1- How did you develop the VASER High Definition Liposcuplture (VHD) technique?
What is the history behind it? What situation or needs from your patients or research that prompted you to create High Definition Liposculpture?
High Definition Liposculpture was born from an innate need to solve a very common problem. It all started with a young woman who came crying to my clinic. She was a model, but was not getting any assignments, because the clients felt that she was ‘fat’. She was turned away by two other plastic surgeons, who felt that she needed psychological help because she was really slim. After listening to her, I understood that the problem was not in her mind, but in the limits of the liposuction as a procedure. I began looking for something that could help me in the medical literature, but nothing was written about that. Everything was for very athletic males.
I slowly started to add little refinements introducing the anatomy of a body builder in to a normal, average person. The patients simply loved the results, and thus, the birth of High Definition Liposculpture. HDL is a totally different surgery, requires the surgeon to have a complete change in the mindset of how liposuction should be performed. Although my fellow practitioners never acknowledged that it was something innovative, I often received calls from some of them to learn the procedure.

2- What is the philosophy behind High Definition Liposculpture . I understand it's a fundamental change in mindset from your average liposuction procedure. How so?
From my personal point of view, I think the patients actually understand what is behind the HDL, better than us as surgeons.
The media confuses us. They drum you with different messages daily. “Skinny is beautiful”, “Models are all anorexic”. If you eat, everything that you eat is bad and will lead you to obesity, which is worse. There lies the misconstrued perfect body image. Slim is good, but to look healthy, is the ultimate goal. It becomes desirable to look like a high performance athlete. Thus, giving the impression of being highly disciplined and a lot of time to spend in a gym. Very often, people who work out realized that they are not able to achieve the results they want.
Combining the raised expectations and mindset from the patients and the enhanced surgical refinements in HDL, we are now able to marry the two concepts into real life.

3- How does High Definition Liposculpture vary from your average conventional liposuction procedure? How is the procedure conducted?
(I understand that several aspects are under NDA, broad specifics will suffice -can it be done under local or is GA necessary? Is tumescent infiltration necessary?
How long is the op time and will it take longer over standard lipo?)
The main difference between VHD and the standard lipo, is that VHD is an exacting technique, and the debulking (standard lipo) is just the first step. Adding two more steps combining superficial and deep liposculpture, the superficial anatomy can be now shown in the desired areas. VAHDL is not about the amount extracted, but what to leave behind. Often, we leave behind more fat than traditional liposuction. Our aim is to create the illusion of ideal shape for the patient.
For example, in some patients that have no waist, it is necessary to leave some fat in the hips, while an intense treatment is required in the waistline. That will leave us the illusion of wider hips bones. In shorter females, we try to visually elongate the torso by contouring the lateral oblique muscles. Every case is different, but the goal is to make the patient look the-best-ever. 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 achieve and attain their dreams and desires.
The procedure can be performed under local anesthesia in certain cases, but when a treatment of the all torso is required, it is more suitable under GA. For an accurate extraction, objective tumescent infiltration is mandatory. The downside of the VHD, is that it requires more time for the surgeon, since is more an artistic job than a surgery. Carving and modeling fat. Remember that VHD begins where the normal liposuction ends. The recovery after VHD has a shorter timeframe than standard lipo. No additional time is needed, although special postoperative care is needed, as compression garments and physical therapy. The results can be seen from the 4th week.

4- Is an internal ultrasound probe (ie. VASER) necessary for best results with the technique or can it be done without it? If so, why is it required (eg- tissue contraction, ability to target closer to skin surface?)?
Usually for reaching the VHD skills, special technology is required, that allows the surgeon to achieve a fine and smooth treatment of the superficial layer of fat, otherwise the patient can have irregularities in the contour and skin problems in the upcoming results. VASER is an enabling technology for VHD; it can give us a consistent and soft management of the superficial layer, making the results more reproducible and reliable by the surgeon.

