard ap-
pearance of their abdomen. This patient population was
fairly athletic, with strict dietary and exercise regiments,
low body fat (8%-15%), and physically fit physiques with
muscular bulk. These patients were unable to obtain the
desired washboard abdominal appearance despite these
vigorous exercise and diet regiments. In this report, there
was high patient satisfaction (100%) and no reported com-
plications. Ersek in 1997 reported on his results with this
procedure in 2 male patients.7 The procedure in these
cases was performed with a custom designed suction can-
nula with a beveled, semi-sharp tip. The authors felt that
this improved their ability to accurately guide and con-
trol the suction in a narrow, superficial plane. One pa-
tient in this study developed a horizontal groove at the
level of the umbilicus that became exaggerated over time;
this was partially corrected with repeated liposuction and
fat grafting. Hoyos described Vibration Amplification of
Sound Energy at Resonance-assisted liposuction to per-
form high-definition liposculpture for abdominal etching
with integration of the entire torso, legs, and back.2 In this
1369
study, high-definition liposculpture was performed on 306
patients. The authors describe high-definition liposculp-
ture as a precision technique that involves a 3D multilayer
concept of body contouring and eliminates the concept of
body contouring in sections. This concept expands that of
etching to both females and males and also expands the
range of patients to include those with higher body fat
(>15%). In this study, the major complication noted was
seroma, port site burns, and prolonged swelling.2
Approaches to abdominal etching have further evolved
with time, with more aggressive approaches including
aggressive superficial liposuction with implants and fat
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grafting as an adjunct to these techniques.13
The concept of “etching” has extended beyond the ab-
domen, with the authors utilizing it for defining the glu-
teal crease in women as first described by Illouz in 1989
and for defining and shaping the pectoral anatomy in men
as well.2,3,5,14 The concept of “etching” has evolved from
its beginnings when it focused mostly on the abdomen in
male bodybuilders and is now employed in a wide variety
of patient types and anatomical regions.
ABDOMINAL ETCHING: OUR EXPERIENCE
AND PROGRESSION
We first reported on the abdominal etching procedure in
1993 in 8 male patients.1 To date, we have performed this
procedure on nearly 1600 patients. With experience and
over time, our techniques for this procedure have changed,
including access ports, liposuction techniques, cannulas
and patient selection.
Patient Selection
Initially, all patients selected for this procedure were
healthy, fit males in good physical condition who pre-
sented for an enhancement in appearance of the abdom-
inal musculature. They desired a washboard abdomen
with enhanced muscular definition. Over time, with the
use of more 3D contouring and expansion of the anatom-
ical regions of interest with “liposculpture” performed on
the entire torso, our patient population expanded to fe-
males and patients with slightly higher body fat content.
Patients who are not good candidates for abdominal
etching include those who have excess skin, and skin
laxity including obese patients and massive weight loss pa-
tients. These patients are better suited for abdominoplasty.
In these cases, abdominal etching can be performed in
a delayed fashion following abdominoplasty. Abdominal
etching in patients with excess skin laxity and excess skin
will produce contour irregularities and unfavorable re-
sults. These patients are susceptible to wrinkling as well as
contour irregularities postoperatively. Patients with mild
1370
A B
Figure 1.  (A, B) Surgical goals in full abdominal etching demonstrated on this 37-year-old man.
skin laxity might be candidates for adjunct procedures in-
cluding noninvasive skin tightening and/or radiofrequency
following abdominal etching. We have yet to utilize these
modalities as an adjunct to abdominal etching in our own
practice.
There are 2 variants of the abdominal etching tech-
nique: modified abdominal etching (MAE) and full ab-
dominal etching (FAE). FAE patients desire enhanced
abdominal contour and have good skin elasticity with thin
fat pads and well-developed abdominal muscles. Patients
undergoing FAE must also have long-term health and fit-
ness goals. MAE patients desire a more athletic appearance
and have good skin elasticity. Unlike the FAE patients,
they have moderate abdominal fat pads. These patients
also should have athletic abdominal muscles and reason-
able health plans. The selection criteria are not as strict for
MAE compared with FAE. Patients undergoing MAE can
have more abdominal fat but must have reasonable health
plans and healthy lifestyles.
Description/Evolution of Technique
There has been much improvement in our technique of
abdominal etching from where it began. Improvements
in technique have included modifications in preoperative
Aesthetic Surgery Journal 39(12)
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markings, strategies for reduced number of incisions, pow-
er-assisted liposuction for more aggressive etching, options
for cannula choices, postoperative bandages and garments,
early and frequent massage, and appropriate patient selec-
tion. Improvements in safety include preoperative warming
garments, incremental compression garments, preoperative
IV hydration, and postoperative blood thinners.
The 2 types of etching we perform include FAE and
MAE. FAE describes the procedure employed to obtain a
muscular six-pack washboard abdomen, and MAE refers
to the procedure utilized to obtain a sculpted but softer
abdominal contour with definition of the linea semilunaris
and linea alba, but not with the full muscular definition
of the six-pack. In our practice, approximately one-third
of male patients request FAE, whereas nearly all female
patients request MAE.
Both techniques are similar with the main difference
being the utilization of medium and small aggressive
cannulas in MAE and large aggressive cannulas in FAE
and the etching pattern. Although both techniques etch
the linea alba and linea semilunaris, FAE also etches the
transverse inscriptions (Figure 1). Both techniques uti-
lize preoperative markings, thinning of the abdominal
pad, tumescent infiltration, foam taping, and compres-
sive garments.
Agochukwu-Nwubah and Mentz 1371

