Your Questions
Your Questions
Q: Dr. Eppley, I am a male that has Scheuermann’s Disease and would like to know if having abdominal liposuction may help relieve some of the discomfort and strain from my back and neck? It makes sense to me since less fat would mean less strain Your thoughts on this?
A: I know of no medical evidence that supports abdominal liposuction as providing symptomatic or preventative benefits with this form of spinal issue. (kyphosis) Having said that perhaps if the abdomen was big enough and the liposuction of sufficient volume that there could be some potential benefit. However, most of abdominal fat in men is intraperitoneal and is not treatable by liposuction extraction. That is a fundamental difference between men and women in their abdominal fat distribution and shape.
Thus I am not sure if liposuction alone would produce an adequate relief of the abdominal ‘load’ that would translate into some form of back pain relief or prevention of further spinal kyphosis. It would make more sense to me that an abdominal panniculectomy would have such back benefits since removing an overhanging and heavy pannus is known to reduce lower back strain due to its size and the pulling on the trunk from hanging down below the waistline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a full tummy tuck three months ago. I opted liposuction with my tummy tuck. I am very pleased with the way the bottom of my abdomen looks, however, I have quite a bit of fat on my upper abdominal. I was under the impression that you would do liposuction on the upper abdominal area during the procedure, however, it wasn’t. Can you advise why? I did pay for the tummy tuck and liposuction. I have researched it quite a bit to make sure I didn’t misunderstand, and it looks like that would be the “norm” if you had a tummy tuck and lipo that it would be done on the upper abdominal area, however, it wasn’t in my case. I look forward to hearing from you.
A: This particular tummy yuck question is not uncommon and there is a very straightforward answer. The concern about fullness in the upper abdominal area is one of the most prevalent after surgery issues after one has had a tummy tuck. One does not have to look too hard on any plastic surgery forums on the internet to see how common this tummy tuck question is.
This question is so common that in every tummy tuck consult I emphasize to patients about this issue and, while liposuction may be done in the flanks and lateral abdominal wall, I do not perform it in the upper abdominal region. Thus, one may be left with an upper abdominal region that may be more protrusive than in the lower area where all of the tissues were cut out if they have any fat thickness in their upper abdomen originally.
It is not the norm in a full tummy tuck to perform full abdominal liposuction on the upper abdominal skin flap. This is avoided by most plastic surgeons because of its devascularizing effect on the skin flap and the risk of causing poor wound healing, central wound dehiscence and even overt tissue necrosis between the new belly button and the incision line. One also does not have to look to hard online to see some disastrous results when upper abdominal liposuction is done with a full tummy tuck. While it may not occur in every such case, one devastating tissue necrosis event can take months to heal and create a permanent abdominal wall deformity.
This makes going for the very flattest total abdominal result possible by widespread use of liposuction at the time of a full tummy tuck a risky manuever. This is one that I will not do out of concern for patient safety and to avoid risks of a postoperative complication. This is why I point this issue out during the initial consultation and emphasize that secondary liposuction may be needed for flattening the upper abdomen six months or more after the procedure when it is safe to do so.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have never been terribly overweight, however, I can’t lose the belly fat. I would also like to take a few years off my face. Most people tell me I look to be about 45, I’m actually 56. My looks probably matter more to me than most people as I currently work in a very visible public position so I feel I need to look my best so I can stay in this business until I retire. I would like to know what I can get done and not have to be off work any long periods of time. I am very interested in liposuction of my stomach/butt/thighs/ and arms, possible facial work later.
A: Since body contouring in your primary focus for now, I will keep my comments to that area. The most important question based on your inquiry is what is the best treatment for your body fat concerns. The abdominal area is always the one body area where the debate is between liposuction and a tummy tuck. It has been my experience that most people assume that liposuction can do too much, that it can magically remove a lot of fat and tighten up a lot of loose skin. While liposuction is a very good fat remover, it can do little for excess skin. Thus whether it is an appropriate surgical method for your abdomen, arm, thighs and buttocks issues will require a physical examination to answer. My concern for you is that the desire for great body contour changes and little time of work often do not go together very well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 52 year-old male and am concerned after some weight loss that my lower abdomen is still fatty, and my pubis area is sagging. This is not exactly the look I want, what can I do? I have attached some pictures for your assessment from the front and the side.
