| Author, year . | Anatomic concept (treated areas) . | Step 1 . | Step 2 . | Step 3 . |
|---|---|---|---|---|
| Mentz et al, 199312 | Anterior abdominal wall: linea alba and linea semi-lunaris; transverse intersections or inscriptions of the rectus muscle | 2- or 3-mm flat Becker-style liposuction cannula was used for superficial liposuction in the marked areas, first with the openings facing the skin, then with the openings facing the muscular surface | A groove was created to the desired depth; superficial liposuction was continued at the marked areas until there was apparent furrowing or deepening of the natural crease | Deep liposuction with a small Mercedes cannula (1.5-2.5 mm), leaving a thicker fat pad in the islands where muscular enhancement was necessary |
| Ersek and Salisbury, 19971 | Abdomen and flanks | Custom-designed 3-mm suction cannula is passed in the same channel many times to create a completely defatted groove; a new etched abdomen is obvious at the end of the procedure | NR | NR |
| Hoyos and Millard, 20079 | Areas with large fat deposits; back and posterior arms; inner thighs, waist, and neck; linea alba and its tendinous insertions, the pectoral inferior line, inguinal ligament | Emulsification: VASER: 1 minute/100 mL of infiltration, the clinical endpoint was the loss of resistance; large fat deposits were treated with a 3.7- or 2.9-mm 3-groove probe, 80% power (continuous mode); back and posterior arms were treated with a 3.7-mm 1-groove probe (continuous mode); skin or delicate areas, were treated with a 2.9-mm 3-groove probe, 60% power (pulsed mode). differential emulsification for each muscle group: superficial emulsification with a 2.9-mm 3-groove probe (pulse mode) | Debulking: areas of fat deposits in the deep layer, with 3.7- or 4.6-mm cannulas, and continued in the midlamellar layer and between muscle groups, avoiding aspiration against the delicate subdermal layer; superficial emulsification and extraction in the subdermal lamellar layer selectively over the muscular frame with a 2.9-mm probe for emulsification and a 3.0-mm cannula for aspiration | Transitioning: some of the remaining fat over each of the muscles was debulked with a 3.7- or 4.6-mm cannula, while the surface overlying the creases over the midlamellar layer was smoothed |
| Monarca and Rizzo, 201526 | Outlining the pectoralis major muscle; if gynecomastia is present, the gland is removed; define the alba and the semilunar lines and pulling out the transverse tendinous intersections and muscular adherences; liposuction on the lines drawn over the deltoid, arm muscles, gluteal, and lower extremity muscles | Careful liposuction removes the adipose tissue, ensuring skin adhesion to the muscular plane; deep liposuction to remove the excess abdominal fat and to ensure tight skin above the muscles | Powerful liposuction is performed with basket/accelerator cannulas at the pectoral borders, and at the sternal notch to emphasize the medial insertions; aggressive cannula is used like a chisel in the subcutaneous tissue for the superficial liposuction | Residual adipose tissue homogenization by cannula avoids irregularity of the treated areas |
| Steinbrech and Sinno, 201628 | Selective lipocontouring (levels 1-6): 1 being sculpting alone to 6 being most extreme fat grafting; supine: abdominal wall and the linea alba, lateral vertical margin, serratus, obliques and inscription of the rectus abdominis; prone: flanks | Lipectomy by PAL or standard traditional suction lipectomy | NR | NR |
| Boeni, 202025 | Love handles, hypogastrium, the area over the serratus anterior, and the lower part over the pectoralis major; linea alba and S-shaped linea semilunaris; the transverse intersections were created with the bent cannula; arm definition: the groove between deltoid muscle and biceps was accessed; this sulcus continues on the back of the arm to a groove between the deltoid muscle and lateral head of triceps | All layer debulking was performed starting from deep to superficial to subdermal liposuction; reciprocating PAL (MicroAire Inc., Charlottesville, VA) with 1 straight 4-mm flared Mercedes cannula and 1 bent 4-mm flared Mercedes cannula | Reciprocating PAL (MicroAire); the fat between the tendinous intersections was retained or, when a thicker fat layer was present, reduced to a 1-cm fat layer from the dermis | Fat equalization step (vibration without suction) after HDL ensures smooth skin in the infraumbilical area |
| Husain et al, 201921 | Prone: flanks; supine: anterior flanks and abdomen | PAL of the deep layers of the abdomen and flanks is performed with a no. 5 Mercedes cannula. | PAL with a blunt-tip cannula (no. 4 or 5) to create the linea alba, semilunaris, and iliac crest lines with the cannula superficially next to the dermis; limit the cannula passes to a maximum of 10 (avoid thermal injury) | NR |
| Agochukwu-Nwubah and Mentz, 201920 | Modified abdominal etching (MAE): linea alba is enhanced; etching along the edge of the linea semilunaris; deep liposuction is performed along the linea semilunaris and along the transverse rectus inscriptions; etch 2-3 cm surrounding the umbilicus; deep and superficial liposuction is performed lateral to the rectus muscle | “Cross-tunneling” is done in all areas | Both superficial and deep liposuction is performed with a 4- and/or 5-mm basket cannula, and with PAL | NR |