performed until there is a notable deepening of the nat-

ural crease along the linea alba. Etching is similarly con-
ducted along the edge of the linea semilunaris. Aggressive
deep and superficial liposuction is performed along the
linea semilunaris and along the transverse rectus inscrip-
tions (superficial etching is not performed along trans-
verse inscriptions for MAE) (Video; Figures 2B-D). The
lower transverse rectus inscriptions are accessed from the
pubic ports, whereas the more proximal transverse rectus
inscriptions are accessed from the nipple-areola complex
ports. It is also necessary to etch 2 to 3  cm surrounding
the umbilicus to prevent a periumbilical “doughnut.”

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Deep and superficial liposuction is performed lateral to the
rectus muscle. Both superficial and deep liposuction is per-
formed with a 4- and/or 5-mm basket cannula and with
power-assisted liposuction. The remaining abdominal fat
Video.  Watch now at https://academic.oup.com/asj/ pad is thinner lateral to the semilunaris, at the superior
articlelookup/doi/10.1093/asj/sjz153 linea alba, and periumbilically. Thicker fat pads (pinch test
of 1-2 cm) are left in the areas over the rectus muscle bulk
where we desire muscular augmentation in order to ob-
Markings are performed while the patient is in a
tain the washboard appearance with enhanced muscular
standing position, which is crucial because the soft tissue
definition. These areas over the rectus muscle should be
orientation changes dramatically when patients are su-
2 to 3× thicker. At intervals, the pad thickness should be
pine. We ask patients to flex their abdominal muscles in
checked for symmetry and smoothness. The intraoperative
order to guide the markings by assisting in the definition of
results closely correlate with the final results. Superficial
the musculature detail. The horizontal inscriptions of the
erythema, especially in the “etched” areas, is often wit-
rectus abdominis muscle are marked as is the linea alba
nessed intraoperatively. Horizontal etching at the hor-
and linea semilunaris for FAE (Figure 2A). For MAE, the
izontal rectus furrows should only be conducted on
linea alba and linea semilunaris are marked.
patients undergoing FAE. See the accompanying video of
Our early performance of abdominal etching utilized 6
abdominal etching being performed by the senior author.
liposuction access ports: 2 in the pubic region, 1 at each lat-
The liposuction access ports are left open to drain.
eral edge of the rectus, and 2 at the midline to gain access for
Dressings consist of abdominal pads, or 4 × 4s, adhesive
liposuction of the linea semilunaris and linea alba, respec-
foam (Reston), and a binder (Figure 2E). The pressure
tively. Currently, we use 5 ports. Three of these ports are
foam over the areas of superficial liposuction help fur-
positioned over the pubis (1 at the center and 1 equidistant
ther flatten and define the areas of superficial liposuction
at each lateral border), and 2 of these ports are positioned
(linea alba, linea semilunaris, and transverse inscriptions).
at the inferior border of the nipple-areola complex. In pa-
Patients are discharged on the same day.
tients who are also undergoing pectoral etching, additional
ports are positioned at each axilla. The midline and rectus
ports previously utilized were fairly “geometric,” making Postoperative Management
them more noticeable and conspicuous. The current port
The foam dressing remains in place for 1 week. Patients
placement method is more acceptable to patients because
shower with it in place and dry it with a towel or blow
they remain well hidden and much less conspicuous.
dryer before placing the binder. The binder is worn for
Liposuction puncture incisions are made with a #11
a total of 4 to 6 weeks. The foam gradually loosens after
blade. A  pump with a 4 mm basket infusion cannula is
about 1 week; as it does, its edges can be trimmed. Exercise
employed to instill tumescent fluid, which consists of 1 L
is allowed 5 days after surgery.
of normal saline with 1 cc of 1:1000 epinephrine and 50
cc of 1% lidocaine. Superwet technique is usually used
(1:1 ratio of tumescent injected:aspirate). One to 2  L of Results and Complications
solution is typically needed, with a delay of 15 minutes for
epinephrine-induced vasoconstriction. “Cross-tunneling” This presentation reviews the original technique and
is conducted in all areas. The linea alba is enhanced by many refinements that have been added through more
aggressively liposuctioning a 1-cm strip from the umbil- than 20 years of experience with this technique. Informed
icus to the xiphoid. Aggressive superficial liposuction is consent was acquired for this study from all patients. The
1372 Aesthetic Surgery Journal 39(12)