A: Thank you for sending your pictures. What I see is mainly a pubic sag issue, not so much go an abdomen overhang. While there is some fat in the pubic area, an equal contributor to the problem is loose skin. Your options for improvement are either liposuction alone or liposuction combined with a pubic lift. A pubic lift, in essence, is really an inverted or reverse mini-abdominoplasty. It lifts the skin from above along the waistline.
There is also some abdominal fat, but no real excess skin that I can see. Thus liposuction of the abdominal area could be performed at the same time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to know if I am a good candidate for liposuction. I have a stomach bulge but as I have been searching various internet sites I have seen bigger women than me that have only had the liposuction and show good results. I don’t want a tummy tuck because of the scar. I have never been pregnant and have no stretch marks just a big bulge. Will liposuction be the best option for me? Is losing a little bit of belly weight before a good idea for me?
A: The ideal candidates for abdominal liposuction is primarily defined by the quality of the overlying skin. Nice taut skin that has good elasticity without excess will always produce the best liposuction result, regardless of the liposuction technique used. Skin that has the natural abiity to tighten will do better than any method of skin tightening that various liposuction devices tout. Being a female and never having been pregnant, by definition, makes you a good liposuction candidate in most cases. It is always good to begin any weight loss efforts before liposuction so you will already been in the lifestyle change that will help ensure you enjoy the long-term benefits of the liposuction procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 30 year old male who works out regularly.(6’4, 200lbs) I am looking to get fat from my lower abdomen removed so my 6-pack can show. Would you recommend Zeltiq or liposuction? Knowing that I am on a budget and prefer non-invasive procedure however still looking for best results.
A: The simple answer is that Zeltiq, or any other form of non-invasive fat treatment, has zero chance of removing enough fat to make a six-pack show. Liposuction with an etching technique is the only procedure that has any hope of making a six-pack look…provided you are lean enough to begin with for the etching results to show. Six-pack abdominal liposuction is only effective on reasonably lean patients. It can not create a sculpted definition on a thick abdominal wall.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, Please see the photos I have included regarding my interest for a breast lift and abdominal procedure. I am a fit individual in that I work out 5 days a week, and try to keep a balanced diet. Your advice and expertise would be appreciated.
A: Thank you for sending your pictures. From an abdominal standpoint, I agree that liposuction on the abdomen and around the waistline would be beneficial. Certainly no form of an excisional procedure (tummy tuck) is needed. For the breasts, however, that is a different story. As you have also mentioned, a breast lift is needed. There is simply too much skin for the amount of breast tissue you now have. The type of breast lift needed is most likely a blend of what I call a type III (vertical or lollipop lift) or a Type IV (anchor or inverted T lift) These names relate to the degree of lifting they achieve and the type of scar pattern that occurs as a trade-off. I think you could only get by with a Type III lift if you were doing a simultaneous implant for volume enhancement as well.
Both a breast lift and abdominal and flank liposuction can be done at the same time for your trunk makeover.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am 31 years old, 5’4” and weigh 162 lbs. I have had three children and my stomach certainly isn’t what it used to be. There is stretch marks and loose skin. I really need to get my body in better shape but I don’t want to undergo a tummy tuck even though I know that would probably be the best thing to do. I don’t need to look like a model but I don’t want to have loose hanging skin afterwards if I undergo liposuction. I know that I will not have perfectly smooth skin after liposuction but I am concerned if I will have loose hanging skin afterwards. Online I have seen stomachs just like mine that show good results afterwards with just liposuction. So do you think I will have wrinkled or hanging skin after liposuction?
