Ultra HD Liposuction: Enhancing Abdominal Etching Using Ultrasound-Guided Rectus Abdominis Fat Transfer (UGRAFT)

Abstract

High-definition (HD) liposuction has allowed surgeons to sculpt the abdomen, enhancing abdominal etching. To create a more athletic abdomen, fat grafting has been used subcutaneously, and rectus abdominis fat grafting has been performed in patients undergoing lipoabdominoplasty. With the objective of increasing muscle volume to obtain a natural-looking abdomen in patients who are not suitable for abdominoplasty, we propose the use of ultrasound-guided rectus abdominis fat grafting (UGRAFT) in association with HD liposuction.

Patients: A prospective study with 10 consecutive patients undergoing UGRAFT was conducted. After HD liposuction, UGRAFT was performed from an incision in the umbilical region, using a blunt 2.5-mm cannula assisted by ultrasound. Fat injection was done closer to the anterior rectus sheath in the lower and middle muscle bellies.

Results: UGRAFT was performed in 10 patients. The mean age was 34.8 years (range, 24-51 years). The mean body mass index was 23.83 kg/m² (range, 20.58-28.39 kg/m²). The mean volume of fat injected per "pack" was 34 cm³ (range, 20-40 cm³). UGRAFT added a mean time of 20 minutes (range, 15-30 minutes) to HD liposuction. Comparing the rectus abdominis muscle thickness pre-UGRAFT and post-UGRAFT, average muscle thickness increase was 5.1 mm (55.7% ± 37%), with P < 0.0001.

Conclusion: UGRAFT showed to be helpful for obtaining muscle expansion and a more natural abdominal contour, avoiding that unnatural appearance that HD liposuction may provide in patients who gain weight or have skin laxity.

Fig. 1.

Surgeon holding an ultrasound probe with the left hand and a cannula with the right hand to perform UGRAFT. The cannula is introduced by an incision in the umbilical region and carefully guided by an ultrasound image until it penetrates the rectus abdominis sheath.

Fig. 2.

Schematic figure demonstrating the UGRAFT. A cannula is introduced by an incision in the umbilical region and, under very careful ultrasound-guided movement, penetrates the rectus abdominis anterior sheath. An intramuscular bolus injection was performed closer to the anterior rectus sheath in the lower and middle “packs.”

Fig. 3.

A 33-year-old female patient classified as “6-pack” and Matarasso type 1 (body mass index = 21.3 kg/m²) undergoing high-definition liposuction with UGRAFT. Thirty milliliter of fat was injected into each of the inferior and middle “packs.” A, Preoperative view. B, Postoperative view.