In the realm of cosmetic surgery, whether it involves the face or the body, and whether it is surgical or non-invasive, plastic surgeons often use two key adjectives to describe the desired outcomes: natural and customized. However, when the field begins to produce artificial, cookie-cutter six-packs under the guise of high-definition liposuction, it sets off a chain reaction. As is common in aesthetic practices, subpar work can overshadow the positive aspects, potentially tarnishing the reputation of a procedure that is otherwise safe and effective (a phenomenon we’ve seen before with windblown facelifts and stiff Botox treatments).
For those new to the concept, high-definition liposuction focuses on enhancing the muscular definition of a specific area by removing excess fat, thereby creating contours rather than simply reducing overall bulk, which is the standard approach with traditional liposuction. Although high-def liposuction is relatively new, leading figures in body sculpting are already expressing concerns about the less-than-ideal results they are witnessing and the repercussions these outcomes bring. “I don’t think many people fully grasp what high-def liposuction entails,” says Dr. David Sieber, a board-certified plastic surgeon in San Francisco. “But among those who are familiar with the term, the image that often comes to mind are those overly defined, oddly shaped men who resemble Ninja Turtles, with surgeons inaccurately drawing abdominal muscles on their stomachs.”
Dr. Christian Subbio, a board-certified plastic surgeon in Philadelphia, shares a similar perspective, noting that high-def liposuction is gaining a negative reputation partly due to certain doctors—those keen on capitalizing on the high-def trend but lacking the necessary hands-on training to execute the procedure correctly—“are being too aggressive with the definition, creating these unnatural physiques that don’t suit the patient and are incredibly difficult to correct,” he remarks.
On the brighter side, disruptions in the otherwise tranquil landscape of plastic surgery often serve as catalysts for change. “I believe we are in the middle of a paradigm shift,” Dr. Sieber tells us. “What I’m currently observing is a significant number of plastic surgeons comparing their results with those of their peers and somewhat puzzled, asking, ‘Their work looks better than what I usually achieve. What are they doing differently?’”
This trend has prompted many U.S.-based surgeons to travel to South America, the birthplace of high-def liposuction, to learn from Dr. Alfredo Hoyos, the Bogota, Colombia-based plastic surgeon who pioneered and popularized the technique. “Most surgeons in the States who offer genuine high-definition liposuction, including myself, have visited Colombia, where the technique originated,” notes Dr. Subbio. While the South American experience is not mandatory, he emphasizes that anyone promising high-def results should “be able to demonstrate that they have invested the time and effort to master the technique—having at least spent time in the operating room with surgeons who perform it well to replicate such outcomes.”
Beyond adequate training and the right tools, the top practitioners of high-def liposuction are meticulous and cautious, with a deep understanding of anatomy and an artistic eye. Here, experts share insights on achieving results that merit only the most favorable descriptions.
1. Ideal Candidates for High-Def Liposuction
Dr. Sieber often emphasizes that “excellent results are frequently dependent on patients who are ideal candidates for the procedure.” Reputable surgeons are highly selective during high-def consultations. Common disqualifiers include a BMI exceeding 28*, a history of yo-yo dieting and weight fluctuations, poor skin elasticity (stretch marks serve as a warning sign), and a lack of sustained commitment to fitness. (*Some doctors are stricter than others regarding this number, but most agree that even those with a BMI of 30 are not suitable for high-def liposuction.)
While being turned down for the procedure you desire can be disheartening, surgeons are actually acting in your best interest by refusing to operate or perhaps steering you in a different direction. “It’s easy to carve a six-pack or a two-pack on someone,” says Dr. Subbio. “But will that patient commit to the healthy lifestyle needed to maintain that outcome? If not, within 6 to 12 months, they might end up with a beer belly that still has a six-pack etched into it.”
When high-def patients gain weight, it typically does not distribute evenly—the valleys that were depleted of fat will not 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. Tailoring the Level of Definition to Individual Anatomy and Goals
Modern surgeons recognize that high-def liposuction is not a one-size-fits-all operation—the technique should be tailored to the patient’s goals and anatomy. To differentiate their approaches from the overly aggressive aesthetic that has become prevalent, many surgeons are striving for a more personalized touch. “I prefer 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 anatomical boundaries of the abdomen.”
Key to this method is respecting the inherent limitations of each person’s body, which will, to some extent, dictate the degree of sculpting that can be performed. Patients may have “bony shapes that don’t align with their goals,” Dr. Unger explains. For men, wide hips can make it nearly impossible to achieve the V-shaped torso they desire. In such cases, “you can be as lean and muscular as you want, but you’ll never reduce the bony width of the hips,” he says—and “it’s essential to point out the natural boundaries of shaping to each patient when formulating the operative plan.”
According to Dr. Sieber, even less obvious factors, such as the native composition of a person’s fat, can affect high-def results. “Some individuals have soft, fluffy fat that is easily extracted—they tend not to achieve as much definition as those with slightly firmer fat,” he states. He further explains how a very thin layer of fat is intentionally left on top of certain muscle groups to enhance them—and firmer fat accentuates these areas more effectively than fluffy fat.
