Secrets to Natural-Looking High-Def Liposuction Results, According to Plastic Surgeons

Plastic surgeons share secrets to getting liposuction results that are worthy of only the best adjectives.

Whether talking face or body, surgical or noninvasive, there are two adjectives that plastic surgeons routinely use to describe ideal outcomes: natural and customized. So when the field starts producing fake, conveyor-belt six-packs in the name of high-definition liposuction, those actions cause a ripple effect. As so often happens in aesthetics, bad work threatens to overshadow good, risking the reputation of a safe and effective procedure (and giving rise to stigmatizing descriptors, as we’ve previously seen with windswept facelifts and frozen Botox). 

High-definition lipo, for those who don’t know, aims to accentuate the musculature of a region by removing extra fat from select areas, to create contours rather than debulking all over in uniform fashion, as is standard with traditional lipo. While high-def is a relatively new technique, leaders in the realm of body sculpting are already raising concerns about the less-than-desirable outcomes they’re seeing and the consequences these breed. “I don’t think a lot of folks even understand what high-def lipo is,” says Dr. David Sieber, a board-certified plastic surgeon in San Francisco. “But if you were to find people familiar with the term, what would probably come to mind most frequently would be these abnormally shaped, overly defined Ninja Turtle–like men who had a surgeon unanatomically draw abs on their stomach and etch them in.” 

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Philadelphia board-certified plastic surgeon Dr. Christian Subbio also believes high-def lipo is getting a bad name, partly because certain doctors—those who are eager to capitalize on the high-def buzz yet lack the specific, hands-on training required to perform the procedure properly—“are being way too aggressive with the definition and creating these weird-looking physiques that don’t fit the patient and are really hard to correct,” he says.

On the upside, ripples in the otherwise placid pond of plastic surgery commonly serve as an impetus for change. “I think we’re in the midst of a paradigm shift,” Dr. Sieber tells us. “What I see happening now is a lot of plastic surgeons comparing their results to those of other plastic surgeons and sort of scratching their heads and saying, ‘Their work looks better than the results I typically get. What are these guys doing differently?’” 

This phenomenon has led a number of U.S.-based surgeons to South America, the birthplace of high-def lipo, to learn from the Bogota, Colombia, plastic surgeon who pioneered and popularized the technique, Dr. Alfredo Hoyos. “Most surgeons in the States who are offering true high-definition lipo, myself included, have traveled to Colombia, where it originated,” notes Dr. Subbio. While the South American experience isn’t an absolute must, he insists that anyone promising high-def results should “be able to demonstrate that [they have] put in the time and effort to actually learn the technique—to have at least spent time in the OR with surgeons who do it well [in order to] be capable of replicating those kinds of outcomes.”

Beyond possessing sufficient training and the right tools for the job, the best purveyors of high-def lipo are discerning and conservative, with a strong sense of anatomy and an artistic eye. Ahead, experts share secrets to getting results that are worthy of only the best adjectives.

1. Fit patients see the best results from high-def lipo

So often, Dr. Sieber says, “home-run results come down to patients who are perfect candidates for the procedure.” Reputable surgeons tend to be quite discriminating during high-def consultations. Disqualifying factors usually include a BMI over 28*, a history of yo-yo dieting and weight fluctuations, poor skin elasticity (stretch marks are a red flag), and an obvious lack of sustained drive in the fitness department. (*Some doctors are stricter than others about this number, but most agree that even those with a BMI of 30 are ill-suited for high-def lipo.)

While being denied the service you want can be disappointing, surgeons are actually acting in your best interests when they refuse to operate or, perhaps, try to steer you in a different direction. “It’s easy to etch a six-pack or a two-pack on someone,” says Dr. Subbio. “But is that patient going to be committed to the healthy lifestyle required to maintain that result? If not, within 6 to 12 months, they may end up with a beer gut [that has] a six-pack on it.” 

When high-def patients put on pounds, they generally don’t gain weight evenly—etched-in valleys that were sucked dry of fat won’t expand in the same way as adjacent areas with more fat cells.

Related: Plastic Surgeons Say the Best Liposuction Outcomes Have These 4 Things in Common

2. Individual anatomy and goals should dictate the level of definition 

Modern surgeons recognize that high-def is not a cookie-cutter operation—that the technique should be customized, to suit the patient’s goals and anatomy. Underscoring this initiative, many are striving to distinguish their individualized approaches from the overdone aesthetic that’s become so ubiquitous. “I like to call what I do soft-def,” says Dr. Jacob Unger, a board-certified plastic surgeon in Nashville, Tennessee. “I’m creating subtle highlights that follow the natural anatomic borders of the abdomen.” 

Key to this method, he notes, is respecting the inherent limitations unique to each person’s body, which will dictate, at least in part, the degree of sculpting that can be done. Patients may have a “bony shape that’s inconsistent with their goals,” Dr. Unger explains. In men, wide hips, for instance, can make it all but impossible to deliver the V-shaped torso they’re after. In this case, “you can be as skinny and muscular as you want, but you’ll never reduce the bony width of the hips,” he says—and “it’s important to point out the natural boundaries of shaping to each patient when creating the operative plan.”

According to Dr. Sieber, even less obvious factors, like the native composition of a person’s fat, can hinder high-def results. “Some people have soft, fluffy fat that comes out very easily—they tend not to get quite as much definition as people with slightly firmer fat,” he says. He goes on to describe how a very thin layer of fat is deliberately left behind atop certain muscle groups, to help accentuate them—and firmer fat punctuates those areas better than fluffy fat.  

