From now until sometime in Spring 2023, we’ll be writing about gender affirming surgeries and procedures. We’re starting with bottom surgeries and will end with office visit procedures such as fillers and botox. We finished our bottom surgery series last week with scrotoplasty, and we’re moving on to procedures for other parts of the body today with body contouring.
Content advisory: we will be using anatomical terms and discussing surgical procedures in this article and this series. External sites that we link to may contain graphic images.
What is body contouring?
Body contouring is sometimes called body sculpting. It can refer to procedures that do not require an incision, like cold, laser, and radio frequency treatments, to injections that target fat cells, and to treatments that require an incision, such as liposuction and fat grafting.
In gender affirming body contouring, these procedures are often used to change the waist-to-hip ratio, the shape or width of body areas such as the abdomen and buttocks, or to add definition in specific areas.
Dr. Scott Mosser’s Gender Confirmation Center website has an excellent section devoted to body contouring. Note that clicking on the “Body Contouring” link will default to the “masculinizing” material. From the link drop-down, you can choose “Masculinization,” “Feminization,” or “Non-Binary.”
A note on language use at QueerDoc:
We believe that there’s no one way to be trans. We also believe that there’s no one way to be masculine, feminine, or non-binary, and that what these terms mean has a lot of overlap for individual people. When we talk about the effects of estrogen on bodies, we like to use wording like “gettin’ curvy” We use “angles” or “gettin’ square” for the effects of testosterone.
If you’d like to read about changing bodies through either hormones or exercise, check out:
Gettin’ Curvy: Estradiol, Progesterone and SERMs
Gettin’ Curvy: Workouts for Flexibilty, Strength, and BOOTY
Gettin’ Square The QueerDoc Way: Testosterone
Building a Broader Physique: Exercises for Angles
Liposuction and Fat Grafting
Liposuction involves inserting a tube through a small incision near the targeted area. The surgeon then uses a vacuum device to break up and remove fat. The strength of the vacuum and shape of the tube can be changed for desired results.
For individuals seeking to create or enhance their curves, a combination of simultaneous liposuction and fat grafting may be done. This is done under anesthesia. The ability to create curves may be restricted by the total amount of fat that is already present in the torso and thighs.
To change the waist-to-hip ratio towards more curves, fat on the sides of the abdomen just above the height of the belly button is moved to the sides of the hips. Fat can also be moved from over the rib cage (front, sides, and back) and the full length of the belly and back, and from the inner and outer thighs.
Changing the height of the waist on the on the torso can also be done. Estrogen-dominant bodies tend to have a waistline closer to the pelvis, while testosterone-dominant bodies tend to have a waistline higher up on the torso.
To make buttocks curvier, fat is moved to create a slope from where the spine dips and starts to curve back out towards the sacrum and coccyx to create fullness higher up on the butt. More definition can be added to the top of the butt crack as well. This can be done simultaneously with waist definition.
For individuals seeking a more angular form, liposuction can be used to change the amount of fat padding at the waist and hips, the abdomen, the inner and outer thighs, and the around the rib cage and back. For a more angular waist and flatter slope to the butt, fat can be removed from the sides of the hips and the transition from back to butt, and change where the butt is most prominent. If needed or desired, fat can be added to the waistline via fat grafting to decrease the difference between the waist and hip circumferences.
Finely tuned liposuction can also increase muscle definition by removing fat above musculature to enhance natural definition (this may not be the most painless way to get a 6-pack, but it probably needs the least reps.) Often “mansculpting” is offered as an additional procedure during top surgery.
Recovery for liposuction often requires a couple of days in bed with very reduced movement, then a gradual return to more strenuous activities. Individuals may need to wear compression garments for a few weeks.
Wanna Get Nerdy?
The article “Gender Affirming Body Contouring and Physical Transformation in Transgender Individuals” may suit your fancy. (1) Contained in the article are pictures and a discussion of some of the techniques mentioned in this blog:
- surgical markings for liposuction and fat grafting (Fig. 5,)
- before and after pictures of liposuction and fat grafting for enhanced curves (Fig. 6,)
- liposuction for a more defined, angular abdomen (a six-pack) (Fig. 10.)
Content Note: These images are of unclothed torsos with and without breasts shown. Some language in the article is gendered, and other images in the article include pictures taken during surgery. The article also discusses shoulder width reduction.
Non-Invasive Body Contouring Procedures (and Brand Names)
Using Cold (CoolSculpting)
The medical term for CoolSculpting is cryolipolysis. This is a “spot” treatment procedure. It works on one part of the body at a time, although a person can have multiple sessions targeting different areas or the same area multiple times. During cryolipolysis, fat cells are treated with specifically aimed cold temperatures. The cold damages the fat cells but not the surrounding tissues. After treatment, the body will gradually get rid of the damaged fat cells over the next few months.
Each treatment takes about an hour, and recovery is minimal. The individual may feel some discomfort in the targeted area after a session.
Find out more at the American Society of Plastic Surgeons’ write up of cryolipolysis.
Using Injections (Kybella)
The medical term for treatments like Kybella is injection lipolysis. It is approved to remove fat deposits under the chin.
The mechanism of injection lipolysis is similar to cryolipolysis – specific fat cells are targeted and then damaged. The body then gets rid of the damaged cells. In injection lipolysis, this is done by injecting deoxycholic acid into the area to be treated. Read up here.
Using Heat (Vanquish)
Vanquish is radiofrequency lipolysis. Instead of freezing fat cells with targeted cold, radiofrequency lipolysis uses radio waves to heat up fat cells, which the body then gets rid of. Radiofrequency lipolysis is typically used to diminish fat deposits in the belly area. Each treatment takes about thirty minutes. Multiple areas may be treated, and specific areas may be treated more than once.
Using Light (SculpSure)
SculpSure is a brand name of laser lipolysis. While the laser uses light waves, the impact is just like using radiofrequency waves: fat cells are damaged by heating them up, then they are removed by the body. Laser lipolysis is typically used on the abdomen and sides of the torso. Laser treatments last about half an hour. Results are seen in several weeks to a few months.
How to Get Body Contouring Treatments: Surgeon and Insurance Requirements
A growing number of insurance plans include body contouring in their gender affirming care policies as they can be medically necessary for the treatment of gender dysphoria.
Check out our blog series on insurance:
We Do It For You: Care Navigation
For insurance coverage of gender affirming procedures, you will likely need two letters from a mental health provider for the person doing your treatments, along with a letter from that person and/or your hormone provider for insurance. While many providers do not require hormone use for liposuction or other body contouring procedures, hormone use does change where the body stores fat, so it may be helpful to have been on hormones for a year or longer to get the process started.
The Who: Finding a Provider
Many plastic surgeons who provide gender affirming surgeries also provide liposuction, and may offer liposuction as an additional option during gender affirming surgeries. If they are in private practice, they may also offer noninvasive forms of contouring. Many plastic surgery departments of hospitals and teaching institutions also provide body contouring procedures.
Some other directories of surgeons and providers include
- WPATH Provider Directory
- OutCare Health
- The r/TransSurgeries wiki on Reddit
We also recommend talking to your gender affirming health care provider and to others in your communities.
- Asokan A, Sudheendran MK. Gender Affirming Body Contouring and Physical Transformation in Transgender Individuals. Indian J Plast Surg. 2022 Aug 23;55(2):179-187. doi: 10.1055/s-0042-1749099. PMID: 36017408; PMCID: PMC9398519.
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