In ideal scenarios where there are no anatomical constraints, the level of definition a surgeon achieves largely depends on the patient’s goals and the surgeon’s judgment. Dr. Sieber offers three levels of definition to suitable patients. For the most natural appearance, minimal sculpting provides “a little bit of definition in the midline and a little in the semilunaris, which is on either side of the rectus muscles,” he says. To give the abdomen a slightly more chiseled, athletic look—which is what the majority of his female patients desire—he’ll create “a significant amount of definition in the midline, good hip-bone definition, and good definition of the semilunaris line.” Extreme definition is only appropriate 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 balance between athletic and extreme.
3. Ensuring the Midsection Complements the Rest of the Body
Believing that less is often more, some surgeons adhere to conservative sculpting across the board, out of fear of creating an abdomen that clashes with the patient’s overall physical appearance. “I never truly offer aggressive high definition in my practice,” Dr. Subbio says, “because I believe, more often than not, it will look artificial. 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 sculpted, if their legs are too slender—then it doesn’t fit.” He also emphasizes that the higher a patient’s BMI, the less aggressive he needs to be to avoid a discordant outcome.
Dr. Sieber concurs: “The more definition you provide someone, the more aware you need to be of addressing the adjacent muscle groups or the entire torso and extremities collectively.”
Establishing balance typically entails adopting a circumferential, 360-degree approach when suctioning the torso to ensure the flanks and back are in harmony with the front of the abdomen. In men, flabby chest muscles often need to be addressed, Dr. Sieber says. In other circumstances, maintaining harmonious proportions requires addition rather than subtraction—and this is where fat transfer comes into play. While all our surgeons firmly oppose the practice of padding a six-pack with fat to make it stand out—“creating that artificial muscle bulge in the abdomen looks unnatural and can age poorly,” Dr. Unger says—they will occasionally transplant fat into larger areas, such as the breasts, chest muscles, buttocks, or deltoids, to enhance these major muscle groups and balance the entire body.
Related: High-Tech to High-Def—How Popular Tools and Techniques Are Reshaping Liposuction
4. The Importance of Technique Over Technology in High-Def Liposuction
VASER has become somewhat synonymous with high-def liposuction. The device uses ultrasound energy to loosen fat from surrounding structures, making extraction easier and more efficient. While some surgeons strongly believe that VASER yields the cleanest and most precise result—particularly in patients with fibrous fat—others assert that it is not the sole 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 gained favor with high-def surgeons aiming for superior results: BodyTite and Renuvion. The former shrinks the skin using radiofrequency; the latter, with plasma energy. The amount of skin contraction surgeons can achieve with these devices varies from patient to patient, but generally speaking, the improvement is relatively modest—and it’s crucial for surgeons to be completely upfront about the limitations of whatever skin tightening technology they might offer.
“In younger individuals with very taut tissues, you might not need [to incorporate any skin tightening],” says Dr. Subbio. “In patients who are a bit older, with slightly more lax tissues, then yes, technologies like Renuvion and BodyTite may offer that last 5–10% of tightening that marginally improves your results.” However, he adds, “nothing, nothing, nothing compares to the power of skin excision.” So frequently, when performing abdominal high-def lipo, surgeons will remove a few inches of skin for unparalleled tightening.
5. Being Realistic About the High-Def Liposuction Recovery
The process of high-def liposuction—targeting fat in deep and superficial layers—is more aggressive than with traditional liposuction, especially when surgeons incorporate devices. “Whenever we add energy, we’re causing a certain degree of tissue damage to achieve these results—and that’s going to increase your recovery time,” says Dr. Subbio, who spent a considerable 10 minutes of our phone conversation criticizing plastic surgery chains that downplay the severity of lipo by marketing it as a “lunchtime procedure.” The reality is, when you sign up for high-def lipo, you’re committing to a substantial recovery, with non-negotiable rules and requirements.
According to Dr. Unger, “the recovery is typically two weeks—unless you have fat added to the buttocks, which significantly extends the downtime due to sitting restrictions.” Patients experience discomfort for one to two weeks, after which swelling and limited range of motion tend to be their main complaints. Dr. Unger prescribes pain medication but mentions that most people transition to over-the-counter analgesics after approximately a week. Swelling may take months to fully subside, meaning final results can be slow to manifest.
Since both energy and trauma contribute to the formation of seromas—collections of fluid beneath the skin—high-def lipo often requires drains. Additionally, to ensure that the skin contracts nicely once excess fat is removed—and to prevent contour irregularities from complicating the outcome—compression garments are essential after surgery. “My high-def patients wear a compression suit constantly for the first month, then 12 hours a day for another two months after that,” Dr. Sieber says.
All our surgeons are strong advocates of post-lipo lymphatic massage. “The majority of my patients receive 12 massages within 30 days, starting the day after surgery,” adds Dr. Sieber. While many are hesitant to begin so soon, he says they typically text him shortly after, expressing how much better they feel. “It truly helps with the swelling and is crucial to the healing process,” he notes.
If you’re contemplating high-def liposuction, approach it with open eyes. Achieving excellent results that endure over time demands “an absolute commitment not only to those immediate postoperative matters, like massages and [compressive] binders, but also to maintaining a healthy lifestyle,” reiterates Dr. Subbio. If exercise and clean eating are merely a passing trend for you—or a means to qualify for high-def liposuction—“you could end up looking incredibly odd” if you eventually revert to bad habits after surgery.
