Even with a good diet and workout routine, some men and women have trouble getting the toned abdominal appearance they want. For these patients, a technique called abdominal etching can help in creating the classic "six-pack abs" physique in men or three-vertical-line abdomen in women, reports a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The procedure uses precisely targeted liposuction to achieve greater definition of the abdominal muscles, according to the paper by Tarik M. Husain, MD, FACS, of University of Miami Leonard M. Miller School of Medicine and colleagues. "Abdominal etching using power-assisted liposuction is a novel method of sculpting an ideal abdomen," Dr. Husain comments. "Our study shows that this is a safe and effective method to create a defined anterior abdominal wall in both male and female patients."

Emerging Liposuction Technique Produces Abdominal 'Six-Pack'

The researchers review their experience with liposuction to improve the appearance of the abdomen in 50 patients: 26 men and 24 women, average age 36 years. Patients seeking abdominal etching were in good shape, with a healthy diet and regular exercise routine, but had "certain resistant areas of fat" that made it difficult to achieve the abdominal muscle definition they desired.

Dr. Husain and coauthors outline the procedure in detail, starting with patient selection and preoperative markup. Following meticulous liposuction technique, the plastic surgeon sculpts the abdominal fat in both the superficial and deeper layers, accentuating the patient's natural "six-pack" lines in males and 3 vertical lines in females. Hip lines are usually desired by both sexes. The technique can be altered to provide a softer, shallower or a harder, more-defined degree of abdominal etching, depending on the patient's preference.

The authors spell out critical steps for postoperative care. Foam dressings are cut to size to compress the newly etched lines for at least three days. This is followed by full-time compression for two weeks postoperatively and two weeks part-time after that.

It is critical to have regular follow up early on to assess for any fluid collections, or seromas. To ensure good results, these seromas -- typically regarded as a minor complication -- need to be treated aggressively if they occur.

Patients can resume light exercise not engaging the core after two weeks, and more rigorous exercise after four weeks. The researchers stress the importance of maintaining good long-term results, with the assistance of a sports nutritionist and/or integrated medicine physician to optimize nutrition, exercise plan, and hormone imbalances. Patients have maintained good results of abdominal etching at follow-up times up to six years.

None of the 50 patients undergoing abdominal etching had major complications requiring hospitalization or return to the operating room. Minor complications occurred in 22 percent of patients, such as contour irregularities (usually "over-etching") that typically soften up and improve over time. Seromas developed in 10 percent of patients, and were promptly managed by a simple office procedure.

"The patients exemplify that the procedure can be performed with optimal aesthetic results, and minimal postoperative complications," Dr. Husain and coauthors conclude. They hope their technique and experience of abdominal etching will serve as a useful guide to other plastic surgeons who are interested in offering this relatively new procedure. The authors add, "We also highlight our extensive post-operative management, with the addition of a multidisciplinary nutrition and personal training team with the goal to maintain [patients'] long-term results and retain their newly etched abdominals."