Liposuction of the Waist

A 34-year-old female patient, three months following high-definition liposuction of the flanks, lower back, middle back, upper back, and abdomen.

Liposuction of the waist is the most popular area treated in the body contouring arena. Our female clients wish to have exaggerated curves that can only be created by maximally narrowing their waist. A snatched waist has popularized maximal narrowing of the waist. Waistline narrowing is created by coring out the fat from the lateral abdomen that extends lateral to the semilunar lines and extends from the lateral hip up to the lateral rib cage. This region overlies the area that is located over the external oblique muscle. This area is best cored out from the front and the back.

This means that liposuction of the waist requires operating on patients from both the front and the back. Specifically, 20% of the waistline fat cells can be removed from the front and 80% from the back. Waist liposuction creates maximum concavity at the mid-torso level. When liposuction of the waist is combined with a filling of the lateral hips, exaggerated curves are created in line with the female silhouette. This liposuction surgery outline has been previously described by the Tilde curve “~”.

The Tilde curve “~” describes a gentle S curve that outlines the optimal lateral female contour outline. The concave portion of the curve fits into the maximally narrowed waistline. The convex portion of the curve describes the prominent lateral hips achieved by transferring the fat from the waistline to the lateral hips. A smooth transition between the concave waistline and the convex lateral hip is a must and is indicated by the central linear portion of the Tilde curve. Patients seen at our centers are meticulously evaluated to customize the liposuction of the waist and the transfer of fat to the hips. Preoperative markings are also critical to ensuring the optimal waistline contour is achieved. If you have considered getting liposuction of the waist, let our liposuction professionals teach you how this contour can be optimally created by removing body fat and tightening any skin laxity.

Liposuction or a tummy tuck with liposuction, also known as an abdominoplasty, are two different surgical procedures that may address the same region. Patients that seek these procedures are looking to transform the midsection of their bellies. Both procedures have the same end goal, resulting in a smaller, tighter, and more highlighted abdomen. An aesthetically pleasing abdomen must demonstrate definition and natural curves and look amazing from all angles. To achieve such goals, we must first evaluate whether a patient will benefit from liposuction or a simultaneous tummy tuck to eliminate excess skin. When assessing patients, first, we listen to what their concerns are. Then we have them undress in front of the mirror, so we both appreciate the cause of the problem that is creating their concern. Only then can we discuss what surgical maneuvers will be required to accomplish the patient’s goal of achieving stunning results. Some patients will only need liposuction while others may need a tummy tuck. A tummy tuck can be performed with or without muscle plication. To make things even more complicated, some patients may need a combination of liposuction and simultaneously modified tummy tuck, termed lipo abdominoplasty.

When deciding which procedure, liposuction or tummy tuck, is the right choice for you, we must look qualify the degree of fat excess and amount of skin redundancy on your abdomen. When assessing your skin, we look at two things, your skin texture and the amount of skin redundancy. Imagine someone who is 300 pounds and who recently lost 150 pounds. They did an amazing job and lost a lot of weight, and their hard work has eliminated a lot of their fat.

This could be dieting and exercise, but unfortunately, they will be left with severe skin redundancy and poor skin texture, often described as the melted candlestick phenomenon. However, skin is supposed to be smooth and soft to the touch, like a flower pedal. That is the goal set for our patients. When evaluating excess fat, we look at the amount of excess fat and the distribution of the undesirable fat on your belly. Now let’s try and visualize this together.

Stand straight in front of the mirror, and it’s better to be shirtless, so you are relaxing your shoulders instead of just pulling up your shirt. Now picture your belly as a squared grid similar to the one you use during a bingo game. Your belly button is the center square, then you have two empty boxes to the right and left of your belly button. You also have three empty boxes above your belly button and three below your belly button. While in front of the mirror, start pulling down on the skin around your belly. Take both hands and pull down the skin below your belly. Then do the same thing above your belly. Place your hands on the squared quadrants furthest from each other on the same row. While doing these maneuvers, if you notice you can stretch back into a smoother petal-appearing surface, you have skin redundancy. Remember, you may have skin redundancy above your belly button, below your belly button, or throughout. Figuring out where the redundancy is will help us decide the best procedure for you.

The next thing is to evaluate your abdominal muscles. This is because, during pregnancy, when your abdomen stretches out, it stretches out your tendons, such as the linea alba, the central tendon that connects your abdominal muscles. Stretching the linea alba results in a distended abdomen. Now, it is important to understand that you can strengthen your abdominal muscles while you work out or do your physical activity.

Yet, you can never strengthen your TENDONS!! Muscles are made up of rope-like fibers, called actin and myosin, that allow them to stretch, and just like a rope, you can strengthen them back up by tightening them. Exercising your muscles will thicken and tighten them. In contrast, your tendons, such as the linea alba, are made up of collagen fibers and connective tissue, thus making them very durable, but they lack elasticity and the ability to recoil and strengthen them. Therefore, when stretched, they are impossible to repair. The stretching out of the linea alba is known as recti-diastasis. When the linea alba stretches, you need a formal tummy tuck with muscle repair.

To find out if you’re a candidate for a tummy tuck with muscle repair, also known as muscle plication, stand sideways in front of your mirror and stick out your belly. Puff it out, then suck it in. If there is a big difference between your puffed-out and sucked-in stomach, then this proves that the tendon between your abdominal muscles has loosened up. How far you can suck your belly is how tight we can make your belly with muscle plication.

Finally, using the same squared quadrants on your belly, let’s look at how much fat you have. Take one of your hands and make it into the shape of the letter “C” or a lobster claw. You will be using this hand to pinch your fat throughout your belly. Stand right in front of the mirror, just like when you pulled your skin down. Using your hand shaped in the letter “C,” gently pin each squared area like a lobster claw. While doing this, notice how much fat is cuffed into your hand. If the fat reaches your palm, then you have moderate to severe fat. If the fat only goes down past the first knuckle of your pointer finger, then you have mild-to-moderate fat. Liposuction will help eliminate all of the fat that you are pinching.

Now let’s put this all together. If you have skin redundancy just below your belly button but not above your belly button, then you have mild-to-moderate skin redundancy and will benefit from just a mini-tuck. Suppose you have skin redundancy below and above your belly button. This is moderate-to-severe skin redundancy, and you DO NOT have recti-diastasis. In that case, you will need a full tummy tuck without muscle repair. If you have recti-diastasis (again, your belly is distended and can easily be sucked in), you require a full tummy tuck with muscle repair.

If you have no skin redundancy (again, when you pull your skin down, it DOES NOT stretch into smooth skin) and just mild fat, then you will benefit from just liposuction. If you have skin redundancy below your belly button and excess fat, you will benefit from a mini tummy tuck and liposuction. Finally, suppose you have skin redundancy both above and below your belly button and excess fat. In that case, you will benefit from SurgiSculpt’s modified tummy tuck and liposuction, termed high-definition tummy tuck. I have made this simple table to help you decide what you need.

Procedure of ChoiceExcess FatRedundant SkinRectus Diastasis
Below Belly ButtonAbove Belly Button
LiposuctionX
Mini Tummy Tuck X
Full Tuck without muscle repair XX
Full Tuck with muscle repair X
Mini Tuck with LipoXX
High Definition TuckXXX