A: While I don’t know what your stomach looks like, you have described several critical points about your abdominal liposuction concerns. Given that you don’t want a tummy tuck, your only abdominal contouring option is liposuction. With that decision you also recognize that the results will not be perfect. Skin irregularities are always a potential issue with any form of abdominal liposuction but that risk dramatically increases when loose skin is present. This is the issue to ponder when one is using liposuction as a substitute for a tummy tuck. As a general rule, if the abdominal skin does not overhang the waistline only irregular wrinkled skin will result. If there is an abdominal overhang, expect that removing fat will still leave you with a loose skin overhang.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had a tummy tuck six months ago and although I am happy with my lower abdomen I am not with my upper. It is still fairly thick and not as slim as the lower half. From the side view, the upper abdomen shows no difference unlike the lower. The only explanation that I can come up with is that my plastic surgeon refused to do liposuction of this area even though he did it to the sides of the tummy tuck. I can’t help but wonder if that had been done also it would look much better now. Can I get the upper abdominal area liposuctioned now and will it result in more loose skin afterwards?
A: Your question/concern of a tummy tuck result is a common one and one in which I review with every patient before surgery. Tummy tucks do their best work in the lower abdomen, where tissue is actually cut out, and offer more modest improvement in the upper abdomen. Your plastic surgeon was very prudent to not liposuction the upper abdomen during your tummy tuck as the risk of major healing problems can ensue at the central closure line . Thus many tummy tuck patients will have an upper abdominal fullness after their tummy tuck due to a persistently thick fat layer. This can be addressed after tummy tuck suction out extra fat and thin out its thickness. It will not cause any extra loose skin as that has been adequately tightened by the previous tummy tuck.
While we wish we could address the upper abdominal fat at the same time as the tummy tuck, it is wise to remember this basic motto in aesthetic surgery. It is far better to have two surgeries done safely than going for the perfect result and suffer a major wound healing complication which ca takes months to heal and leave a more devastating aesthetic problem than what one was initially trying to treat.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 45 year-old man that would like to improve my body. I am a little overweight and I seem to carry all of it in my belly. My chest and arms have no muscular definition and I would like implants to pumo them up. I have attached some pictures. Tell me if you think I am a good candidates for these procedures.
A: Thank you for your inquiry and sending your pictures. In considering your request, the first issue is that of your belly. (abdomen) Given that you are a male with a round firm belly, it is important to realize that a significant part of the abdominal fat you are seeing is intra-abdominal (around the organs) and not extra-abdominal (between the muscles and the skin) where it can be reached by liposuction. That is a unique feature of most men that have large bellies. While there is some fat that can be suctioned, the critical question is whether it is enough to justify the surgical effort. If I examined you I would know by feel. But in just looking at your pictures, I am concerned that the result obtained may not meet your expectations. Liposuction will help but it is not magical and it will not make your abdomen flat. The only way to get closer to what you desire is a combination of liposuction and weight loss. Liposuction will likely only get you halfway there.
When it comes to body contouring implants, like pectoral and arm implants, it would first be appropriate to get your abdomen in better condition. Given your abdomen the way it is now, pectoral implants would merely get lost in the shape of your body and may not make enough of a visual difference to justify the effort. At the very least, you are not now a candidate for arm implants. Body implants in general work and look best in men who are at a good body weight and are lean enough that the profiles of the implants can be seen.
In conclusion, the only option I would consider at this point is abdominal and flank liposuction and possibly pectoral implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 30 years old and have had one child. Last year, I had liposuction to get rid of some ugly fat deposits on my stomach and thighs. It turned out very well and I am overall very pleased with the contour reduction of the treated areas. But I have noticed a little loose skin on my stmach and there are a few small uneven areas. My skin doesn’t look quite as tight as it did before the procedure. Is this normal? Is there anything that can be done to help tighten and smooth out the skin any further?