| Full abdominal etching (FAE): linea alba is enhanced; etching along the edge of the linea semilunaris; aggressive deep and superficial liposuction is performed along the linea semilunaris and along the transverse rectus inscriptions; etch 2-3 cm surrounding the umbilicus; deep and superficial liposuction is performed lateral to the rectus muscle | ||||
| Saad et al, 202023 | Deep fat compartments in the lower back; superficial fat compartments were treated to mark the lower back lines (caudal border of the latissimus dorsi muscle following along the lateral thoracolumbar fascia and the lateral vertical line of the erector spinae muscle caudally); the posterior upper arms were marked by suctioning the superficial fat between the deltoid and the triceps; deep medial and lateral abdominal compartments (below and above the umbilicus) and the deep fat compartment in the axilla; superficial fat compartments along the preoperatively marked lines on the abdomen and chest; abdominal inscriptions overlying the rectus abdominis | Separation: superficial and deep fat is separated through continuous passing of the cannula while no suctioning is performed; allows release from tethering structures such as blood vessels and fibrous septae | Aspiration: less aggressive cannulas to aspirate this low-resistance, separated fat; size depends on the region of treatment but, on average, ranges from 1 to 4 mm | Fat equalization: no suction; the exploded-tip cannula is used to smooth out irregular areas; equalization of the treated areas is accomplished by further emulsification of the remaining fat bed, evening out the inevitable thicker and thinner areas that exist |
| Niddam et al, 201922 | NS | When additional conventional contouring liposuction was needed, it was performed before the abdominal etching, with the same 4-mm cannula | The abdominal etching was carried out with a 4-mm 3-hole cannula along the drawings; the liposuction was performed mostly in the superficial planes but also in the deep plane, at full-power suction pressure | NR |
| Hoyos and Perez, 202037 | B (basic-definition liposculpture): vertical rectus abdominis, semilunaris line, obliques; posterior: erector spinae; arms: anterior posterior deltoid | Superficial subcutaneous fat was treated first in VASER mode, usually starting with a 3.7-mm 2-groove probe at an amplitude of 80%; if excessive resistance, energy was increased to 90%, or an alternative probe was selected; continuous mode was used to emulsify the deeper fat; 60-90 seconds of ultrasound delivery per 100 mL of tumescent fluid infiltrated | Completed liposuction with 4- and 3-mm cannulas connected to PowerX or MicroAire system; thorough liposuction is performed in the deep layer and after debulking, the 3-mm cannula is used to treat the superficial plane; controlled deformities are created by sculpting the underlying muscle anatomy, following the preoperative markings (lights, shadows, negative spaces, and dynamic zones) | Additional superficial lipoplasty is performed with small cannulas (3 mm) in order to define muscle groups and create shadows by removing almost all of the fat in the subdermal layer |
| M (moderate-definition liposculpture): whole rectus abdominis—transverse insertions, external obliques, pectoralis; posterior: erector spinae, upper and lower trapezius; arms: anterior posterior deltoid, biceps triceps | ||||
| X (extreme-definition liposculpture): whole rectus abdominis, transverse insertions, external obliques, pectoralis, serratus; posterior: erector spinae, upper and lower trapezius; arms: anterior posterior deltoid, biceps triceps | ||||
| Taha et al, 202024 | Lateral position: waist, iliac, lateral chest, and back regions: contralateral waist, iliac, lateral chest, and back regions; supine position for liposuction of the abdomen, chest, and thigh (if planned); prone position for completion of liposuction of the gluteal region, upper posterior thighs, and gluteal fat grafting, if needed | When VASER is used, 70%, pulsed mode was used and applied immediately following infiltration; fat emulsification until no resistance was encountered | Liposuction was performed with power-assisted techniques with the Lipomatic (Euromai) | NR |
| Saad et al, 202127 | Upper and lower back, including the gluteal region and the posterior arms; anterior arms, chest, medial and lateral abdomen | Dispersion: use of PAL’s vibratory energy without suction power; maximize the interaction between the tumescent fluid components and the fat tissue | Aspiration: liposuction was performed by PAL; superficial and deep fat harvesting was done with 5 mm (straight and bent) PAL HD cannulas (MicroAire Inc., Charlottesville, VA); superficial fat liposculpting consists of the detailed sculpting of the superficial fat layer to enhance the underlying musculoskeletal structures | Fat equalization: reciprocating movement of the PAL technology without suction; treat irregularities and correct any step-offs that could have been created during the aspiration phase |
| Author, year . | Anatomic concept (treated areas) . | Step 1 . | Step 2 . | Step 3 . |
