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Surgical Concept

General body contouring involves areas from the neck to the calf. Because female breasts have been publicly considered as independent organs for plastic surgery, body contouring surgery, which we define, mainly concentrates on abdominal plastic surgery and buttock and leg shape adjustment. Limited by congenital stature proportion and skeletomuscular development and the need to accommodate functions, body contouring surgery generally does not make drastic changes as on the face or breasts. However, for patients with an aging-induced out-of-shape stature, skin looseness, or even calf muscular hypertrophy, WiSH Clinic offers numerous plastic surgeries to maximally reshape the stature, conceal drawbacks, and restore prior confidence.

Although individual body height and stature proportion are based on skeletal development, the body shape gradually changes due to aging, life style, habits, diets, pregnancy, childbearing, or even morbidity or weight loss, and the primary differences are ascribed to aging and looseness of soft tissues. Therefore, Dr. Chuang upholds that to successfully correct stature problems, the skin, fat, and muscles should be systematically evaluated and designed to obtain obvious improvement. Taking female body change as an example, the most common problems are stomach cellulite due to fat accumulation from obesity, abdominal droopiness, stretch markers because of the extension of abdominal muscles and skin during gestation, buttock sagging due to the loss of support because of aging, or congenital calf hypertrophy and thunder leg frequently seen in young patients, which all result in comprehensive ectosteal factors. Therefore, patient’s skin elasticity, fat thickness, and muscular volume should be prudently evaluated before surgery to focus body sculpting on tightening the skin elasticity and reducing the fat volume and even lifting droopy parts. If such principles are followed, body contouring surgery generally achieves immediate and significant corrections.

Stature aging is not limited to a single organ or site, but it implicates adjunct and interconnected tissues, so body contouring surgery needs to be conducted at an extensive site to attain ideal results, which would, however, inevitably leave incisions or scars. Therefore, patients expecting a rapid stature change should also consider their acceptance and tolerance to scars because such surgeries usually necessitate a long period of scar care and individual constitution affects scar severity. Even if modern improved surgeries conceal wounds in skin folds or under the underwear, patients should still have a full understanding of the surgical method and incision pattern before the operation. If patients are with a predisposition to keloids, they should inform the physician in advance as it will help the physician formulate the most suitable surgery to prevent scarring in advance. Besides, in case of postoperative scar proliferation, the patient should apply long-term cosmetic tapes or anti- scar injections to prevent scars from undermining surgical satisfaction.

Because the body contour is predominated by the skin and adipose tissues and sagging does not stop once started and involves a relatively extensive area, it is quite difficult to fix such problems by nonsurgical procedures such as mini-invasive or phototherapy indicated for the face; thus, body contouring surgery becomes the priority to achieve a rapid change in stature and is the final resort for many patients who may have tried various nonsurgical treatments but whose results are invalid. Despite the seemingly wide surgical extent and the relatively long recovery period, body contouring involves the superficial skin and muscular plastic surgery but does not affect the skeleton or viscera, so there should be no doubts on surgical safety. Therefore, as long as the patient has a good preoperative communication with the physician, selects the symptomatic surgery, and cultivates a reasonable expectation and mental preparation for the results, this surgery provides effective and immediate improvement to restore the youthful body curvature.

Surgical characteristics

Concurrent performance of multiple surgeries

Body aging and laxity are mostly the result of mutual waxing and waning among the skins, fats, and muscles, so all these factors need to be simultaneously corrected during surgery to attain a stable and lasting result. Dr. Chuang currently utilizes the concept of comprehensive composite surgery in body sculpting. For example, for patients with a loose or redundant abdominal skin due to pregnancy, waist and abdomen circumferential liposuction, abdominal muscle tightening stitching, and loose skin excision should be conducted to address multiple problems such as loose skin, fat acumination, abdominal or stomach protrusion, and pregnancy lines. For patients with calf hypertrophy and lower limb edema, combined procedures of calf liposuction and muscle resection or nerve blocking are recommended to achieve concurrent calf slimming and curvature sculpting. Despite being complex, composite surgeries resolve the prolonged stature problems of patients at one time and ensure optimal results without blind angles.

Body - Concurrent performance of multiple surgeries

Precise evaluation and sophisticated surgery execution will ensure success of body sculpting surgeries.

Simultaneous removal of skin and fats (tummy tuck)

Skin laxity is mainly attributed to the drastic changes of body weight and age-associated fat or collagen loss. Both factors cause the skin to lose support and become droopy by gravity, which is a major detriment to figure curvature; in particular, the skin at the lower abdomen, arms, or medial thighs is most likely to develop problems. Normal skin needs to be buttressed by adipocytes at the bottom, and obsessive weight loss or abundant liposuction exacerbates skin looseness; in particular, for patients with prolonged or exceeding obesity, overt liposuction is more likely to form cellulite or an orange peel-like skin due to the sudden absence of support to epidermal tissues, which cannot be redressed simply by wearing a compression garment after the operation. Therefore, Dr. Chuang recommends abdominal liposuction and concurrent abdominal lift with the excision of redundant skin to achieve the dual results of fat removal and skin tightening. At WiSH Clinic, this method is frequently applicable to patients with excess obesity undergoing liposuction or those with thick lower abdominal cellulite (triple layers) due to obesity, which attains better results and satisfaction degree than single liposuction. Nevertheless, since abdominoplasty (tommy tuck) leaves a long scar, patients should realize this and mentally prepare well before the operation and undertake long- term scar caring to attain perfect and ultimate results.

Reduction in muscular volume

Protruded or thick muscles are the primary causes affecting leg curvature, particularly at the calf. Thunder thighs are mainly caused by congenital medial gastrocnemius hypertrophy or acquired calf muscular hypertrophy due to performing exercises or wearing high heels for a long time. To obtain the sustained improvement of such problems, surgery must be performed to reduce the thickness and volume of the muscle, and the surgical methods include calf nerve blocking or total/partial gastrocnemius muscle dissection. The former is primarily used to treat mild and moderate calf hypertrophy or adjust leg lines, which fully replaces the effects of a Botox injection. The latter is targeted for patients with a congenitally thick calf (thunder legs); if nerve blocking cannot effectively improve the leg shape on evaluation by the physician, more radical excision of the medial gastrocnemius muscle is considered or concurrent partial removal of lateral gastrocnemius is performed to enhance leg slimming effects.

Restoration of lost tissues

Body contouring mostly concentrates on removing skin and subcutaneous fats, which entails the creation of large incisions to achieve a tight and slim body curvature. However, the adjustment of aging buttocks is different from the aforementioned surgical concept, and this is mainly ascribed to the increase in motions and loads at the buttock than at other body parts, while droopiness is mainly caused by fat loss, muscle sagging, and skin looseness. The mere excision or lift of buttock skin not only leaves a visible scar but also does not create plump buttocks. Therefore, the treatment principle that Dr. Chuang upholds in buttock surgery is to first refill or increase the drained buttock muscles, thus propping up and tightening the skin, which also lifts the buttocks to a certain level. Current buttock augmentation is implemented by autologous fat injection or buttock prosthesis emplacement, which is determined in light of the patient’s buttock shape, requirements, and skin elasticity.