In best-case scenarios, where there are no anatomical constraints, the level of definition a surgeon achieves hinges largely on the patient’s goals and the surgeon’s judgment. Dr. Sieber offers three levels of definition to appropriate patients. For the most natural look, minimal sculpting imparts “a little bit of definition in the midline and a little bit in the semilunaris, which is on either side of the rectus muscles,” he says. To give the abdomen a slightly more cut, athletic appearance—which is what most of his female patients request—he’ll create “a lot of definition in the midline, good hip-bone definition, and good definition of the semilunaris line.” Extreme def is suitable only for true bodybuilder types with body-fat levels in the single digits, he notes, and involves etching horizontal lines between muscles as well as those key vertical grooves. The majority of men he treats aim for a happy medium between athletic and extreme. 

3. The midsection should suit the rest of the body

Believing less is always more, some surgeons stick to conservative sculpting across the board, for fear of carving out an abdomen that clashes with the patient’s overall physique. “I never really offer aggressive high definition in my practice,” Dr. Subbio says, “because I think, more times than not, it’s going to look fake. Even if the shadows and contours you create are believable, if it doesn’t match the rest of the patient—if their arms aren’t toned, if their face isn’t chiseled, if their legs are too skinny—then it doesn’t fit.” He also makes the point that the higher a patient’s BMI, the less aggressive he needs to be in order to avoid a discordant outcome. 

Dr. Sieber agrees: “The more definition you give someone, the more cognizant you need to be about addressing the adjacent muscle groups or the whole torso and extremities together.” 

Creating balance typically means taking a circumferential, 360-degree approach when suctioning the torso so that the flanks and back are in harmony with the front of the abdomen. In men, flabby pecs often need to be addressed, Dr. Sieber says. In other situations, maintaining agreeable proportions requires addition, not subtraction—and that’s where fat transfer comes in. While all our surgeons are firmly against the practice of padding a six-pack with fat to make it pop—“creating that fake muscle bulge in the abdomen looks unnatural and can age poorly,” Dr. Unger says—they will occasionally graft fat into larger areas, like the breasts, pecs, buttocks, or deltoids, to bulk up these major muscle groups and balance the entire body.

Related: High-Tech to High-Def—How Popular Tools and Techniques Are Reshaping Liposuction

4. With high-def lipo, technique matters more than technology

VASER has become somewhat synonymous with high-def liposuction. The device uses ultrasound energy to essentially shake fat loose from surrounding structures, for easier, more efficient extraction. While some surgeons feel strongly that VASER begets the cleanest, most precise result—particularly in patients with fibrous fat—others insist it’s not the only tool for the job. Dr. Unger, for instance, follows a SAFELipo approach, using MicroAire, a power-assisted nonthermal device, for his high-def cases.

More recently, two minimally invasive skin tightening tools have ingratiated themselves with high-def surgeons aiming for next-level results: BodyTite and Renuvion. The former shrinks skin with radiofrequency; the latter, with plasma energy. The amount of skin contraction surgeons can get with these gadgets varies from patient to patient, but generally speaking, the improvement is fairly modest—and it’s important for surgeons to be completely up-front about the limitations of whatever skin tightening technology they might offer.

“In younger people with very taut tissues, you might not need [to incorporate any skin tightening],” says Dr. Subbio. “In patients who are a little bit older, with slightly more lax tissues, then yes, technologies like Renuvion and BodyTite may provide that last 5–10% of tightening that makes your results marginally better.” However, he adds, “nothing, nothing, nothing equates to the power of skin excision.” So oftentimes, when performing abdominal high-def lipo, surgeons will slice away a few inches of skin, for unparalleled tightening.

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5. It pays to be real about the high-def lipo recovery

The process of high-def lipo—targeting fat in deep and superficial planes—is more aggressive than with traditional lipo, especially when surgeons incorporate devices. “Whenever we add energy, we’re causing some degree of tissue injury to effect these results—and that’s going to increase your downtime,” says Dr. Subbio, who spent a good 10 minutes of our phone call railing against plastic surgery chains that downplay the seriousness of lipo by marketing it as a “lunchtime procedure.” The fact is, when you sign up for high-def lipo, you’re committing to a significant recovery, with nonnegotiable rules and requirements.

According to Dr. Unger, “the recovery is two weeks, typically—unless you have fat added to the buttocks, which lengthens the downtime substantially due to sitting restrictions.” Patients are uncomfortable for one to two weeks, after which swelling and limited range of motion tend to be their biggest gripes. Dr. Unger prescribes pain meds but says that most folks transition to over-the-counter analgesics after about a week. Swelling may take months to fully resolve, which means final results can be slow to show. 

Since both energy and trauma contribute to the formation of seromas—collections of fluid under the skin—high-def lipo tends to require drains. Moreover, to ensure that skin shrink-wraps nicely, once cleared of excess fat—and contour irregularities don’t complicate your outcome—compression garments are a must following surgery. “My high-def patients are in a compression suit all the time for the first month, then 12 hours a day for another two months after that,” Dr. Sieber says.

All our surgeons are big proponents of post-lipo lymphatic massage. “Most of my patients get 12 massages in 30 days, beginning the day after surgery,” adds Dr. Sieber. While many are apprehensive to start so soon, he says they typically text him right after, saying how much better they feel. “It really helps with the swelling and is critical to the healing process,” he notes.

If you’re considering high-def lipo, go in with your eyes wide open. Getting great results that wear well over time demands “an absolute commitment to not only those immediate postoperative things, like massages and [compressive] binders, but also to maintaining a healthy lifestyle,” reiterates Dr. Subbio. If exercise and clean eating are merely a fad for you—or a way to qualify for high-def lipo—“you could wind up looking weird as hell” if you ultimately fall back into bad habits after surgery.