|---|---|---|---|---|
| Mentz et al, 199312 | Anterior abdominal wall: linea alba and linea semi-lunaris; transverse intersections or inscriptions of the rectus muscle | 2- or 3-mm flat Becker-style liposuction cannula was used for superficial liposuction in the marked areas, first with the openings facing the skin, then with the openings facing the muscular surface | A groove was created to the desired depth; superficial liposuction was continued at the marked areas until there was apparent furrowing or deepening of the natural crease | Deep liposuction with a small Mercedes cannula (1.5-2.5 mm), leaving a thicker fat pad in the islands where muscular enhancement was necessary |
| Ersek and Salisbury, 19971 | Abdomen and flanks | Custom-designed 3-mm suction cannula is passed in the same channel many times to create a completely defatted groove; a new etched abdomen is obvious at the end of the procedure | NR | NR |
| Hoyos and Millard, 20079 | Areas with large fat deposits; back and posterior arms; inner thighs, waist, and neck; linea alba and its tendinous insertions, the pectoral inferior line, inguinal ligament | Emulsification: VASER: 1 minute/100 mL of infiltration, the clinical endpoint was the loss of resistance; large fat deposits were treated with a 3.7- or 2.9-mm 3-groove probe, 80% power (continuous mode); back and posterior arms were treated with a 3.7-mm 1-groove probe (continuous mode); skin or delicate areas, were treated with a 2.9-mm 3-groove probe, 60% power (pulsed mode). differential emulsification for each muscle group: superficial emulsification with a 2.9-mm 3-groove probe (pulse mode) | Debulking: areas of fat deposits in the deep layer, with 3.7- or 4.6-mm cannulas, and continued in the midlamellar layer and between muscle groups, avoiding aspiration against the delicate subdermal layer; superficial emulsification and extraction in the subdermal lamellar layer selectively over the muscular frame with a 2.9-mm probe for emulsification and a 3.0-mm cannula for aspiration | Transitioning: some of the remaining fat over each of the muscles was debulked with a 3.7- or 4.6-mm cannula, while the surface overlying the creases over the midlamellar layer was smoothed |
| Monarca and Rizzo, 201526 | Outlining the pectoralis major muscle; if gynecomastia is present, the gland is removed; define the alba and the semilunar lines and pulling out the transverse tendinous intersections and muscular adherences; liposuction on the lines drawn over the deltoid, arm muscles, gluteal, and lower extremity muscles | Careful liposuction removes the adipose tissue, ensuring skin adhesion to the muscular plane; deep liposuction to remove the excess abdominal fat and to ensure tight skin above the muscles | Powerful liposuction is performed with basket/accelerator cannulas at the pectoral borders, and at the sternal notch to emphasize the medial insertions; aggressive cannula is used like a chisel in the subcutaneous tissue for the superficial liposuction | Residual adipose tissue homogenization by cannula avoids irregularity of the treated areas |
| Steinbrech and Sinno, 201628 | Selective lipocontouring (levels 1-6): 1 being sculpting alone to 6 being most extreme fat grafting; supine: abdominal wall and the linea alba, lateral vertical margin, serratus, obliques and inscription of the rectus abdominis; prone: flanks | Lipectomy by PAL or standard traditional suction lipectomy | NR | NR |
| Boeni, 202025 | Love handles, hypogastrium, the area over the serratus anterior, and the lower part over the pectoralis major; linea alba and S-shaped linea semilunaris; the transverse intersections were created with the bent cannula; arm definition: the groove between deltoid muscle and biceps was accessed; this sulcus continues on the back of the arm to a groove between the deltoid muscle and lateral head of triceps | All layer debulking was performed starting from deep to superficial to subdermal liposuction; reciprocating PAL (MicroAire Inc., Charlottesville, VA) with 1 straight 4-mm flared Mercedes cannula and 1 bent 4-mm flared Mercedes cannula | Reciprocating PAL (MicroAire); the fat between the tendinous intersections was retained or, when a thicker fat layer was present, reduced to a 1-cm fat layer from the dermis | Fat equalization step (vibration without suction) after HDL ensures smooth skin in the infraumbilical area |
| Husain et al, 201921 | Prone: flanks; supine: anterior flanks and abdomen | PAL of the deep layers of the abdomen and flanks is performed with a no. 5 Mercedes cannula. | PAL with a blunt-tip cannula (no. 4 or 5) to create the linea alba, semilunaris, and iliac crest lines with the cannula superficially next to the dermis; limit the cannula passes to a maximum of 10 (avoid thermal injury) | NR |
| Agochukwu-Nwubah and Mentz, 201920 | Modified abdominal etching (MAE): linea alba is enhanced; etching along the edge of the linea semilunaris; deep liposuction is performed along the linea semilunaris and along the transverse rectus inscriptions; etch 2-3 cm surrounding the umbilicus; deep and superficial liposuction is performed lateral to the rectus muscle | “Cross-tunneling” is done in all areas | Both superficial and deep liposuction is performed with a 4- and/or 5-mm basket cannula, and with PAL | NR |
