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Six-Pack Abs Through Surgery

From Zero to Hero

In the movie 300, King Leonidas (Gerard Butler) led 300 of his Spartan soldiers out for some manly fisticuffs against a horde of angry Persians. The acting primarily consisted of lots of shouting and poking each other with sharp sticks, but what made every woman (and man!) open their eyes wide and drop their jaws was the fact that the movie had not one, not two, but 300 actors playing the Spartans, including Gerard, clad in nothing but loincloths showing off six-packs, trim waists, buns and thighs of steel with Gerard leading the pack with abs so hard that arrows bounced off them.

The price of physical perfection? Nothing much, just something affectionately referred to by the cast as the ‘300 workout’: 50 pushups, 50 deadlifts with 135-pound barbells, 25 pull-ups and more a day without a break. For us mortals, the odds of summoning up the willpower or the time to get a body like that are probably marginally more than winning the lottery.

Previously, people sought a range of surgical solutions ranging from silicone pecs to liposuction with painful ‘ab etching’ to achieve this athletic six-pack look with varying degrees of success; some results fell short of the mark or were downright unnatural, even bizarre to look at. While it was possible to turn someone from Average Joe into a possible Slim Jim, liposuction was simply not able to turn Joe into Superman. As a surgical procedure, prior surgical techniques were able to help create a slimmer silhouette in patients but had definite limitations.

Now, a new technique is making its way around the globe that allows men and women alike to achieve that desired state of physical perfection – a body like an athlete and a six-pack (or a tube-pack for the fairer sex) – without swearing, sweating and grunting their way through years of backbreaking workouts. Enter Vaser® Assisted High Definition Liposculpture.

Defining VAHDL

"Vaser® Assisted High Definition Liposculpture, or VAHDL, is an advanced technique of surgical body contouring that involves the radical removal of deep body fat, the selective removal of superficial fat near the surface of the skin with the Vaser® system, as well as autologous fat injections to create highly defined male and female torsos that are characterized by a well toned and athletic appearance," explains Singaporean plastic surgeon Dr. Martin Huang.

While comparisons may initially be drawn between conventional liposuction and VAHDL – both follow very different philosophies. In conventional liposuction, surgeons aim to simply create a slimmer appearance by removing as much fat as possible, which is commonly known as ‘debulking’ in the trade. "Conventional liposuction aims to reduce excess fat and create a slim appearance to treated areas," notes Dr. Huang. "VAHDL takes things a step further – not only do we create a slim body, but also a more beautiful body that has a well toned and athletic appearance."

"VAHDL is not about the amount of fat extracted, but what we leave behind. Often, we leave behind more fat than traditional liposuction. Our aim is to create the illusion of an ideal shape for the patient," says Colombian plastic surgeon Dr. Alfredo Hoyos, the creator of the VAHDL technique. Only Dr. Hoyos and a pioneer team of surgeons personally trained by him from all over the world are qualified and capable of performing the technique. Dr. Huang is part of that pioneer team, as is Malaysian plastic surgeon Dr. Heng Kien Seng.

In addition to proper technique, VAHDL requires the use of a medical device known as the Vaser® system. Advanced ultrasound technology, the Vaser® system made its debut on the ASEAN medical scene in 2006. The system features a number of innovations that allow trained surgeons to effect gentler, safer and more effective removal of fat in patients than conventional liposuction. It has been shown to remove fat without harming other tissues and nerves critical to fast recovery. Combined with a specific technique, the Vaser® system enables surgeons to effectively create an athletic, sculpted look in patients as if they’ve spent half their lives at the gym.

"VAHDL is probably the best way to achieve the six-pack or muscled look for men and the athletic, trim look in women," says Dr. Huang. "The other alternative is of course to exercise more, but even a lot of exercise doesn’t work for many people."

Patients undergoing VAHDL are able to achieve physiques akin to Greek statues. "VAHDL allows for the creation of an abdominal six-pack, accentuation of the serratus anterior muscle, highlighting of the external oblique muscle; defining the pectoralis major muscle in the chest and the radical removal of excess fat in the love handle area to create a ‘V’ shaped physique with a six-pack and a broad, muscled chest," explains Dr. Huang.

