Q: Dr. Eppley, I am having abdominal etching liposuction next week. How defined do you think you can get for me as well as removing my love handles? I know this guy is 28 and I’m 52 but I really want to get some definition with the abdominal etching.
A: I believe your answer comes from what you have stated after your initial question. Your observation that the model is 28 while you are age 52 speaks volumes in terms of result expectations….that is not an achievable goal. Three factors come into play in any type of body contouring that will define the result…1) How toned and defined are the underlying muscles, 2) how thick is the fat layer between the muscle and the outer skin and, of equal if not greater importance, 3) how much elasticity of the skin exists to shrink down around the reduced fat areas. The older one gets the loss of skin elasticity plays a major limiting factor. I have seen goal pictures like the one you have provided many times and I have yet to see any patient get that type of abdominal etching result no matter how much fat is removed.
In short I think we should temper our expectations to an abdominal result that has some definition but never as defined as we would like.
Dr. Barry Eppley
Can Abdominal and Pectoral Etching Be Done At The Same Time As Abdominal Liposuction and Gynecomastia Reduction?
Q: Dr. Eppley, I’ve been seeing a lot of stuff online regarding abdominal and pectoral etching that brings out the corresponding muscles. Is this something you can do along with the liposuction/gynecomastia procedure I am undergoing? Thanks.
A: Pectoral and abdominal liposculpture (to be differentiated from volumetric liposuction reduction) are fine cannula liposuction techniques that can be done as a stand alone procedure or combined with overall chest and abdominal liposuction. They are designed to try and highlight the natural underlying musculature which everyone has. In the abdomen it is known as etching where linear liposuction is done along the linea alba vertically and horizontally along the tendinous inscription lines to hopefully create more of a six- or eight-pack look. In the chest, the lateral pectoral triangle is aggressively reduced along the lateral pectoral muscle border up into the axilla as well as fat injections done into the lower pectoral muscle border hopefully creating a more defined pectoral outline. The success of these manuevers is highly dependent on the patient’s natural fat anatomy and work best in individuals that are already somewhat thinner.
What done as a stand alone procedure in already thin patients who do not require much volume reduction, they produce the best results. When done as part of an overall gynecomastia and abdominal reduction in someone who is not heavy or grossly overweight (you) usually modest definition is achieved. In heavier patients or patients with thicker abdominal fat and fuller gynecomastia problems, these are not good techniques as the results will simply not be very visible.
In short, these liposculpture techniques can be applied at the time of your gynecomastia and abdomninal liposuction procedure. They add a little more time to the procedure as they involve etching manuevers after the gross fat removal is done. They key about them is that patients need to have realistic expectations as how visible the muscular outlines will be and that it usually takes up to 3 months to see the fine details of the result.
Dr. Barry Eppley
Q: I am interested in learning more about abdominal etching. I am into bodybuilding and and love to sculpt my body. However, even when I diet down my love handles take away the full V-taper appearance. Also, my abs are never really etched like I want them to be. Right now I am actually pretty lean and do not have a lot of fat around my mid-section. It seems like from various pictures on the web, most after images are not really that great. Granted they were not in the best shape to begin with, but I would feel better seeing more pictures of a better after-shot. I was wondering if you had a computer program or are able to manipulate a photo to show what the end result could look like after the surgery?
A: Contrary to whatever pictures you may have seen, I have found that abdominal etching gives very good results. The key is proper patient selection. Not everyone is an ideal candidate as the most lean patients are those who benefit the most. The results are also affected by how aggressive one is with the technique and what expectations the patient has. Etching is basically linear liposuction done with the intent to remove almost all fat between the skin and the underlying abdominal fascia. (this is not what you normally do in liposuction) There is always a central vertical line and at least 3 horizontal lines at select levels. Occasionally additional vertical rows are put in out laterally. It is a very simple recovery since this is really liposculpture and not volume liposuction removal. I find the use of the Smartlipo probe to be very helpful in performing this procedure.
