Corporal Filler HD, a Minimally Invasive Technique for Male Body Contouring: A Pilot Study

Abstract

Background:

The perception of body image is highly influenced by culture and society. Lean, more muscular, and strong bodies are usually pursued by men. Body aesthetics procedures have become popular, and minimally invasive procedures have been used to achieve body image satisfaction.

Methods:

This article describes a technique that utilizes hyaluronic acid filler to enhance muscular contours in the abdominal and pectoral regions. The procedure involves injecting hyaluronic acid filler at a level anterior to the pectoralis major and rectus abdominis muscles through marked entry points, creating an illusion of light and shadow that accentuates muscle definition. Additionally, the iliac region can be addressed to enhance the oblique muscles.

Results:

The results are illustrated with pre- and postprocedure images, demonstrating a significant aesthetic improvement, high patient satisfaction, and absence of serious adverse events.

Conclusions:

This minimally invasive technique is suitable for patients with a low body fat percentage and a desire to enhance muscle definition, providing immediate results with no downtime. Although the scientific literature on filler applications in the thoracoabdominal region is limited, this study demonstrates that precision in minimally invasive procedures can yield highly satisfactory outcomes.

Takeaways

Question: The study addresses a minimally invasive technique using hyaluronic acid filler for enhancing male abdominal and pectoral muscle contours.

Findings: The technique, involving hyaluronic acid filler injections, produced significant aesthetic improvements in the thoracoabdominal region. Results were demonstrated through pre- and postprocedure images, showcasing enhanced muscle definition. Patient satisfaction was high, and no serious adverse events were reported.

Meaning: This minimally invasive technique, utilizing hyaluronic acid filler, is ideal for individuals with low body fat percentages seeking immediate enhancement of muscle definition in the abdominal and pectoral regions, with no downtime.

INTRODUCTION

Beauty has been a subject of discussion for centuries, explored by great philosophers such as Plato and remains a contemporary topic. What is “beautiful?” It is more of a concept, an individual idea, rather than a concrete definition. The true definition of beauty remains ambiguous, and there is no unanimous explanation. The definition of beauty varies in the mind of each individual and throughout the course of human history.¹

Sociocultural influences are closely related to the perception of bodily beauty. Currently, a leaner body with more defined and visible muscles is associated with the ideology of a healthier and more desirable physique.²

The rectus abdominis muscle is a central anatomical structure in the abdominal region that plays a significant role in body aesthetics. It extends vertically from the pubic bone to the xiphoid process of the sternum, with its distinctive feature being the presence of a vertical band of fibrous connective tissue called the “linea alba” and its tendinous intersections separating the rectus abdominis into individual bellies. This division creates the appearance of six-pack divisions on the abdominal surface, which are highly valued in terms of body aesthetics.^3,4 The development and definition of the rectus abdominis muscles are considered essential for achieving a sculpted and athletic abdominal appearance, being a common goal in plastic surgery for body enhancement and contouring.^5,6

Another muscle of extreme aesthetic importance appreciated in the male athletic physique is the pectoralis major muscle. The pectoralis major muscle is an essential anatomical structure in the chest region, playing a crucial role in both body function and aesthetics. This bilateral muscle extends horizontally from the sternum, ribs, and clavicle to the upper part of the humerus. Its distinctive feature includes the presence of muscle fibers radiating from a central point, creating a pattern resembling a fan.⁴ A well-developed pectoral muscle not only imparts an athletic and robust appearance but also significantly contributes to symmetry and bodily proportion, characteristics highly valued in terms of male aesthetics.

In this article, we will provide a detailed description of the technique used for enhancing the lean appearance of thoracoabdominal region, which entails the application of hyaluronic acid (HA) to accentuate the muscular contours of the abdomen and pectoral area, creating visual contrasts that enhance body aesthetics.

METHODS

A detailed demonstration of the marking and application technique described can be viewed in the Video, providing visual guidance to complement the written instructions below. (See Video [online], which displays a detailed demonstration of the marking and application technique corporal filler HD.)

Video 1. which displays a detailed demonstration of the marking and application technique corporal filler HD.

Download video file ^{(35.5MB, mp4)}

Patient Selection

It is very important to consider patient selection as the results might be impacted mainly by the fat body percentage. The ideal patient must be in good physical health, low fat body percentage, and stable weight that desires to enhance muscle definition in abdomen and pectoral areas.

Anatomy-based Marking

A comprehensive understanding of the anatomical structure of the anterior thoracoabdominal wall is of extreme importance. The marking process for our technique, which involves innovative injection points (P1–P3, A1–A4, and I) should be performed with the individual in a supine position and under muscle contraction to better identify the intended projection area of the pectoralis major and abdominal muscles based on the patient anatomy for a more natural result.