A B

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C D

Figure 2.  (A) Preoperative markings for full abdominal etching demonstrated on this 36-year-old man. (B) Intraoperative
photograph following deep and superficial liposuction. Note deepening of the natural crease along the linea alba, linea
semilunaris, and transverse rectus inscriptions. (C) Preoperative photograph prior to abdominal etching. (D) Intraoperative
photograph following abdominal etching. Note deepening of the natural crease along the transverse rectus inscriptions
following superficial liposuction of the transverse rectus inscriptions in this patient who underwent full abdominal etching. (E)
Foam pressure dressing placed over areas of superficial liposuction. A binder will be placed over this.
Agochukwu-Nwubah and Mentz 1373

Table 1.  Patient Description and Outcomes Of the 512 male liposuctions, 160 received FAE, and 352
received MAE. A  total of 273 men also underwent chest
Characteristic Values
liposuction or pectoral etching with or without puncture
No. of patients 512 glandular removal, and 119 underwent other cosmetic
Age, y
procedures concomitant with some form of abdominal
etching. Complication rates were low with no infections,
 Mean 39 seroma, or skin necrosis. Three patients (0.5%) had con-
 Range 18-71 tour defects that required revisions. There were no throm-
boembolic events.
Follow-up
Early on in our experience with abdominal etching, the
 Mean 3 years periumbilical “doughnut” appeared in patients with mod-
erate reduction of abdominal fat. In later patients, this ex-
 Range 6 months to 10 years

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cess was eliminated by more vigorous liposuction in the
Total fat removed, cc periumbilical region. Skin laxity, particularly above the
 Mean 3325 umbilicus, did cause postoperative wrinkling in older and
sun-damaged patients. This pointed out the importance of
 Range 100-10,200
assessing the skin quality and laxity preoperatively and
Tumescent fluid given, cc reexamining our selection criteria.
Problems with waviness occurred below the umbilicus.
 Mean 4681
This demonstrated to us the importance of taking care to
 Range 300-15,700 evaluate thickness irregularities intraoperatively. More fat
Full abdominal etching 160
should be left overlying the rectus, thicker near the xiphoid
and gradually thinned toward the pubis, to promote the
Modified abdominal etching 352 appearance of a flatter lower abdomen.
Chest liposuction or pectoral etching 273 Results can be maintained in the long term (Figures 3
and 4; Supplementary Figures 1 and 2) and is dependent on
Other/adjunct cosmetic procedures 119
patient adherence to a diet and exercise regimen. Weight
Complications 3 gain can impact long-term results and reduce the defini-
tion of the abdominal wall musculature obtained through
  Contour defects requiring revision 3 (0.5%)
etching. This is why patient selection for this procedure
 Infections 0 is paramount. Individuals who receive this procedure and
 Seroma 0 gain weight will require more liposuction but are likely
to have a notable deformity with an etched six-pack over
  Skin necrosis 0
an obese abdomen. Patients are extensively counseled on
  Thromboembolic events 0 this preoperatively. With advancing age, it is expected that
there may be some wrinkling, but in the ideal patient who
is fit the abdomen is expected to age as it would in a nor-
Declaration of Helsinki was the guiding ethical principle mally fit patient with a six-pack abdomen who did not
regarding human research. have abdominal etching.
Of the more than 1600 male liposuctions we have per- Abdominal etching can also be employed effectively
formed, we examined the results of 512 male patients in as an adjunct to body contouring surgeries, such as ab-
the last 4 years, some of whom chose to have some form dominoplasty (Supplementary Figure 2). When utilized
of abdominal etching in combination with other cosmetic as an adjunct, abdominal etching is typically performed
procedures and others who elected to have only abdominal 3 to 6  months following abdominoplasty. Due to the ag-
etching (Table 1). During the past 4  years, from January gressive nature of abdominal etching, this delay was al-
2013 to January 2017, we have treated 512 consecutive lowed so as to prevent a compromise in blood flow to the
male patients. Follow-up ranged from 6 months to 10 years abdominoplasty flap.
(mean, 3  years). The age of patients ranged from 18 to In our early experience, we noted a fairly high rate of
71 years (average, 39 years). Total fat removed ranged from seroma. We no longer suture the liposuction access ports,
100 cc to 10,200 cc (average, 3325 cc of supernatant fat). thus allowing these areas to drain. Since making this ad-
Tumescent fluid given ranged from 300 cc to 15,700 cc (av- justment, we have noted a marked decrease in the inci-
erage, 4681 cc). dence of this complication.
1374 Aesthetic Surgery Journal 39(12)