| Full abdominal etching (FAE): linea alba is enhanced; etching along the edge of the linea semilunaris; aggressive deep and superficial liposuction is performed along the linea semilunaris and along the transverse rectus inscriptions; etch 2-3 cm surrounding the umbilicus; deep and superficial liposuction is performed lateral to the rectus muscle | ||||
| Saad et al, 202023 | Deep fat compartments in the lower back; superficial fat compartments were treated to mark the lower back lines (caudal border of the latissimus dorsi muscle following along the lateral thoracolumbar fascia and the lateral vertical line of the erector spinae muscle caudally); the posterior upper arms were marked by suctioning the superficial fat between the deltoid and the triceps; deep medial and lateral abdominal compartments (below and above the umbilicus) and the deep fat compartment in the axilla; superficial fat compartments along the preoperatively marked lines on the abdomen and chest; abdominal inscriptions overlying the rectus abdominis | Separation: superficial and deep fat is separated through continuous passing of the cannula while no suctioning is performed; allows release from tethering structures such as blood vessels and fibrous septae | Aspiration: less aggressive cannulas to aspirate this low-resistance, separated fat; size depends on the region of treatment but, on average, ranges from 1 to 4 mm | Fat equalization: no suction; the exploded-tip cannula is used to smooth out irregular areas; equalization of the treated areas is accomplished by further emulsification of the remaining fat bed, evening out the inevitable thicker and thinner areas that exist |
| Niddam et al, 201922 | NS | When additional conventional contouring liposuction was needed, it was performed before the abdominal etching, with the same 4-mm cannula | The abdominal etching was carried out with a 4-mm 3-hole cannula along the drawings; the liposuction was performed mostly in the superficial planes but also in the deep plane, at full-power suction pressure | NR |
| Hoyos and Perez, 202037 | B (basic-definition liposculpture): vertical rectus abdominis, semilunaris line, obliques; posterior: erector spinae; arms: anterior posterior deltoid | Superficial subcutaneous fat was treated first in VASER mode, usually starting with a 3.7-mm 2-groove probe at an amplitude of 80%; if excessive resistance, energy was increased to 90%, or an alternative probe was selected; continuous mode was used to emulsify the deeper fat; 60-90 seconds of ultrasound delivery per 100 mL of tumescent fluid infiltrated | Completed liposuction with 4- and 3-mm cannulas connected to PowerX or MicroAire system; thorough liposuction is performed in the deep layer and after debulking, the 3-mm cannula is used to treat the superficial plane; controlled deformities are created by sculpting the underlying muscle anatomy, following the preoperative markings (lights, shadows, negative spaces, and dynamic zones) | Additional superficial lipoplasty is performed with small cannulas (3 mm) in order to define muscle groups and create shadows by removing almost all of the fat in the subdermal layer |
| M (moderate-definition liposculpture): whole rectus abdominis—transverse insertions, external obliques, pectoralis; posterior: erector spinae, upper and lower trapezius; arms: anterior posterior deltoid, biceps triceps | ||||
| X (extreme-definition liposculpture): whole rectus abdominis, transverse insertions, external obliques, pectoralis, serratus; posterior: erector spinae, upper and lower trapezius; arms: anterior posterior deltoid, biceps triceps | ||||
| Taha et al, 202024 | Lateral position: waist, iliac, lateral chest, and back regions: contralateral waist, iliac, lateral chest, and back regions; supine position for liposuction of the abdomen, chest, and thigh (if planned); prone position for completion of liposuction of the gluteal region, upper posterior thighs, and gluteal fat grafting, if needed | When VASER is used, 70%, pulsed mode was used and applied immediately following infiltration; fat emulsification until no resistance was encountered | Liposuction was performed with power-assisted techniques with the Lipomatic (Euromai) | NR |
| Saad et al, 202127 | Upper and lower back, including the gluteal region and the posterior arms; anterior arms, chest, medial and lateral abdomen | Dispersion: use of PAL’s vibratory energy without suction power; maximize the interaction between the tumescent fluid components and the fat tissue | Aspiration: liposuction was performed by PAL; superficial and deep fat harvesting was done with 5 mm (straight and bent) PAL HD cannulas (MicroAire Inc., Charlottesville, VA); superficial fat liposculpting consists of the detailed sculpting of the superficial fat layer to enhance the underlying musculoskeletal structures | Fat equalization: reciprocating movement of the PAL technology without suction; treat irregularities and correct any step-offs that could have been created during the aspiration phase |
HD, high definition; NR, not reported; NS, not specified; PAL, power-assisted lipectomy; VASER, vibration amplification of sound energy at resonance.