5- What is the change in mindset that you teach your students in when they wish to adopt Vaser-Assisted High Definition LipoSculpture technique?
The philosophy behind VHD requires a totally different mindset from the doctor. Usually for a surgeon, liposuction is a boring - non-creative procedure, with no passion or art involved. It was created just for debulking, for the slim look, but not for obese, and definitively not for people with high expectations.
The first thing I teach my students is to learn to observe a human form differently, looking for detail on the street, in the magazines, at the gym, and in their own patients. It has to become an obsession for art. As they become more fascinated by the beauty of the human body, the procedure becomes more of an art than a science. The technique itself is easy and reproducible, but the key to doing VAHDL is an understanding of the anatomy as an artistic manifestation of surgery.

6- I understand that the technique has been personally developed by you and has currently only been taught to a selected few. Is there any form of certification or authentication that patients seeking VAHDL will know that they are getting it from an actual, legitimate student?
For me it is important that the people who learn this procedure have all the resources and the proper training. The training is performed by a team of expert surgeons and myself through the VASER Institute. A special program has been designed to offer hands-on training and certification to our students. Designed for surgeons by surgeons, the VAHDL training is a dynamic view of the marriage of new techniques and new technologies. We already have trained 8* surgeons in Asia. The patients seeking a High Definition procedure will have a list of the surgeons trained in VAHDL on the websites: http://www.alfredohoyos.com & http://www.vaserinstitute.com

7- What sort of results can a patient ultimately achieve with High Definition Liposuction? If one were to walk up to a patient who have had VHD and pokes their muscles, will it feel real?
The results of VAHDL are different on every patient, but the goal is to obtain very natural, very athletic results. An athletic appearance is more appealing, and makes the patient to look younger also. With the proper care, a patient can look like they have been in the gym all their lives.

8- Are there any additional risks when undergoing High Definition Liposuction compared to traditional liposuction?
The risks of HDL are just the same risks as any liposuction. High Definition can not only extract the fat but also selectively retain some of it. The amount of fat extracted can be less than traditional methods, and so it is, in a sense, safer. On the other side, VHD requires more time and precision, and the length of the procedure can be slightly longer.

9 - Will high definition liposuction render standard liposuction obsolete? Where do you see liposuction technology heading in the future? In my personal opinion, the globalization and the speed of media had already set for us a high point of beauty standards, but the technology and techniques were not available to fulfill these desires. The trends are not going anywhere but up, and the people will become more and more interested in a procedure that can offer safer surgery and better results.
The future is certainly bright. Since the existence of liposuction 30 years ago, technology has been updated every day in the area of body contouring surgery. This enabling technology has helped numerous surgeons perform better and improve the techniques, going beyond the obsolete debulking.

10 - Is there any particular point or information you'd like to emphasize to readers?
HDL was invented as a different option for people who want to look more healthy and athletic, without exhausting sessions at the gym. But it has to be accompanied by a change in the lifestyle to get long lasting results. It is very easy to stay fit after HDL, when the patient already has the figure that they always desired and dreamed of. The enhanced image reflected from the mirror can be a good starting point to change general attitudes of proper diet and exercise. HDL can be a real life changer.

11 -How much on average would a high definition liposuction procedure cost in USD

The pricing of a HDL procedure can be very variable, according to each case, but the general average is from US$8000 to as high as US$30 000.

12. Are there any finite limits as to what can be achieved? What sort of results can a patient realistically expect? Can you get the Michelin man (or woman) and turn them into Kate Moss or Arnie?
Before the surgery, it is mandatory to show the patients what can or cannot be done with the VHD. Some before and after pictures can assess the patient expectations more realistically.
The limit of what VHD can achieve is defined by the indications. VHD can be performed in male and female between mild to moderate obesity, but it is not suitable for morbidly obese patients. The skin tone and the presence of stretch marks are not contraindications for the procedure, but can affect the final results. Also, some medical conditions such as heavy smokers or sedentary lifestyle must be taken into account. After VHD, it is recommended to seek advisory in dieting, exercise and personal health care for a permanent lifestyle change.