Pectoral

Initially, delineate the contour of the pectoralis major muscle in its medial and inframammary portion on both sides, respecting the sternal region and extending superiorly along the clavicular line, as depicted in Figure 1. Three entry points per side are marked: superiorly, a point is demarcated just below the clavicle (P1); inferiorly, a point is marked at the inframammary border of the pectoral muscle (P3); and the medial point, P2, is located at the midpoint between P1 and P3 (Fig. 1).

Fig. 1.

Illustration with the required markings for the execution of the technique. P1, P2, P3, A1, A2, and I points represent the entry points. Medical illustration by Rodrigo Tonan and used with permission. Copyright © 2024 Rodrigo Tonan.

Abdomen

Two median abdominal lines must be drawn while respecting the linea alba. With the patient in a supine position and abdominal contraction, mark the upper and lower lines of the rectus abdominis muscles in “packs,” typically ranging from 4 to 8, depending on the patient’s anatomy and desired definition. Trace lines around the rectus abdominis muscles, separating the “packs” as desired while respecting the tendinous intersections. The entry points for the cannula are located in the lateral border at the midpoint of each “pack,” designated as points A1 to A4 depending on the number of “packs” to be treated (Fig. 1).

Iliac Region

If desired, the lower abdominal region for highlighting the oblique muscle near the iliac insertion can be addressed. The marking follows the upper contour of the iliac tendon to the iliac crest. The entry point should be at the highest point of the iliac crest on each side (Fig. 1).

Product

For the execution of this technique, a high G-prime cross-linked HA product, UP Max, Ilikia (CG Bio), is used, which consists of 20 mg/mL of HA with multiphase technology, where the particles are combined by the R² technology. This technology, revolution-rotation guarantees consistent encapsulation of all HA particles. Multiphase dermal fillers demonstrate superior viscoelastic properties, facilitating the uniform distribution of larger volumes during the injection process.^7,8

Preparation

Asepsis was performed on the entire anterior thoracoabdominal region. Local anesthesia consisting of lidocaine HCl 2% (without Epinephrin) was administered within the entry points.

Technique

Pectoral

A 22-G blunt cannula is inserted through the skin in the marked entry points P1, P2, and P3 at each side, advancing fully to the marked muscle contour. The HA is then injected into the subcutaneous plane as the cannula is withdrawn (retroinjection technique). It is recommended to deposit a larger amount of product in the area adjacent to the pectoral border and use a smaller quantity in the retroinjection to create a gradient effect and achieve a more natural result. Repeat the process through the premarked area (Fig. 1). The volume of product applied depends on the patient’s physical structure and the desired effect. It is suggested to use 3 mL of filler at each P1 and P3 point and 1.5 mL of product in the P2 region. This will result in a total volume of 15 mL of filler applied in the pectoral region.

Abdomen

Access this region through the marked entry points (A1–A4). The subcutaneous application technique using retroinjection and initial application at the demarcation border should be maintained (Fig. 1). For the upper packs, it is suggested to apply 4.5 mL of product per pack, and for the lower packs, use 3 mL of product in each pack, totaling 15 mL of filler.

Initially, it is recommended to address the four upper packs marked in Figure 1. Depending on the patient’s anatomy, the remaining packs can be addressed using the same technique. Great attention should be given to avoid filling the area of the linea alba and tendinous lines, maintaining a high-definition play of light and shadow.

Iliac Region

For the detailing of the iliac region and enhancing the definition of the oblique muscle, the area should be addressed according to the demarcation presented in Figure 1, applying the filler in a superolateral and inferomedial direction through the marked entry point. The detailing of the inguinal region involves the precise application of the oblique muscle area (Fig. 1). It is suggested to apply 7.5 mL of product per side, through retroinjection in the subcutaneous plane.

RESULTS

In our experience, we have performed 10 cases of minimally invasive thoracoabdominal male body contouring using the described technique, with an average age of 35 years, average body mass index of 21.4 kg/m², and none of the patients presenting relevant medical history. The average quantity of filler used was 42 mL, having excellent results and patient satisfaction.

In Figure 2, we show images depicting preprocedure, immediate postprocedure, 30 days postprocedure, and 120 days postprocedure in a 25-year-old patient. In Figures 3 and 4, we show others patients’ images depicting preprocedure, immediate postprocedure, and 90 days postprocedure. All patients rated aesthetic result as very much improved on the Global Aesthetic Improvement Scale and throughout the follow-up period, and there were no reports of adverse events.