| Author, year . | Anatomic concept (treated areas) . | Step 1 . | Step 2 . | Step 3 . |
|---|---|---|---|---|
| Mentz et al, 199312 | Anterior abdominal wall: linea alba and linea semi-lunaris; transverse intersections or inscriptions of the rectus muscle | 2- or 3-mm flat Becker-style liposuction cannula was used for superficial liposuction in the marked areas, first with the openings facing the skin, then with the openings facing the muscular surface | A groove was created to the desired depth; superficial liposuction was continued at the marked areas until there was apparent furrowing or deepening of the natural crease | Deep liposuction with a small Mercedes cannula (1.5-2.5 mm), leaving a thicker fat pad in the islands where muscular enhancement was necessary |
| Ersek and Salisbury, 19971 | Abdomen and flanks | Custom-designed 3-mm suction cannula is passed in the same channel many times to create a completely defatted groove; a new etched abdomen is obvious at the end of the procedure | NR | NR |
| Hoyos and Millard, 20079 | Areas with large fat deposits; back and posterior arms; inner thighs, waist, and neck; linea alba and its tendinous insertions, the pectoral inferior line, inguinal ligament | Emulsification: VASER: 1 minute/100 mL of infiltration, the clinical endpoint was the loss of resistance; large fat deposits were treated with a 3.7- or 2.9-mm 3-groove probe, 80% power (continuous mode); back and posterior arms were treated with a 3.7-mm 1-groove probe (continuous mode); skin or delicate areas, were treated with a 2.9-mm 3-groove probe, 60% power (pulsed mode). differential emulsification for each muscle group: superficial emulsification with a 2.9-mm 3-groove probe (pulse mode) | Debulking: areas of fat deposits in the deep layer, with 3.7- or 4.6-mm cannulas, and continued in the midlamellar layer and between muscle groups, avoiding aspiration against the delicate subdermal layer; superficial emulsification and extraction in the subdermal lamellar layer selectively over the muscular frame with a 2.9-mm probe for emulsification and a 3.0-mm cannula for aspiration | Transitioning: some of the remaining fat over each of the muscles was debulked with a 3.7- or 4.6-mm cannula, while the surface overlying the creases over the midlamellar layer was smoothed |
| Monarca and Rizzo, 201526 | Outlining the pectoralis major muscle; if gynecomastia is present, the gland is removed; define the alba and the semilunar lines and pulling out the transverse tendinous intersections and muscular adherences; liposuction on the lines drawn over the deltoid, arm muscles, gluteal, and lower extremity muscles | Careful liposuction removes the adipose tissue, ensuring skin adhesion to the muscular plane; deep liposuction to remove the excess abdominal fat and to ensure tight skin above the muscles | Powerful liposuction is performed with basket/accelerator cannulas at the pectoral borders, and at the sternal notch to emphasize the medial insertions; aggressive cannula is used like a chisel in the subcutaneous tissue for the superficial liposuction | Residual adipose tissue homogenization by cannula avoids irregularity of the treated areas |
| Steinbrech and Sinno, 201628 | Selective lipocontouring (levels 1-6): 1 being sculpting alone to 6 being most extreme fat grafting; supine: abdominal wall and the linea alba, lateral vertical margin, serratus, obliques and inscription of the rectus abdominis; prone: flanks | Lipectomy by PAL or standard traditional suction lipectomy | NR | NR |
| Boeni, 202025 | Love handles, hypogastrium, the area over the serratus anterior, and the lower part over the pectoralis major; linea alba and S-shaped linea semilunaris; the transverse intersections were created with the bent cannula; arm definition: the groove between deltoid muscle and biceps was accessed; this sulcus continues on the back of the arm to a groove between the deltoid muscle and lateral head of triceps | All layer debulking was performed starting from deep to superficial to subdermal liposuction; reciprocating PAL (MicroAire Inc., Charlottesville, VA) with 1 straight 4-mm flared Mercedes cannula and 1 bent 4-mm flared Mercedes cannula | Reciprocating PAL (MicroAire); the fat between the tendinous intersections was retained or, when a thicker fat layer was present, reduced to a 1-cm fat layer from the dermis | Fat equalization step (vibration without suction) after HDL ensures smooth skin in the infraumbilical area |
| Husain et al, 201921 | Prone: flanks; supine: anterior flanks and abdomen | PAL of the deep layers of the abdomen and flanks is performed with a no. 5 Mercedes cannula. | PAL with a blunt-tip cannula (no. 4 or 5) to create the linea alba, semilunaris, and iliac crest lines with the cannula superficially next to the dermis; limit the cannula passes to a maximum of 10 (avoid thermal injury) | NR |
| Agochukwu-Nwubah and Mentz, 201920 | Modified abdominal etching (MAE): linea alba is enhanced; etching along the edge of the linea semilunaris; deep liposuction is performed along the linea semilunaris and along the transverse rectus inscriptions; etch 2-3 cm surrounding the umbilicus; deep and superficial liposuction is performed lateral to the rectus muscle | “Cross-tunneling” is done in all areas | Both superficial and deep liposuction is performed with a 4- and/or 5-mm basket cannula, and with PAL | NR |