Women can achieve equally impressive results. "Via VAHDL we create the following features: in the abdomen we create a well shaped tube-pack and we perform a radical removal of excess fat in the love handle area, the lower spine and the tail bone area to create the illusion of a narrow waist along with the creation of two tail bone dimples. This latter manoeuvre accentuates the curve of the lower spine by creating a very feminine silhouette in the lower back while making the upper buttocks look fuller and rounder," says Dr. Huang. In other words, VAHDL creates shapely hips, rounded buttocks, a classic S-curve from the back down to the buttocks when viewed from the side, and a chiselled tube-pack appearance for a tummy that looks carved out of marble and alabaster.

Abs–olutely Amazing

Before the procedure, the surgeon works with the patient to mark out areas to be sculpted. This is critical. There is significantly less margin for error, as the surgeon will operate closer to the surface of the skin than with conventional liposuction in order to remove and sculpt fat. A miscalculation could leave a patient with burns, scars or skin craters, should too much fat be removed or if fat is removed in an uneven fashion.

Much like how a sculptor approaches a block of marble and marks out the bits to chip, remove, grind and sand to create a work of art, the surgeon marks out parts where he will remove more fat, parts where he removes just a little bit and others where he adds just a tad bit more from elsewhere. Like art, this isn’t a paint-by-the-numbers approach; each patient has a unique tack and a unique set of requirements to make them look athletic. "Every case is different but the goal is to make them look the best ever. For example, in some female patients who have no waist, it is necessary to leave some fat in the hips while intensive removal is required in the waist. In shorter females, we try to visually elongate the torso by contouring the outer abdominal muscles," says Dr. Hoyos.

The Procedure

Once marked, the patient is then prepared for surgery and put under general or epidural anaesthesia. Unlike traditional liposuction where advancements in safety and surgical techniques permit light sedation and local anaesthesia, VAHDL is best done under general or epidural anaesthesia for several reasons. The most immediate is that the procedure takes longer, and local anaesthesia and light sedation could wear off before the surgeon completes the procedure. In addition, VAHDL works very close to the surface of the skin, which is richly imbued with thousands of nerve endings. The procedure may be too painful without general anaesthesia – unless the patient has a pain threshold to the point where they consider root canals a stimulating way to relax on the weekend!

Once the patient is sedated, the real work begins. The surgeon follows his markings to create tiny incisions at key points on the body. Through these, a solution of saline and drugs that minimise bleeding and pain is slowly infused into the tissues of the patient until the flesh around the area to be operated on swells up like a firm balloon. This allows the surgeon to raise the skin in the treatment area to form a ‘scaffold’ that allows room to work as well as a medium for the Vaser® probe to safely liquefy fat.

Where conventional liposuction procedures generally take two to three hours, VAHDL normally takes more. "As soon as the surgeon gets comfortable with the technique and technology, surgical times can be reduced," notes Dr. Hoyos. It’s a long, artistic process as the surgeon methodically works to carefully thin out the fat in certain areas to show the underlying muscles and radically thin out fat in other areas to create a slimmer silhouette. In a way, it’s like sculpting a living statue.

Once the procedure is complete, fine silicone drains are inserted into the incision sites to allow for stale blood and other fluid to drain out. "This is so that these fluids do not accumulate in the body. This speeds up recovery and reduces swelling in the patient," says Dr. Huang.

In a couple of weeks, the stitched up incision sites will have healed. Because the incisions are so small, they’re virtually indistinguishable even if the patient prances around in the most revealing swimwear.

The recovery procedure is relatively similar to conventional liposuction. If the procedure is scheduled in the morning, patients can normally return home the same day. Some surgeons prefer patients to spend a night in the hospital under observation before returning home the next day. For the next few weeks, the patient is expected to wear a skin-hugging compression garment to ensure optimal results. Final results can be seen three to six months after the procedure when the swelling goes down. The procedure will last a lifetime; with regular exercise and a proper diet the results will improve even more.

Limitations of VAHDL

While VAHDL is capable of creating a dramatic change in people, it has its limits. VAHDL can’t turn the Michelin Man into Superman. "The limits of what VAHDL can achieve are defined by the indications. It can be performed on either gender with mild to moderate obesity but it is not suitable for the morbidly obese or when the patient has a lot of skin laxity. The skin tone and the presence of stretch marks are not contraindications for the procedure but can affect the final results," says Dr. Hoyos. Dr. Huang adds, "There are limits in terms of how much definition can be created in that there must be some underlying muscle mass to define in the first place."

