Roundtable: Redefined Bodily Appearance

Roundtable discussions appearing in the Consumer Guide to Plastic Surgery are derived from comments from leading plastic and cosmetic surgeons who are recognized experts in given fields. Biographies of doctors who participated in this roundtable discussion may be found at the end of the article.

An emerging trend exists in the United States of procedures that provide a more shapely or muscular appearance for any area of the body. The trend primarily involves body fat transfers and body implants.

While the U.S. trend appears to be recently emerging, such procedures have been available for quite some time. Implantable materials have been used in orthopedic surgery for decades. Breast implants have been used for many years. Today's body fat transfers and body implants can be applied to the chest, bicep or tricep muscles, buttocks, calf muscles, or breasts. The body fat transfer procedure may also be performed on the hands or penis. We now turn to some of the nation's leading surgeons to get their take on body fat transfers and body implants.

What are the most common reasons that your patients seek a body fat transfer or body implant?

The two most common reasons are

• aesthetic reasons
• reconstructive reasons

Patients may want to enhance a specific bodily feature by creating more volume or increasing size. Other patients wish to have a more muscular appearance for a particular body area. There are also patients who want to correct congenital defects. In these cases, patients may not have any muscle at all. Also, some liposuction patients return to a plastic surgeon's office to correct a previous liposuction defect such as an uneven appearance of the abdomen.

Which is your procedure of choice for creating a more shapely or muscular appearance in a patient?

Doctors may have a specific preference for one procedure or the other, depending upon the circumstances. During an initial consultation with a patient, the doctor will consider the specific area requiring treatment, the patient's anatomy, overall health, and commitment to treatment. Each patient's situation is different.

The Body Fat Transfer

Body fat transfers can be appealing for many body areas in several ways. Patients with small localized areas that require treatment may be served well with a shapely, even appearance through a body fat transfer. Without question, body fat transfers are non-allergenic, ensuring no risk of rejection. The goal of a body fat transfer is to create volume by filling in an uneven or saggy area.

Patients considering body fat transfers should realize that three to four fat transfer procedures may be necessary in order to maintain an ideal result. They must also understand that fat transfers are unpredictable. This is because up to 40 percent of the fat may be absorbed after treatment. On the upside, the remaining fat can last forever. Doctors work closely with patients until the final re-absorption occurs to determine the next step for a fully satisfactory outcome. However, body fat transfers will not lend a muscular appearance. Nor are body fat transfers suitable for the treatment of a large area.

The Body Implant

Body implants provide a more muscular appearance, increasing volume and size. Body implants may work well for patients who wish to treat large areas of the body. Silicone body implants are one of the preferred implant choices because they give the "feel" of muscle and greater biocompatibility possibilities than some others used in the past. However, body implants are generally associated with a higher complication rate. There are usually treatment options available to address complications, but recovery for a patient with complications may be longer.

Other Options

There may be more suitable alternative treatment options available for certain patients. For example, patients who seek to create a "six pack" abdominal appearance opt for a liposuction technique called abdominal etching. Candidates who qualify for this procedure have less than 12 percent body fat as well as underlying muscles that would serve well by being exposed through abdominal etching.

What are some of the common patient concerns about these procedures?

During an initial consultation with a doctor, patients are made aware that there are risks associated with every medical procedure. Patients are advised to conduct significant research about procedures to set reasonable expectations for the outcome. Many patients feel that the risk for complications is reduced by selecting a doctor with extensive skill in the procedure that they are interested in. Doctors in plastic surgery will typically spend quite a bit of time with patients to determine candidacy for these procedures.

Knowledgeable body fat transfer patients are aware that if they lose weight, the body fat transfer area may lose volume. If a body fat transfer patient gains weight, the treated area may appear larger. In the case of a body implant, even though the implant does not change over time, the body might lose body fat content as part of the natural aging process. In this case, the implant may become more palpable or visible under the skin. Though rare, the body implant may need to be replaced at a later date.

Patients understand that there are risks, though infrequent, for infection, fluid formation, capsular contracture, asymmetry between areas, migration, or incompatibility of the implant. Some patients may be concerned about having a "foreign" implant in their body despite significant supporting body implant research. These patients may opt for body fat transfers instead. Many patients are fully satisfied with the outcome of either procedure.

Does experience and technique vary among doctors?

The level of expertise and technique may vary among doctors. In fact, doctors may have a specific preference for one procedure or the other. The technique in either procedure is very important. The techniques can vary among doctors as well.

For example, a breast implant may be placed in different plane levels; subglandular, partially submuscular, fully submuscular and sub-facial. A buttock implant may be placed subcutaneously, sub-facially, intramuscularly, and intermuscularly.

The best technique in a body fat transfer is one that is associated with a high fat survival rate. Doctors prepare injectable fat cells differently. Some doctors will "spin" the fat cells before injecting them into the treatable area. Other doctors will not. Some techniques for either procedure may be considered safer than others. It may be very difficult for a patient to discern between techniques for either procedure.

Patients are advised to choose a surgeon who has extensive surgical training and who has had considerable experience in the type of procedure that they are interested in. To a large degree, surgical outcomes depend on the experience and technique of the doctor.

Doctor Biographies

Michael Olding, MD, FACS, serves on the advisory board of the Consumer Guide to Plastic Surgery and is the Associate Professor of Surgery and Chief, Division of Plastic and Reconstructive Surgery and Director of Cosmetic Surgery and Laser Center at George Washington University Medical Faculty Associates. Dr. Olding is involved in clinically related activities in the areas of cosmetic surgery, body contouring, as well as many other procedures. He is board certified in Plastic and Reconstructive Surgery and also in Plastic and Reconstructive Surgery by the American Board of Plastic Surgery. Learn more about Dr. Olding.

Munish Batra, MD, FACS, is also an advisory board member of the Consumer Guide to Plastic Surgery and is double board certified by the American Board of Plastic Surgery and the American Board of Surgery. He is also the founder of Docs, a non-profit organization committed to serving the underprivileged in plastic reconstructive surgery. He has written articles and chapters in numerous medical publications, as well as been featured in many news segments relating to body contouring in plastic surgery. Dr. Batra has also worked with national authorities in the field of cosmetic breast surgery and body contouring. Learn more about Dr. Batra.

Adrien Aiache, MD, is board certified by the American Board of Plastic Surgery and has maintained memberships with medical organizations such as the American Society for Aesthetic Plastic Surgery and the American College of Surgeons. He is a founding member and Director of the Aesthetic Surgery Education and Research Foundation. He has taught courses and presented lectures for audiences in the medical community, including the American Society for Aesthetic Plastic Surgery, on topics such as breast and abdomen surgery, fat transplantation and calf implants.

Ronald E. Iverson, MD, is the Chair of the Patient Safety Committee for the American Society of Plastic Surgeons and the Adjunct Clinical Professor of Plastic Surgery at Stanford University Medical School. He is President of the American Association for the Accreditation of Ambulatory Surgical Facilities and a former President of the American Society of Plastic Surgeons — among holding many more top level titles in the medical community. He is Board Certified by the American Board of Plastic Surgery.

[page updated June 2008]