| Full abdominal etching (FAE): linea alba is enhanced; etching along the edge of the linea semilunaris; aggressive deep and superficial liposuction is performed along the linea semilunaris and along the transverse rectus inscriptions; etch 2-3 cm surrounding the umbilicus; deep and superficial liposuction is performed lateral to the rectus muscle | ||||
| Saad et al, 202023 | Deep fat compartments in the lower back; superficial fat compartments were treated to mark the lower back lines (caudal border of the latissimus dorsi muscle following along the lateral thoracolumbar fascia and the lateral vertical line of the erector spinae muscle caudally); the posterior upper arms were marked by suctioning the superficial fat between the deltoid and the triceps; deep medial and lateral abdominal compartments (below and above the umbilicus) and the deep fat compartment in the axilla; superficial fat compartments along the preoperatively marked lines on the abdomen and chest; abdominal inscriptions overlying the rectus abdominis | Separation: superficial and deep fat is separated through continuous passing of the cannula while no suctioning is performed; allows release from tethering structures such as blood vessels and fibrous septae | Aspiration: less aggressive cannulas to aspirate this low-resistance, separated fat; size depends on the region of treatment but, on average, ranges from 1 to 4 mm | Fat equalization: no suction; the exploded-tip cannula is used to smooth out irregular areas; equalization of the treated areas is accomplished by further emulsification of the remaining fat bed, evening out the inevitable thicker and thinner areas that exist |
| Niddam et al, 201922 | NS | When additional conventional contouring liposuction was needed, it was performed before the abdominal etching, with the same 4-mm cannula | The abdominal etching was carried out with a 4-mm 3-hole cannula along the drawings; the liposuction was performed mostly in the superficial planes but also in the deep plane, at full-power suction pressure | NR |
| Hoyos and Perez, 202037 | B (basic-definition liposculpture): vertical rectus abdominis, semilunaris line, obliques; posterior: erector spinae; arms: anterior posterior deltoid | Superficial subcutaneous fat was treated first in VASER mode, usually starting with a 3.7-mm 2-groove probe at an amplitude of 80%; if excessive resistance, energy was increased to 90%, or an alternative probe was selected; continuous mode was used to emulsify the deeper fat; 60-90 seconds of ultrasound delivery per 100 mL of tumescent fluid infiltrated | Completed liposuction with 4- and 3-mm cannulas connected to PowerX or MicroAire system; thorough liposuction is performed in the deep layer and after debulking, the 3-mm cannula is used to treat the superficial plane; controlled deformities are created by sculpting the underlying muscle anatomy, following the preoperative markings (lights, shadows, negative spaces, and dynamic zones) | Additional superficial lipoplasty is performed with small cannulas (3 mm) in order to define muscle groups and create shadows by removing almost all of the fat in the subdermal layer |
| M (moderate-definition liposculpture): whole rectus abdominis—transverse insertions, external obliques, pectoralis; posterior: erector spinae, upper and lower trapezius; arms: anterior posterior deltoid, biceps triceps | ||||
| X (extreme-definition liposculpture): whole rectus abdominis, transverse insertions, external obliques, pectoralis, serratus; posterior: erector spinae, upper and lower trapezius; arms: anterior posterior deltoid, biceps triceps | ||||
| Taha et al, 202024 | Lateral position: waist, iliac, lateral chest, and back regions: contralateral waist, iliac, lateral chest, and back regions; supine position for liposuction of the abdomen, chest, and thigh (if planned); prone position for completion of liposuction of the gluteal region, upper posterior thighs, and gluteal fat grafting, if needed | When VASER is used, 70%, pulsed mode was used and applied immediately following infiltration; fat emulsification until no resistance was encountered | Liposuction was performed with power-assisted techniques with the Lipomatic (Euromai) | NR |
| Saad et al, 202127 | Upper and lower back, including the gluteal region and the posterior arms; anterior arms, chest, medial and lateral abdomen | Dispersion: use of PAL’s vibratory energy without suction power; maximize the interaction between the tumescent fluid components and the fat tissue | Aspiration: liposuction was performed by PAL; superficial and deep fat harvesting was done with 5 mm (straight and bent) PAL HD cannulas (MicroAire Inc., Charlottesville, VA); superficial fat liposculpting consists of the detailed sculpting of the superficial fat layer to enhance the underlying musculoskeletal structures | Fat equalization: reciprocating movement of the PAL technology without suction; treat irregularities and correct any step-offs that could have been created during the aspiration phase |
| Author, year . | Anatomic concept (treated areas) . | Step 1 . | Step 2 . | Step 3 . |
|---|---|---|---|---|
