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Getting good results in liposculpture and buttock augmentation using fat grafts is a real challenge. Thin patients with very small localized fat deposits are difficult to handle. The author explains how to get good results using little hints that are very important for good results. It all begins with the marking, goes on with the infiltration, and finishes with the technique. Good, long-lasting results depend on the way the fat is grafted and the way the patient takes care of herself after treatment.

Treatment modalities for cellulite, localized fat, and other cosmetic conditions have proliferated over the last several years. With the escalating demand for noninvasive cosmetic procedures, mesotherapy have attracted interest from physicians and the general public.

Liposuction is an outstanding technique created, described, and popularized by Yves Gerard Illouz. He created the cannula, which is a fundamental instrument for liposuction to create tunnels inside the adipose tissue instead of undermining. He also developed a machine that exerts negative pressure in order for the fat to be aspirated. Liposuction is used for the treatment of localized fat in all regions of the human body and it is not a method for treatment of obesity. The cannula should work in deep tissue plane in order to leave a superficial fat layer on the panniculus in order to have harmonious results. The use of local infiltration is obligatory in order to avoid bleeding. Illouz taught his technique worldwide by giving lectures, performing surgical demonstrations, and by scientific publications. Liposuction brings many advantages for the treatment of localized fat deposits and a very high rate of satisfaction to patients.

Localized fat deposit in man and woman represents one of the main causes of dissatisfaction of the body image in this millennium, where the consideration for a slim and pleasant proportioned body has taken the place of the fat woman of the middle ages at the beginning of 1900. New models introduced by the media and imaging have pushed the population to follow diet and regime to try to be on shape, and for most of the lifetime, struggling against the temptations of good food and lazy life. Healthy food, gymnastics, exercise, and running are all types of new trends of life scenario that have been introduced in the last 20 years and have revolutionized our lifestyle. Despite all these attempts, fat deposits in women and men have remained unchanged. This is mainly because of hereditary disturbance of constitution and hormonal change mostly in woman, rather than for the difficulty of most races, such as Black and Arab, to change their style of life and nutrition through the ages. The new generation is very focused on the aspects of the body, aiming to be slim and sexy and devote great attention to nutrition, exercise, and body enhancement. For limited areas of fat accumulation, what we generally call lipodystrophies, a new treatment has been introduced recently following the previous experience of internal and external ultrasound energy.

The topic of injection lipolysis remains controversial even 5 years after of becoming a popular treatment for reducing localized fat deposits with injections rather than surgery. The technique was invented by Rittes who had studied mesotherapy with Lecoz in France. A patient, knowing of Rittes skill with injections, requested an injectable fat reduction for her lower lid bags. The patient persisted despite the absence of an injectable technique for localized fat reduction at that time. Rittes researched the pharmaceutical and clinical literature for a solution. She found Bobkova’s article describing the endovenous plaque reducing qualities in Lipostabil, a Sanofi Aventis drug containing phosphatidylcholine (PC) made from soy lecithin [1]. Rittes’ paper, published in 2001 [2], is often quoted as the origin of the injection lipolysis procedure.

Since the beginning of the 20th century many surgeons have tried to alter the body contours to fit the concepts of beauty of each period of time. Since its introduction by Illouz, liposuction has become the gold-standard option for body contouring surgery, i.e., the treatment of localized fat deposits. Initially, improvements in standard lipoplasty outcomes were due primarily to advances in the aspiration cannula tip design and reductions in diameter. Other advances in lipoplasty involved the addition of technology and techniques that used energy-based devices, such as external ultrasonic assisted lipoplasty, ultrasonic assisted lipoplasty (UAL), and power assisted lipoplasty (PAL). In this article the author describes a new approach to lipoplasty, combining a new body contouring technology, the VASER, with a new technique where cannulae and probes are only passed in the same direction as the muscular fibers underneath instead of the more traditional cross-tunneling. Excellent results have been achieved and the number of revisions after lipoplasties has been decreased.