A: It is very common after liposuction to have less than perfectly smooth skin. That is often the trade-off for the volume reduction. Simply put, when you have less fat you need a little less skin. That accounts for what you perceive as skin that is just not as tight as before. This particularly occurs in the abdominal region in women who have lost a little skin elasticity after pregnancy. There certainly is no harm in trying any of the numerous skin tightening devices that are available, such as Exilis. The only question will be how effective it may be.
In addition, liposuction is about fat removal but it is a blind procedure. There is no way for the treating doctor to see what they are removing and how even that removal is underneath the skin. This is the art form of liposuction and it takes a lot of experience and attention to detail to get the smoothest result possible. Eventually the healing will reveal how close to even that fat removal was.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting liposuction for my belly area. I am 36 years old and had very successful breast reduction surgery seven years ago. While I was put to sleep for my breast reduction and had no problems, I am more anxious now considering it since I have two small children. Do you think it would be better to have regular liposuction under general anesthesia or Smartlipo under local anesthesia? I think I want to flatten my hips area as well. It is time to get ready for the summer!
A: You are under a classic misconception that Smartlipo is a liposuction procedure done only under local anesthesia. While it can be done in some smaller areas under local anesthesia, the reality is so can regular liposuction. The type of anesthesia has little to do with what type of liposuction can be performed. But it often controls how good a result one can get from any type of liposuction procedure. How thoroughly fat can be removed from multiple areas largely depends on a patient’s comfort to do so. In my experience, better liposuction results are almost always obtained under general anesthesia. More body areas can be concurrently treated and a more aggressive approach can be taken with how much fat is removed. While Smartlipo can be done under local anesthesia, I have found in many cases that patient comfort and the desire to treat more than one body area make it less than an ideal approach to liposuction fat reduction.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in lipodissolve or laser liposuction of the lower abdomen. I am having a breast reduction done next month. My question is when is the best time for me to have the lipo procedures performed, before surgery or after surgery? I was informed that the best time would be during the same time as my breast reduction surgery. However, my insurance is covering the breast reduction and it does not cover the liposuction. I am also unsure if the doctor performing my surgery performs the lipo procedures I am interested in receiving. I was hoping for a lipo procedure that was less invasive such as lipodissolve or laser lipo.
A: Let me clarify some misconceptions that you have about various ‘lipo’ procedures. Lipodissolve injections are only useful for very small fat collections, no more than the size of one’s hand. I suspect your lower abdominal issue is bigger than that in size. Laser liposuction (aka Smartlipo) is simply an advanced form of liposuction and is just as invasive, it is not a minimally invasive procedure. In short, there is no non-surgical way to get rid of your abdominal fat concerns that would be as effective as liposuction. You could try Exilis radiofrequency treatments which does have some fat reduction effects.
In reality, there would be no better time than doing abdominal liposuction with your breast reduction and this is a common combination of cosmetic procedures. Otherwise you will have to have liposuction done separately where the out of pocket expenses will be higher.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley My problem is that I look pregnant even though I am not. I was very athletic until I went through three pregnancies and never had time to get back to exercise between them. My underlying stomach muscles feel tight and I can suck in my stomach but there still remains a pouch. If I wear tight clothes it hides it but otherwise it just sticks right out. I’ve had a c-section but I do not want a tummy tuck because of the scar. Would liposuction help reduce the size of this pouch? Thank you in advance as I would value your opinion.