| Mentz et al, 199312 | Anterior abdominal wall: linea alba and linea semi-lunaris; transverse intersections or inscriptions of the rectus muscle | 2- or 3-mm flat Becker-style liposuction cannula was used for superficial liposuction in the marked areas, first with the openings facing the skin, then with the openings facing the muscular surface | A groove was created to the desired depth; superficial liposuction was continued at the marked areas until there was apparent furrowing or deepening of the natural crease | Deep liposuction with a small Mercedes cannula (1.5-2.5 mm), leaving a thicker fat pad in the islands where muscular enhancement was necessary |
| Ersek and Salisbury, 19971 | Abdomen and flanks | Custom-designed 3-mm suction cannula is passed in the same channel many times to create a completely defatted groove; a new etched abdomen is obvious at the end of the procedure | NR | NR |
| Hoyos and Millard, 20079 | Areas with large fat deposits; back and posterior arms; inner thighs, waist, and neck; linea alba and its tendinous insertions, the pectoral inferior line, inguinal ligament | Emulsification: VASER: 1 minute/100 mL of infiltration, the clinical endpoint was the loss of resistance; large fat deposits were treated with a 3.7- or 2.9-mm 3-groove probe, 80% power (continuous mode); back and posterior arms were treated with a 3.7-mm 1-groove probe (continuous mode); skin or delicate areas, were treated with a 2.9-mm 3-groove probe, 60% power (pulsed mode). differential emulsification for each muscle group: superficial emulsification with a 2.9-mm 3-groove probe (pulse mode) | Debulking: areas of fat deposits in the deep layer, with 3.7- or 4.6-mm cannulas, and continued in the midlamellar layer and between muscle groups, avoiding aspiration against the delicate subdermal layer; superficial emulsification and extraction in the subdermal lamellar layer selectively over the muscular frame with a 2.9-mm probe for emulsification and a 3.0-mm cannula for aspiration | Transitioning: some of the remaining fat over each of the muscles was debulked with a 3.7- or 4.6-mm cannula, while the surface overlying the creases over the midlamellar layer was smoothed |
| Monarca and Rizzo, 201526 | Outlining the pectoralis major muscle; if gynecomastia is present, the gland is removed; define the alba and the semilunar lines and pulling out the transverse tendinous intersections and muscular adherences; liposuction on the lines drawn over the deltoid, arm muscles, gluteal, and lower extremity muscles | Careful liposuction removes the adipose tissue, ensuring skin adhesion to the muscular plane; deep liposuction to remove the excess abdominal fat and to ensure tight skin above the muscles | Powerful liposuction is performed with basket/accelerator cannulas at the pectoral borders, and at the sternal notch to emphasize the medial insertions; aggressive cannula is used like a chisel in the subcutaneous tissue for the superficial liposuction | Residual adipose tissue homogenization by cannula avoids irregularity of the treated areas |
| Steinbrech and Sinno, 201628 | Selective lipocontouring (levels 1-6): 1 being sculpting alone to 6 being most extreme fat grafting; supine: abdominal wall and the linea alba, lateral vertical margin, serratus, obliques and inscription of the rectus abdominis; prone: flanks | Lipectomy by PAL or standard traditional suction lipectomy | NR | NR |
| Boeni, 202025 | Love handles, hypogastrium, the area over the serratus anterior, and the lower part over the pectoralis major; linea alba and S-shaped linea semilunaris; the transverse intersections were created with the bent cannula; arm definition: the groove between deltoid muscle and biceps was accessed; this sulcus continues on the back of the arm to a groove between the deltoid muscle and lateral head of triceps | All layer debulking was performed starting from deep to superficial to subdermal liposuction; reciprocating PAL (MicroAire Inc., Charlottesville, VA) with 1 straight 4-mm flared Mercedes cannula and 1 bent 4-mm flared Mercedes cannula | Reciprocating PAL (MicroAire); the fat between the tendinous intersections was retained or, when a thicker fat layer was present, reduced to a 1-cm fat layer from the dermis | Fat equalization step (vibration without suction) after HDL ensures smooth skin in the infraumbilical area |
| Husain et al, 201921 | Prone: flanks; supine: anterior flanks and abdomen | PAL of the deep layers of the abdomen and flanks is performed with a no. 5 Mercedes cannula. | PAL with a blunt-tip cannula (no. 4 or 5) to create the linea alba, semilunaris, and iliac crest lines with the cannula superficially next to the dermis; limit the cannula passes to a maximum of 10 (avoid thermal injury) | NR |
| Agochukwu-Nwubah and Mentz, 201920 | Modified abdominal etching (MAE): linea alba is enhanced; etching along the edge of the linea semilunaris; deep liposuction is performed along the linea semilunaris and along the transverse rectus inscriptions; etch 2-3 cm surrounding the umbilicus; deep and superficial liposuction is performed lateral to the rectus muscle | “Cross-tunneling” is done in all areas | Both superficial and deep liposuction is performed with a 4- and/or 5-mm basket cannula, and with PAL | NR |
