Figure 1. This female patient had VASER High-Definition Liposculpture of her abdomen and flanks, as well as a breast augmentation with a gel implant and High-Definition breast Liposculpture, which defines the lateral and anterior axillary portion of the implant by removing specific fat from the bra roll and anterior axilla. PHOTOS COURTESY OF DAVID BROADWAY, MD, FACS

Body contouring is one type of procedure that is often cited as being most like an art form.

Of all the procedures in which to specialize, it is the most challenging and rewarding, allowing the plastic surgeon to literally resculpt the body as an artist would reshape a hunk of clay into a masterpiece.

Those who choose this specialized work will no doubt agree, and the tool set available to them has improved, technologically, in recent years.

David Broadway, MD, FACS—who practices in the Denver Metro area—is triple board certified, holding certifications in otolaryngology, facial plastics, and plastic surgery. In his 17 years in the field, he has created a reputation for being just that kind of artist.

Despite his extensive background and certifications, his current work is actually 100% aesthetic in nature. And although he is properly credentialed, he now opts for cosmetic procedures—especially body contouring, which to him implies a far deeper meaning than cutting and suturing.

PSP: What are the newest technology and techniques that you use?

Broadway: VASER High-Definition Liposculpture is really a new technique that is built on the old ones. The standard liposuction, coupled with more superficial work, allows us to obtain a more 3D appearance, where we can not only etch the skin and make furrows for a six-pack but actually get the underlying anatomy to project through the skin. This includes both the muscular and bony structures circumferentially, not just in the abdomen, as was described for just etching. I offer this to both male and female patients. The goal is to make them look more athletic, not just thinner. Most of the patients who have this procedure are already thin, so it helps them with definition.

Figure 2. This 56-year-old patient elected to have VASER High-Definition Liposculpture of the abdomen.

PSP: Could Velashape or Velasmooth techniques be beneficial to postbariatric patients?

Broadway: It is possible that it could be helpful in some of the minor contour irregularities and cellulite issues they have.

PSP: What are the most common procedures you perform?

Broadway: We do a lot of breast surgeries and a lot of liposuction, in particular the High-Def Liposculpture. We are doing a very high number of Hi-Def Lipo [procedures] in conjunction with fat transfers. We are doing the fat transfers to breasts, male chests, the buttocks, to contour irregularities from previous liposuctions or to correct traumatic defects. We are using not just liposuction by itself but with the fat injections, in order to give the body a more overall even contour.

PSP: Do you see more patients statistically that are insured or self pay, and has there been a decline in the procedures you do based on the decline of the economy?

Broadway: Actually, 100% of [my] patients are private pay. And despite the economy, my practice is increasing; in fact, we are consistently ahead of where we were last year and even the year before. It’s because we are offering the opportunity for the patients to go to a level they have not previously been able to achieve.

Figure 3. This patient had VASER Hi-Def Lipo of his abdomen and flanks with a fat transfer to his pectorals.

PSP: What’s the general population or age range for your practice?

Broadway: The oldest patient I have had recently was a 52-year-old. The general majority of patients I see are what I call “gym rats”—those who work out diligently, eat right, and are very health conscious. But, for whatever reason, either genetics or DNA is not able to achieve the level of definition they would like. They work hard, but just can’t get the actual contour they want.

PSP: Why is what you do and how you do it different from what many other practitioners do?

Broadway: The ability to do this has transformed my practice. In fact, we have trained students and over 60 surgeons from about 14 different countries to do this procedure. Some of those offer the High-Def Liposculpture exclusively. The technique requires the use of products such as VASER or Smart Lipo to emulsify fat and make it easier to work with, more pliable.

I compare it to a woodworker versus one who sculpts. It allows us to sculpt more than ever before, and pay attention to minor details we were not previously able to attend to. Doing more superficial work also allows us to deal with a lot of the complications that may have arisen from prior surgeries and liposuction.

PSP: Would you define “superficial” work in more depth and explain what you can do to minimize the complications arising from the body-contouring procedure?

See also “Same Make, New Model” by David S. Kaufman, MD, FACS, in the April 2008 issue of PSP.

Broadway: There are basically three layers of fat. Most surgeons stay within the deep layers with lipo because it is safer and more comfortable. They are able to do a lot of debulking, but are unable to achieve very good results with the 3D contours of the body. The intermediate layer allows for more sculpting and contouring, but getting to the third—the superficial layer—is where the most detailed work can be done.

We aren’t taking away a lot of fat or just trying to make them skinny; we are truly contouring. On this level, we can address areas where as little as a few cc’s of fat make a remarkable difference in the sculpting process. This does put patients at more risk for seromas or contour irregularities or deformities. We have devised a foam vest for use over the trunk area that works well to avoid the issues commonly associated with the use of other garments generally worn after surgery. It has been very effective.

PSP: Do you use the High-Def Lipo solely for the trunk area?

Broadway: It was originally done by Dr Hoeas and confined to the trunk, but we have extended its use into the arms, legs, and breasts as well. Again, it has tremendous appeal for people who are physically fit and just have problem areas that need correction, or that because of genetics [they] just cannot achieve the definition they want despite any amount of diet or exercise they do.

Connie Jennings is a contributing writer for PSP. She can be reached at [email protected].