Compared to traditional liposuction, VAHDL patients may risk additional complications. "Most of the complications seen in VAHDL are similar to the ones seen in traditional liposuction but the incidence of them is quite low and the surgery is just as safe as conventional liposuction," says Dr. Heng. He cautions that the procedure is complex and there is a potentially greater chance of irregularities because the work is much closer to the skin surface as well as performing more radical liposuction. In addition, the procedure can result in burns if the ultrasound probe is not used by trained hands as well as the chance for over-resection, a situation where too much fat is removed from an area, creating an obvious crater in the skin."

Recovery can also be a little more painful than conventional liposuction as it targets fat closer to the skin where a large amount of sensitive nerves are located. Another potential side effect of VAHDL is the increased tendency of seromas (pockets of clear fluid) occuring. These can be prevented by using silicone drains after the procedure.

The million dollar question beckons: can the results pass the look and – dare we say – the touch and feel test? Dr. Huang answers in the affirmative. "It’s possible to achieve very fine results that will stand up to close scrutiny. It is the muscles that you are actually poking. The patient’s natural flexing and movements will be natural for the same reason. "Dr. Heng concurs, "The results are natural and will pass the visual and touch test – when touched, the muscles feel firm and natural."

"The overall rate of satisfaction is very high, with a nice natural athletic contour achieved," says Dr. Hoyos, who has conducted over 900 cases of VAHDL. He adds, "Some of my patients come to me afterwards and tell me, ‘I never thought I could be this beautiful’. That, to me, is the most rewarding and profound message that my technique is helping patients attain the body of their dreams."

How Much? How Long?

Because VAHDL is so new in Malaysia and Singapore, prices have not been fixed and are determined on a case-by-case basis considering the extent of the work required. In general, it will cost significantly more than conventional liposuction due to the extra expertise, time and effort required to perform the procedure. The need for general anaesthesia during VAHDL also increases the cost.

How long will the results last? "Results will last as long as the patient has a constant body weight by maintaining a healthy lifestyle, a balanced diet and exercise," says Dr. Huang. Dr. Heng adds that, "While the results of VAHDL are excellent, they can be further improved if patients exercise regularly to enhance their muscle tone."

Essentially – you’ve been given the abs of your dreams, and it would make sense for you to keep them. Results will get better – provided you work at it that is.

With the ability to surgically create an athlete’s appearance with VAHDL, one may reason that virtually everyone would be lining up to turn himself or herself into the next Brad Pitt or Angelina Jolie. But that’s not yet the case. Neither is traditional liposuction expected to disappear.

While Dr. Heng has successfully completed his training in VAHDL, he receives more requests to conduct Vaser® LipoSelection® than for VAHDL. LipoSelection® is the term commonly used when surgeons use the Vaser® system to perform liposuction. "Not everybody wants an athletic look. Some just want the slim look achievable by conventional liposuction techniques or LipoSelection®," says Dr. Heng.

Over the Causeway, Dr. Huang has experienced similar feedback. "There’s been moderately strong interest, but not every interested patient ends up doing it. Sometimes this is due to the high cost. Other times, patients realise that maybe they don’t need or want to look so athletic and that they just want to look slim."

Dr. Huang, who uses only Vaser® LipoSelection® and VAHDL as his body contouring techniques, adds that, "VAHDL will not render the conventional Vaser® procedure obsolete, not at all, because not everyone is a candidate and not everyone wants it."

Dr. Hoyos says, "For those individuals, we highly recommend LipoSelection®, a major improvement over conventional liposuction that promotes fast recovery and smooth results." But for those who want to achieve that athletic look, VAHDL may be just the ticket.

Who Can Perform VAHDL?

Not just anyone can claim to be certified to perform VAHDL. In addition to the proper equipment (the VASER® ultrasound system) the surgeon must be certified via a special course before they can successfully perform the VAHDL procedure. A list of VAHDL certified surgeons worldwide can be obtained from www.alfredohoyos.com


Guide to Malaysian Doctors of Aesthetics

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