| Full abdominal etching (FAE): linea alba is enhanced; etching along the edge of the linea semilunaris; aggressive deep and superficial liposuction is performed along the linea semilunaris and along the transverse rectus inscriptions; etch 2-3 cm surrounding the umbilicus; deep and superficial liposuction is performed lateral to the rectus muscle | ||||
| Saad et al, 202023 | Deep fat compartments in the lower back; superficial fat compartments were treated to mark the lower back lines (caudal border of the latissimus dorsi muscle following along the lateral thoracolumbar fascia and the lateral vertical line of the erector spinae muscle caudally); the posterior upper arms were marked by suctioning the superficial fat between the deltoid and the triceps; deep medial and lateral abdominal compartments (below and above the umbilicus) and the deep fat compartment in the axilla; superficial fat compartments along the preoperatively marked lines on the abdomen and chest; abdominal inscriptions overlying the rectus abdominis | Separation: superficial and deep fat is separated through continuous passing of the cannula while no suctioning is performed; allows release from tethering structures such as blood vessels and fibrous septae | Aspiration: less aggressive cannulas to aspirate this low-resistance, separated fat; size depends on the region of treatment but, on average, ranges from 1 to 4 mm | Fat equalization: no suction; the exploded-tip cannula is used to smooth out irregular areas; equalization of the treated areas is accomplished by further emulsification of the remaining fat bed, evening out the inevitable thicker and thinner areas that exist |
| Niddam et al, 201922 | NS | When additional conventional contouring liposuction was needed, it was performed before the abdominal etching, with the same 4-mm cannula | The abdominal etching was carried out with a 4-mm 3-hole cannula along the drawings; the liposuction was performed mostly in the superficial planes but also in the deep plane, at full-power suction pressure | NR |
| Hoyos and Perez, 202037 | B (basic-definition liposculpture): vertical rectus abdominis, semilunaris line, obliques; posterior: erector spinae; arms: anterior posterior deltoid | Superficial subcutaneous fat was treated first in VASER mode, usually starting with a 3.7-mm 2-groove probe at an amplitude of 80%; if excessive resistance, energy was increased to 90%, or an alternative probe was selected; continuous mode was used to emulsify the deeper fat; 60-90 seconds of ultrasound delivery per 100 mL of tumescent fluid infiltrated | Completed liposuction with 4- and 3-mm cannulas connected to PowerX or MicroAire system; thorough liposuction is performed in the deep layer and after debulking, the 3-mm cannula is used to treat the superficial plane; controlled deformities are created by sculpting the underlying muscle anatomy, following the preoperative markings (lights, shadows, negative spaces, and dynamic zones) | Additional superficial lipoplasty is performed with small cannulas (3 mm) in order to define muscle groups and create shadows by removing almost all of the fat in the subdermal layer |
| M (moderate-definition liposculpture): whole rectus abdominis—transverse insertions, external obliques, pectoralis; posterior: erector spinae, upper and lower trapezius; arms: anterior posterior deltoid, biceps triceps | ||||
| X (extreme-definition liposculpture): whole rectus abdominis, transverse insertions, external obliques, pectoralis, serratus; posterior: erector spinae, upper and lower trapezius; arms: anterior posterior deltoid, biceps triceps | ||||
| Taha et al, 202024 | Lateral position: waist, iliac, lateral chest, and back regions: contralateral waist, iliac, lateral chest, and back regions; supine position for liposuction of the abdomen, chest, and thigh (if planned); prone position for completion of liposuction of the gluteal region, upper posterior thighs, and gluteal fat grafting, if needed | When VASER is used, 70%, pulsed mode was used and applied immediately following infiltration; fat emulsification until no resistance was encountered | Liposuction was performed with power-assisted techniques with the Lipomatic (Euromai) | NR |
| Saad et al, 202127 | Upper and lower back, including the gluteal region and the posterior arms; anterior arms, chest, medial and lateral abdomen | Dispersion: use of PAL’s vibratory energy without suction power; maximize the interaction between the tumescent fluid components and the fat tissue | Aspiration: liposuction was performed by PAL; superficial and deep fat harvesting was done with 5 mm (straight and bent) PAL HD cannulas (MicroAire Inc., Charlottesville, VA); superficial fat liposculpting consists of the detailed sculpting of the superficial fat layer to enhance the underlying musculoskeletal structures | Fat equalization: reciprocating movement of the PAL technology without suction; treat irregularities and correct any step-offs that could have been created during the aspiration phase |
HD, high definition; NR, not reported; NS, not specified; PAL, power-assisted lipectomy; VASER, vibration amplification of sound energy at resonance.
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