A B

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C D

E F

G H

Figure 3.  (A, C, E, G) Preoperative views of this 30-year-old woman who underwent full abdominal etching. (B, D, F, H)
Three-year postoperative views of the patient.
Agochukwu-Nwubah and Mentz
A B
Figure 4.  (A) Preoperative view of this 45-year-old man prior to full abdominal etching. (B) Five-year (age 50 years) and (C)
10-year (age 55 years) postoperative views of the same patient following full abdominal etching.
DISCUSSION
Liposuction has remained an extremely popular pro-
cedure since its beginnings and, per American Society for
Aesthetic Plastic Surgery statistics, has remained in the
top 5 cosmetic procedures performed yearly for the past
decade with an upward trend in its popularity during this
time period (American Society for Aesthetic Plastic Surgery
statistics).15 It was the second-most commonly performed
procedure in 2017. When separating statistics of proced-
ures performed by gender, it was the second most common
procedure in women and the most common procedure in
men in 2017. The use of liposuction to perform anatom-
ical etching of the body (pectoral, abdominal, arm, legs) is
without a doubt a major contributor to this trend due to its
popularity among males.
Our experience with abdominal etching has evolved
over a more than 20-year period. This technique is per-
formed reliably and with consistent results with minimal
complications in our practice. A limitation of this study
is our lack of images demonstrating complications and
how we correct them. This is addressed within the text,
but images are a potential way particularly in plastic
surgery to assist readers in understanding key concepts.
An additional limitation of this study is that it demon-
strates our experience that has evolved over 20 years. It
is this length of experience that has allowed us to pro-
duce results that are consistent and reliable. This may
lead readers to assume that this technique is simple and
straightforward. We should note that there is indeed a
steep learning curve with this technique and should be
performed with caution. We utilize basket cannulas,
however, beginning with the use of smaller, less aggres-
sive cannulas, and MAE (etching linea alba and linea
1375
C
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semilunaris only) is a safe approach for the surgeon
starting to utilize this technique. Akin to rhinoplasty, a
surgeon beginning to perform rhinoplasty should start
with more straightforward, primary rhinoplasties as op-
posed to the most complex, revisionary rhinoplasties.
Superficial liposuction is not without complications.
Several cited complications include skin necrosis, infec-
tion, and contour irregularities.16 Establishing comfort
first with the creation of grooves via superficial lipo-
suction and differential liposuction is key. Being aware
of the technique and learning its finesse and nuances
is critical. Spending time counseling patients and also
strict patient selection are also paramount.
Our complication rates were very low at 0.5%. There
are several reasons for this. Our complication rates were
higher when we first began this procedure in the 1990s,
with contour deformities and seroma being the most
common complications. As we expand on in this article,
we implemented several measures including leaving the
liposuction access ports open to drain, which has essen-
tially eliminated the occurrence of seroma. Additionally,
we perform a pinch test at various intervals throughout
the procedure to minimize contour irregularities. When
even the slightest irregularity seems present, we utilize
“mulching,” or equalization, where we pass the can-
nula—not connected to suction—through the plane to
evenly distribute the fat. We had no infections and skin
necrosis, likely related to our utilization of postoperative
antibiotics and no employment of laser or other energy
modalities with liposuction. A  limitation of our study is
that we do not have the precise numbers and percentages
of complications from our early experience to compare
with our current experience. Anecdotally, we are aware
that complications have decreased over time, which is
1376
as expected with any procedure you perform and adjust
with time.
There are 7 main principles of etching to ensure con-
sistency and reliability that are employed in our practice:
(1) Thorough counseling is necessary. Long-term issues
of future weight changes, postoperative irregular-
ities, and possible metabolic effects of liposuction are
discussed.
(2) Preoperative marking is important. The patient is
marked with a permanent marker while standing.
Intermittent flexion of the trunk can assist the
marking. The patient checks the marks in the mirror
to corroborate operative goals.
(3) Tumescent liposuction (pressurized infusion tech-
nique) is employed1 to reduce blood loss and lessen
the incidence of contour irregularities, fluid depletion,
and postoperative pain.
(4) Cannulas are chosen for each area. Small Mercedes
cannulas can be utilized when the fat aspirates easily.
Larger cannulas can be employed if the tissue is more
fibrous. Power-assisted liposuction machines make
the etching process easier.
(5) Careful, frequent monitoring of tissue thickness by the
“pinch method” helps prevent gouging and dimples.
Uneven areas can be smoothed by cross-tunneling
without suction.
(6) Wounds are left open to allow serosanguinous fluid
drainage, which reduces postoperative seroma and
ecchymosis.
(7) Adherent foam pads plus a compression garment con-
tribute to reduced postoperative edema and a faster
recovery time.
Liposuction has come very far from its traditional begin-
nings. Traditional liposuction sought to simply reduce the
subcutaneous fat in the deep compartment to improve
lipodystrophy. Plastic surgeons did not settle there and
sought to improve. This brought about subdermal superfi-
cial liposuction to enhance the overall contraction through
cicatricial fibrosis of all layers. This truly was the early
beginning of advanced liposuction. Differential liposuc-
tion came about and combined traditional liposuction
and subdermal superficial liposuction at variable levels
to achieve intricate, sophisticated, and unique aesthetic
goals. These advanced techniques have a steeper learning
curve, are technically demanding, and require experi-
ence. This evolution in liposuction has truly brought out
the artistry and excitement in liposuction. Furthermore, it
has begun to separate the plastic surgeon who performs
liposuction from the liposuction performed by non-plastic
surgeon practitioners. Liposuction and its evolution rep-
resent the innovation and technology that is perhaps the
most exciting and unique aspect of our specialty as plastic
surgeons.
Aesthetic Surgery Journal 39(12)
CONCLUSIONS
After more than 20 years of utilization and more than 1600
male contouring cases, we feel that the procedure is well
established and useful for enhancing male torso contours
with a very limited rate of complications. Improvements in
our technique have resulted in improved results, providing
a more natural and athletic contour. With the proper tech-
nique, patient selection, and postoperative care, surgeons
can achieve excellent aesthetic results and high patient sat-
isfaction with this procedure. In time, we can expect that
more innovation and evolution will continue to change the
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field of liposuction and subsequently aesthetic results for
patients while minimizing complications and maximizing
safety.
Supplementary Material
This article contains supplementary material located online at
www.aestheticsurgeryjournal.com.
Acknowledgments
We are grateful to the pioneers of liposuction and to those
that have contributed to its development and history both
past and present. We thank our patients who afford us the
privilege to care for them. We are also grateful to Jennifer
Higginbotham, our videographer.
Disclosures
The authors declared no potential conflicts of interest with
respect to the research, authorship, and publication of this
article.
Funding
The authors received no financial support for the research,
authorship, and publication of this article.
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2. Hoyos AE, Millard JA. VASER-assisted high-definition lip-
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3. Mentz  HA, Ruiz-Razura  A, Newall  G, Patronella  CK,
Miniel LA. Pectoral etching: a method for augmentation,
delineation, and contouring the thoracic musculature in
men. Plast Reconstr Surg. 2007;120(7):2051-2055.
4. Leclère  FM, Moreno-Moraga  J, Mordon  S, et  al. Laser-
assisted lipolysis for cankle remodelling: a prospective
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