Waistline Narrowing | SurgiSculpt
Author: Babak Moein, MD FACSBoard-certified,
Fellowship trained in Cosmetic Surgery

Waistline Narrowing

Introduction To Waistline Narrowing

Waistline Narrowing has become one of the top sought procedures requested today. Women desire a narrow waistline to exaggerate their curves and optimize their feminine figures. High Definition liposuction optimizes and enhances what was previously impossible with traditional liposuction procedures. Maximizing waistline narrowing has only recently become feasible with the advent of VASER liposuction technology.

Since it is the only machine capable of comprehensive and uniform fat removal from the waist, only VASER liposuction can create the dramatic and highly desired narrow waist. Specifically, the waistline is narrowed by removing the fat layer circumferentially over the areas of the external oblique muscle from the front and the upper flanks from the back. Patients don't just want a slim waist but demand an exaggerated narrow waist, coined waistline snatching. What makes this plastic surgery procedure difficult is twofold. First, the fat in this layer lies in three separate layers, the superficial, middle, and deep layers; this contrasts with the rest of the body, where the fat exists only in the superficial and deep planes. The second factor is that the fat is interposed with a high connective tissue density. Attempts at completely removing these fat layers fail with traditional liposuction since the fat is difficult because it is intimately attached to the connective tissues. VASER ultrasound-assisted technology allows your cosmetic surgeon to melt the fat away from the connective tissue before removal. By loosening the fat first,  over 95% of the fat around the waistline can be eliminated, resulting in the extremely slim waist and sculpted body typically desired. In men, removing fat from the lower back and flanks is equally desirable as male patients wish to eliminate their love handles. Flank liposuction is the second most popular procedure, following chest liposuction to treat gynecomastia. Flank liposuction removes the fat from the abdominal muscles in the front and the hip bone in the back. This fat is similar in composition to the middle back fat and is difficult to eliminate using traditional liposuction techniques. The strain required to remove the fat without the utility of ultrasound energy can add potential risks, such as inadvertent injury to internal organs. Instead, VASER ultrasound technology allows patients to appreciate dramatic average waistline reductions and even shorter rehabilitation periods. Shorter rehabilitation periods follow since less physical strain and less time liposuctioning is required to remove the fat from the connective tissues.

In addition to eliminating fat, patients desiring waistline narrowing also need tightening, which often requires skin tightening.  Skin looseness is best characterized by two descriptions, skin laxity and redundancy. When minimal skin laxity is present, the heat generated by the VASER ultrasound energy and the elimination of superficial fat allows the skin to retract and tighten. When moderate skin looseness or minimal skin redundancy is present, skin tightening is accomplished using minimally invasive Renuvion technology.

Renuvion technology uses helium-activated radiofrequency energy to heat the deepest layer of the skin, called the dermis, and the structural support cables that connect the skin to the muscles called retinacular ligaments. Heating affects the collagen in the connective tissues resulting in a shrinkwrap effect that tightens loose skin, a process called subdermal coagulation. When maximum waistline narrowing is accomplished with comprehensive fat removal, it is critical to avoid any skin redundancy that may compromise the overall outcome.

When severe skin elasticity or moderate to severe skin redundancy is present, then excision of the skin is advocated using a lateral thigh and buttock tuck. When this body contouring procedure is combined with a tummy tuck, it is called a lower body lift. Please see the table below, which takes into account body fat and skin excess, which is reviewed with the patient before surgery. This surgical algorithm optimizes surgical outcomes and patient satisfaction who are concerned about lack of waist narrowing.  These surgical treatments have allowed our team to succeed in waistline narrowing without rib removal. Rib removal has the hypothetical risk of causing injury to intercostal muscle fibers causing anesthesiologic risk, chronic pain, and potential functional pulmonary risks.

Skin Laxity Skin Redundancy Treatment
Minimal None VASER only
Moderate Minimal Renuvion J Plasma
Severe Moderate to Severe Excisional surgery

When optimal waistline narrowing is coupled with shaping and/or augmentation of the buttocks, a dramatic differential of the waistline to buttocks width ratio is appreciated. Using Renuvion technology, synchronously with VASER liposuction, skin tightening, and optimal fat reduction are accomplished. Aesthetically superior waistline contouring is now possible with the advent of high definition liposuction protocols.