A: If any form of a tummy tuck is not acceptable, the question then becomes how much of a difference liposuction can make. No plastic surgeon can say for sure without at least seeing some pictures of you. But knowing that you have had three pregnancies spaced fairly close together suggests that the quality of your skin may not be good. (poor elasticity) This is relevant in that as the fat is removed what will happen to your abdominal skin. If your pouch is less but your skin sags and hangs worse, you may not consider that a good aesthetic trade-off. Liposuction is always an option as an alternative to a tummy tuck, the question is whether it is a good one. Not all fat reductions necessarily make the body part better looking even though it may be smaller.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I came upon your case study thru google –Case Study: Secondary Liposuction After Tummy Tuck Surgery. I am 3 months post op for diastasis repair (to above button) and c-section scar revision . I did not have a full tummy tuck and no liposuction. The skin was pulled down at area of incision. I had a drain at upper abdomen below ribs for 5 days. There is persistent skin elevation there, like a bulge, delimiting the curvilinear path of the drain. Dr says it’s fibrosis and to massage area. I’ve done this daily and no change. I am now wondering if this is fat as you state in your case study. I am, and was, very thin, especially upper abdomen. The area is soft to touch and no fluid (ultrasound was done). It’s just so odd that it follows the path of the drain yet what you state in article makes a lot of sense. Any advice will be greatly appreciated as this is very disturbing for me to look at . Thanks!
A: If I understand what you had done…a muscle repair to a level above the umbilicus and some form of a mini-abdominoplasty. (c-section scar revision) The key in determining why this bulge exists has to do with the muscle repair and how the abdominal skin was elevated to do it. I suspect that the muscle repair was done through a ‘tunnel approach’ above the belly button given that a mini-abdminoplasty incision was used. This means a tunnel of abdominal skin and fat was raised above the belly button to perform the muscle repair rather than a wide undermining of the upper abdominal skin flap. When the muscle was sewn together, this creates a midline bunching or bulge because the side tissues remained attached to the muscle. As the muscle is brought in by suturing, so is the side tissues pushing them together in middle. The fact that a drain was temporarily there is coincidental not causatory. (I have never seen a drain cause a raised skin tract) In essence, this is an ‘excess‘ of abdominal skin and fat that has created the bulge. The best treatment would be for some small cannula liposuction to reduce the underlying fat thickness and the overlying bulge.
Dr. Barry Eppley
Indianapolis, Indiana
Q: What is the cost of tummy liposuction?
A: This seemingly simple question is actually more complex that it appears. When people request liposuction of their stomachs, and its associated fees, they often are under a false perception that this is what will work for them. About half of the patients that I see for tummy liposuction do not need or do not get that procedure. Many actually need a tummy tuck due to their excess and loose tummy skin. But assuming that liposuction of the stomach is the right procedure, there are other variables that will affect the time and cost of performing the procedure. Does the whole stomach need to be done or just the lower half? Does the flanks or muffin tops along the waistline need to be done in addition to the stomach to get a better overall result? All of these affects both the results and cost of the liposuction procedure. This makes for a cost range of between $4000 to $5500 depending upon how much work needs to be done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am a 52 year old female that weighs 127 pounds. Several years ago I was down to 117 pounds and the lower belly pouch didn’t get much better. At that time I was exercising 4 days a week and doing everything I could to lose that belly. This seems to be a family trait as both my mom and her sisters had it. Do you think liposuction can remove this lower belly pouch?
A: There is no question, even without seeing most patients, that the description of a lower belly pouch signifies that they have some excess fat there. So the use of liposuction for abdominal fat reduction is going to be useful. Whether liposuction would be of benefit, therefore, is not really in question. The issue is how much lower abdominal skin do you have and what will happen to it when the lower belly is deflated so to speak. In other words, do you need some type of a tummy tuck with the liposuction? The aesthetic outcome of liposuction is predicated, partially, on how well the skin contracts down once there is less volume. If there are a lot of stretch marks and you can pinch more than an inch or two of skin, then it is likely than some skin removal (mini-tummy tuck) may be helpful also. If there is a question as to whether skin removal is really needed, you can always do the liposuction first and let that outcome make that decision for you. I would use Smartlipo (laser liposuction) for your abdominal liposuction as that has the best chance of shrinking down the skin you have the best.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am considering liposuction of my stomach. I am not fat but just want to thin it out further than I can do on my own. What is the best liposuction method to avoid any uneven or irregular areas on my stomach area afterwards. Since I am thinner to begin with I think it is more likely on someone like me. Would Smartlipo be best?