Fig. 2.

Thoracoabdominal images of a 25-year-old man. A, Before the procedure. B, Immediately after the procedure. C, Thirty days after the procedure. D, One hundred twenty days after the procedure.

Fig. 3.

Thoracoabdominal images of a 34-year-old man. A, Before the procedure. B, Immediately after the procedure. C, Ninety days after the procedure. The procedure was performed only in the pectoral region.

Fig. 4.

Thoracoabdominal images of a 29-year-old man. A, Before the procedure. B, Immediately after the procedure.

DISCUSSION AND CONCLUSIONS

Gould et al⁹ used a crowdsourcing approach to explore the public’s criteria for the ideal abdomen and their attitudes toward available methods, whether surgical or nonsurgical, to achieve this aesthetic ideal. In the cohort of patients of 25–34 years of age, it was found that 57% expressed a willingness to undergo nonsurgical interventions to attain the ideal abdomen, although only 17% showed interest in surgical procedures. These findings reveal a clear preference for nonsurgical approaches among study participants when it comes to enhancing abdominal aesthetics.⁹

The described technique is particularly suitable for patients with a low body fat percentage who maintain good physical fitness and are committed to exercise. This approach is designed for those who want to enhance muscle definition in areas like the pectoral and abdominal regions, seeking a more pronounced aesthetic appearance through a minimally invasive cosmetic procedure, with no downtime period. Patients should be made aware that weight fluctuations can influence the final result, and maintaining a stable weight is important for long-term satisfaction. Despite having a significant cost, this technique can be advantageous for patients looking for nonsurgical procedures.

A comprehensive patient history and alignment of expectations in this context are essential. It is crucial to highlight that the amount of filler used is variable and should be customized to ensure an individualized and satisfactory aesthetic result. Our findings show that by following the technique, we achieve precise filler distribution with minimal irregularities. During muscle contraction, the product becomes more visible. Although muscle activation can affect contour postprocedure, we have not seen significant irregularities. Importantly, no filler migration was observed in our study, though long-term monitoring is essential to fully understand potential degradation and migration over time.

Meticulous filling in the iliac region further accentuates abdominal muscle definition, creating a smooth and aesthetically pleasing transition. This results in a more sculpted and symmetric appearance, contributing to an overall satisfactory aesthetic outcome.

Although the scientific literature related to filling in the thoracoabdominal region is limited, it is essential to note that, due to the superficial subcutaneous application, the risks associated with this procedure are minimized. In this region, despite having a rich vascular network, careful positioning of the cannula during filling also contributes to risk minimization, as the subcutaneous layer typically lacks major blood vessels. Various surgical procedures have been described to achieve the coveted 6-pack abdomen.^5,6,10–12 However, it is important to recognize that, despite their effectiveness, these surgical interventions come with significant risks and drawbacks. This includes the recovery period, the need for anesthesia, the potential risk for fluid collections or seromas, occurrence of hyperpigmentation, visible scars, contour irregularities, and in some cases, the need for revision surgery.⁶ Beyond HA fillers, there are few products that could be used for a similar procedure. In the authors’ experience, calcium hydroxyapatite could be considered, but it is primarily intended for treating skin laxity rather than body contouring. Additionally, HA filler can be removed with hyaluronidase if necessary.

The procedure described here has already been performed on more than 10 patients, resulting in high patient satisfaction, immediate results, and no adverse events. Despite the latest follow-up being conducted at 120 days, no loss of results was observed. Studies on the durability of this specific dermal filler have yet to be conducted to establish the longevity on this area. However, according to the manufacturer, the product lasts between 12 and 18 months. Some patients reported pain on touch, equimoses, and hematoma for a short period of time, but no serious adverse events were reported. Further studies and long-term follow-up are warranted. However, because the product degrades over time, it is recommended to consider periodic maintenance sessions to ensure continued patient satisfaction. This description serves as evidence that minimally invasive procedures, when applied properly and executed with great care and precision, can lead to highly satisfactory results.

DISCLOSURE

Dr. Dziabas is a speaker for Galderma, Merz Aesthetics, IBSA Derma, Entera, LMG Lasers, participating in lectures and medical events for these brands. Dr. Kasai is a scientific consultor for Ilikia Brasil, participating in lectures, consulting, and medical events. Dr. Viana is a scientific consultor for Ilikia Brasil. To perform the described technique, a high G-prime HA filler is required, and the product used was UP Max from Ilikia. The company Ilikia Brasil provided support in medical writing as well as in the publication of this article.

PATIENT CONSENT

Patients provided written consent for the use of their images.