Muscular Progression in Dynamic Definition Liposculpture: The BMX Algorithm.
Throughout history, sculptors have created body masterpieces by the careful depiction of the chest, abdominal contour and shape of arms and legs. Gender individual anatomic differences are unique features that ultimately define beauty and physical attraction between couples. Based on their morphology, anthropologists classified the human body in biotypes, which were further subdivided into different categories that led them to realize the uniqueness of the human being[i]. Our patients usually request for a specific outcome of muscular definition or body stereotype, either by following their own desire or pushed by social media (influencers, actors, models, singers, etc.), their partner, relatives or friends. However, the ideal body shape is not universal at all, multiple variations do exist among different socioeconomic and ethnic groups worldwide[ii].
Body Biotypes
In 1940, Sheldon[iii] described 3 biotype groups, based on the development of the embryologic follicles:
- Endomorph: Individual characterized by excess of corporal and visceral fat percentage, underdeveloped muscular mass and a typical posture.
- Mesomorph: Individual with prominent muscular mass and bones. This biotype corresponds to the athletic or fit appearance.
- Ectomorph: Represented by a general fragility, with poor development of the muscle mass in addition to delicate bones.
Patient Dynamics
Our main purpose is to give the patient a toned, defined and athletic look, that may be natural enough to mislead the untrained eye. The 360-degree approach[iv] and artistic anatomy[v] concepts from Dynamic Definition Liposculpture (HD2) are crucial for the unique short- and long-term results. The ‘Dynamic’ concept also contemplates the effect of muscle contraction over skin by describing “dynamic zones” at specific anatomical landmarks that follow the pattern of their motion[vi],[vii].
Methods/Technique
:In real life, athletes and individuals usually follow a muscular definition pattern as their workout routines progress:
- Stage 1: Weight loss by decreasing body fat percentage, with some secondarily muscle gain. Areas more prone to these changes are upper abdomen, pectorals and arms for men, and gluteal and legs for women.
- Stage 2: Men tend to increase their muscle mass in the upper torso, while improving the six-pack definition. Women buttocks, legs and arms start to change, as well as the semilunaris line and linea alba in the abdomen.
- Stage 3: Secondary muscles such as serratus anterior and obliques are defined in men, while women acquire a masculine appearance through the upper torso volumetric augmentation and a full six pack definition.
BMX Algorithm
After the patient’s biotype is determined, the degree of muscle definition must be assessed for each case: Basic, Moderate and eXtreme (BMX) as follows (Figure 1):
- Endomorph: B and M definitions can be done, but X definition is only suitable for those who have a great underlying muscular composition (Endomorphic-mesomorphic).
- Ectomorph: All three categories for definition can be performed (B, M, X), because patients are already thin. However, fat grafting is almost always needed for muscle projection enhancement.
- Mesomorph: B definition is almost never offered, as it would be a deteriorating rather than an improvement procedure. M and X definitions are truly achievable and relatively easy to perform.
Results/Complications
:Some commons mistakes in High Definition Liposculpture, result after bad preoperative decisions. So, an Ectomorph patient who undergoes an Extreme muscular definition would seem as weird and unnatural as a Mesomorph patient with a Basic one. Their body shape would simply not match their muscular demarcation. We called this flaw the ‘ninja turtle’ appearance. Hence, we used the BMX algorithm not only to classify patients but also to match their expectations with the real objectives that could be achieved by HD2. It actually allowed us to fulfill even more natural results without neglecting the athletic appearance.
Conclusion
:Specific factors such as patients’ age, gender, ethnicity, skin quality and expectations, play a determining role when analyzing outcomes after HD2. We have achieved top-quality results after applying the BMX algorithm, since more aesthetic, natural, and stable long-term results have been achieved.
[i] Zerón, A. Biotipos, fenotipos y genotipos. ¿Qué biotipo tenemos? Revista Mexicana de Periodontologia, 2011; 2(1), pp 22-33.
[ii] Wells JCK, Cole TJ, Bruner D, Treleaven P. Body shape in American and British adults: between-country and inter-ethnic comparisons. International Journal of Obesity. 2007;32(1):152-159. doi:10.1038/sj.ijo.0803685..
[iii] Sheldon WH. (collaboration of S.S. Stevens and W.B. Tucker). The varieties of human physique. Harper and Brothers, New York; 1940.
[iv] Hoyos A, Millard J. VASER-assisted high-definition liposculpture. Aesthetic Surgery Journal. 2007;27(6):594-604. doi:10.1016/j.asj.2007.08.007..
[v] Hoyos A, Prendergast PM. High Definition Body Sculpting Art and Advanced Lipoplasty Techniques. Berlin: Springer Berlin; 2014.
[vi] Hoyos, A. and Perez, M. Dynamic-Definition Male Pectoral Reshaping and Enhancement in Slim, Athletic, Obese, and Gynecomastic Patients Through Selective Fat Removal and Grafting. Aesthetic Plastic Surgery, 2012; 36(5), pp.1066-1077. doi: 10.1007/s00266-012-9940-z.
[vii] Hoyos, A., Perez, M. Arm dynamic definition by liposculpture and fat grafting. Aesthetic surgery journal, 2012; 32(8), pp 974-987. doi: 10.1177/1090820X12461498.