A: While highly effective at removing abdominal fat, irregularities after abdominal liposuction are not rare. Since the outer contour of an abdominal liposuction result is a direct reflection of the evenness of fat removal underneath the skin, it is important to have as even removal of fat as possible. While many new technologies have emerged for performing liposuction, they have not necessarily resulted in a lower incidence of contour problems. This is because the technique for performing liposuction is more important than the device.
No matter what liposuction method is used, the tracks or tunnels that are made under the skin by different types of cannulas in the fat layer is ultimately important for the final contour. This has lead to the use of smaller cannulas for fat removal and this has definitely decreased irregularity problems. But small cannula size alone is not enough to guarantee no contour irregularities…and it is probably not the most important.
Superceding cannula size is the precision of the underlying tunnels that are made. This is the in and out pattern of the liposuction cannula that most people associate with the procedure. While this movement may look random, it is not. Rather it should be a deliberate and evenly distributed method of cross-tunneling.
Cross-tunneling, when possible, during liposuction is still one of the most important concepts in liposuction to avoid abdominal irregularities. By cutting tunnels in the fat from multiple directions in any given area, fat is removed in a more even fashion. This is especially important in the abdomen where the cross-tunneling method can be most effectively used.
In short, the operator and not the device is the most important consideration when performing liposuction and avoiding postoperative irregularities.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I just had my second baby six months ago and I want to get my body fixed. I am almost back to my pre-baby weight, maybe just 4 or 6 pounds more than I was. It seems like I have a lot of grease accumulations especially in the tummy and thighs that I would like removed. But I would need to know more or less how much it would cost so I discuss it with my husband.
A: Recovering one’s body shape after pregnancies usually focuses on the abdomen and waistline areas. For some women, this is just a matter of resistant fat accumulations that can be relatively easily improved by liposuction alone. For most women, however, it is more than just a fat issue. It is skin that has been stretched out and is lax. Liposuction alone will not tighten this skin but merely deflate it. Some form of a tummy tuck, combined with liposuction, is often what is needed.
Whether it is liposuction, a tummy tuck, or some combination thereof is impossible to know without actually seeing you. Women are so different in how their bodies respond to pregnancy that any one of these options may be right for you. But to give you a price range based on pure liposuction alone up to a fully tummy tuck with liposuction is in the range of $4,500 to $8,000, all costs included. This may be a wide range but costs of such surgery are dependent on the extent and time required to do the procedure.
Dr. Barry Eppley
Indianapolis Indiana
Q: I had breast reduction surgery last year and , while those results were great, my stomach area is now the problem. What is the best way to get rid of some (or a lot of!) stomach fat? I have read about Zerona. Is it better than liposuction or does it just depend on the person?
A: It is not uncommon after breast reduction that one notices that they now have ( or have had) a larger stomach than they knew. Since the breasts hung down on the stomach, the size of the stomach is usually obscured. After breast reduction, where the breasts are lifted and reduced, these ‘new’ stomach problem appears.
While fat reduction can be done both surgically (liposuction) and non-surgically (Zerona), the results and the process are not the same. Do not equate Zerona and liposuction as providing the same results. Liposuction is a much more effective and rapid way of eliminating unwanted fat, albeit with surgery. Zerona is best considered as a non-surgical step before one considers liposuction. In the right patient (5 to 20 lbs overweight), Zerona may provide enough of a result that liposuction may never be needed. In larger fat collections, liposuction may ultimately be needed.
Therefore, patient selection is critical when deciding what approach to take for abdominal fat reduction. For small to modest abdominal fat fullness, Zerona is probably worthwhile as enough of a result can usually be obtained without surgery. But if you have a large abdominal girth or any excess overhanging abdominal skin, some form of surgery will be more effective whether it is liposuction, a tummy tuck or some combination thereof.
Dr. Barry Eppley
Indianapolis, Indiana
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