I would need to see a picture of your abdominal area to see if you are a candidate. Computer simulations I do not find helpfulfor this procedure for patients as anything can be done with Photoshop, that does not mean it will turn out that way from actual surgery. Marking the lines on the photo, however, can be educational for the patient.
Dr. Barry Eppley
Q: I am interested in getting a six-pack look to my stomach. I work out all the time and do a lot of abdominal crunches but it is just not appearing. I am a man who is fairly lean and have only 9% body fat at 34 years of age. I have read about a liposuction method called ‘etching’ which can make the six-pack look in one surgery. Can you tell me how it is done and what makes it work? Are there any long-term problems with having it done?
A: The abdominal etching surgery to which you refer is a modified liposuction method for producing abdominal highlights. Using fine liposuction cannulas, fat is removed along predetermined highlight lines in a linear array of a central vertical line and multiple (usually three) horizontal lines. By removing linear lines of fat lines, this causes the stomach skin to selectively indent inward which then appears like the underlying abdominal muscles lines, creating the ‘six-pack’ look. Interestingly, abdominal etching is done in exactly the opposite way that traditional liposuction is done. Rather than trying to remove an even amount of fat over a broad surface area of the abdomen to avoid any irregularities, etching deliberately aims to create indentations through an uneven (but precise) amount of fat removal. Abdominal etching is really best done on someone who already has a near flat abdomen and wishes for a more liposculpture approach rather than a large amount of fat removal. It is not a good idea for someone who has a large protuberant abdomen or is significantly overweight. The only long-term issue is what would happen if you gain abdominal weight. The etch lines may look peculiar on a bigger belly.
Dr. Barry Eppley
Q: I had an abdominal etching procedure with liposuction of the love handles one month ago. I also had a lower buttock lift. But I still have not seen abdominal muscles. I want to have abdominal etching again. Is it possible? How long will I have to wait? I also want to have a buttock augmentation using fat cells. My butt looks too small and I want to make them lifted rounder and fuller. Is that possible?
A: Abdominal etching is essentially a linear form of superficial liposuction. While the swelling from this surgery is not completely gone from this operation, you should be seeing some of the etching at one month after surgery. If you are not seeing any signs of the etching pattern by now, that would indicate that it may not been done aggressively enough or with inadequate technique. The etching can be redone but I would wait at least 3 months after the first procedure before doing a revision. That will give you adequate time to be sure that the etching result is insufficient.
Buttock augmentation is commonly done with fat injections, often called a Brazilian Butt Lift. The only limiting factor in this non-implant buttock augmentation is whether you have enough fat to harvest. It is usually taken from the abdomen and flanks but those donor sites may have already been liposuctioned in your first procedure.
Dr. Barry Eppley
Q: Just wondering how common abdominal etching is amongst females. Most research online seems to be pointing to men only.
A: Abdominal etching is a plastic surgery procedure for the artificial creation of a ‘six-pack’ appearance. This is done through liposuction techniques by removing linear strips of subcutaneous fat to highlight where the muscular inscriptions would be. This creates indentations in the overlying skin which looks like muscular definition. It should only be considered in a fit individual whose has a limited fat thickness over the abdominal area. It not only works better in this type of patient but will also look more natural. I currently use a Smartlipo technique which has a 3mm wide probe and metal cover which creates nice thin tunnels with very small entrance incisions. The heat from the laser helps the skin contract down as well.
You are correct in that it is much more commonly requested and done in men. That undoubtably reflects our current cultural fashion standards where men are defined by their muscle mass and definition while women are better appreciated for their curves. (history also shows that this is true through the ages) In my Indianapolis plastic surgery practice for every 10 abdominal etchings I have done, nine are done in men. But I have done a few in women.
The surgical technique is the same in women and is actually a little easier to do with more consistent definition in my observation. This is likely due to the thinner subcutanous fat layer that exists in most athletic women.
Dr. Barry Eppley