Waistline Narrowing Description:

Procedure: Ultimate elimination of excess fat and redundant skin that may have accumulated over the mid-abdomen, upper flanks, and lower back.

Length: 1 to 2 hours, dependent on the degree of fat excess and skin redundancy.

Anesthesia: General anesthesia.

Place of Treatment: Outpatient surgical suite.

Waistline Narrowing Side Effects:

Bruising of the waistline is very rare as it is compressed tightly with a compression garment and customized foam inlay. If bruising is noted, it is because inadequate compression is being applied to this region. Infrequently, the second layer of foam may be applied along the waistline to ensure appropriate compression. If bruising occurs, it will resolve over the first week following surgery.

Recovery: The recovery for waistline narrowing requires as little as 1 to 2 weeks, depending on your pain tolerance. Most patients are urged to go to the gym and participate in full physical activities no later than 2 weeks following surgery.

Duration of Results: Maximum waistline narrowing creates exaggerated curves that female patients are drawn to. Patients are universally enamored with the differential in the waistline to buttocks width ratios, creating "jaw-dropping" outcomes.

Waistline Narrowing Frequently Asked Questions:

Waistline narrowing requires maximal removal of soft tissue fullness, i.e., excess fat, and tightening of skin redundancy at the waist level. To achieve this, the VASER ultrasound technology is used to first liquefy the fat before liposuction. In a small number of patients with skin redundancy, Renuvion minimally invasive helium plasma-activated radiofrequency is used to tighten the skin.

You are a good candidate for waistline narrowing if you have fullness in the waist that makes your torso look like a barrel rather than an hourglass. Following high definition liposuction you will admire your exaggerated curves generated from waistline narrowing interposed on optimally shaped and augmented buttocks. The Tilde curve "~" is often used to describe the ideal waistline curve created using high definition liposuction principles.

You need to consider several items in planning for your high definition liposuction waistline narrowing surgery. First, you must quit smoking cigarettes and even marijuana, as they contain nicotine detrimental to the microvessels that deliver oxygenation to your skin. The skin can become compromised after the aggressive removal of all fat from your waistline. We recommend you avoid all smoking for one month before and two weeks following surgery. Marijuana is even more critical and must be avoided postoperatively as it will vasodilate your microvessels, causing leakage of blood and unnecessary blood loss. The next item is to avoid all blood-thinning medications, nutrients, and food products. A few more popular items must be avoided, including all aspirin-like products (NSAIDS), fish oils (omega 3 fatty acids), Ginko Biloba, and almonds. We will provide you a list of all products to be avoided for one month before and two weeks following surgery. Finally, high definition liposuction can result in significant blood loss in the tumescent solution, thus necessitating a higher-than-normal blood count. Your blood level will be checked early, and an iron supplement may be advocated to increase your blood count before surgery.

You can expect exaggerated curves around the waist region when viewed from both the front and back. The classic "Tilde curve = ~ " has been used to describe this exaggerated curve. When waistline narrowing is achieved using Vaser Liposuction and Renuvion skin tightening, patients should expect maximum waistline narrowing and elimination of any skin redundancy.

You will be able to return to work after 10 days following waistline narrowing surgery. In addition, patients are urged to return to full physical activity as soon as 2 weeks following high definition liposuction waistline narrowing.

Waistline Narrowing Patient-Specific Questions:

When using VASER liposuction it is important to recognize that all fat layers will be comprehensively removed. In the flank region, i.e., the middle back region, the fat is distributed in three layers, i.e., the superficial, middle, and deep layers. Whereas the deeper fat layer is loose and easy to remove, the middle and superficial layers are very fibrous and difficult to remove with traditional liposuction. However, since VASER liposuction melts the fat in all three layers, it allows for maximal fat removal down to the waistline muscles. Overall, VASER liposuction provides the ultimate modality for fat removal in the waist region.

The ideal waistline should be positioned at the point of maximum indentation, located between the subcostal margin and the lateral crest of the hip bone. This area should be maximally narrowed when viewed from the front and the back and is located approximately one inch above the belly button.

The waistline indentation is created by the prominence of the rib cage superiorly and lateral hip bone inferiorly that border the softer middle indentation spanned by the external oblique muscles. When contouring the waistline, the fat over the external oblique muscle is maximally removed to create an exaggerated curvature that is aesthetically desirable.


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