The Hourglass Tummy Tuck

There’s a reason tummy tucks are among the most popular plastic surgery procedures: by removing excess skin and fat, tightening stretched muscles, and repositioning the belly button, they can deliver total abdominal rejuvenation. This includes creating a more hourglass figure, where your waist is slimmer compared to the dimensions of your shoulders and hips.

Even when people don’t specifically ask for one, this type of curvier silhouette is often a goal for Tummy Tuck patients.

Key Components of a Curvier Shape

Traditional tummy tucks, including the Hourglass Tummy Tuck, typically include two components that specifically help to trim the waistline:

Liposuction

In addition to performing liposuction on the abdomen to reduce fat during a tummy tuck, you have to liposuction the flanks very aggressively. That’s one thing that really helps to curve in the sides of the body. Without liposuction of the flanks, the abdomen can look flat but squared.

Luckily, the skin in this area is very forgiving. In some areas that you liposuction, if the skin elasticity isn’t great, you can end up with skin irregularities. That doesn’t happen in the flanks, so you can be very aggressive.

This aggressiveness is key. You can have liposuction during a tummy tuck, but the question is, is the goal to make you as curvy as possible or just to decrease the thickness of the abdomen? It’s two different things.

Depending on a person’s anatomy, an hourglass shape may require circumferential truncal liposuction (aka 360 liposuction), particularly liposuction of the back, love handles, and flanks, to fully contour the waist and torso. Performing liposuction on the lower back also makes the butt look rounder and fuller, a plus for those who want to enhance their bum—but not necessarily make it bigger, à la the Brazilian butt lift or butt implants.

When consulting with plastic surgeons, be sure they’re skilled in performing liposuction in combination with a tummy tuck, because these procedures together can increase the risk of complications of wound healing if the surgeon isn’t careful.

Muscle Tightening

When it becomes stretched due to dramatic weight gain (such as from pregnancy), the lining, or fascia, that surrounds and connects your abdominal muscles can contribute to the look of a wide waist. This is why most tummy tucks include what’s technically called a rectus plication, or the stitching back together of the fascia with strong, internal sutures that run vertically up the centre of the abdomen (think of it like “lacing up” sneakers). That fascia runs from the front of the tummy around the sides, and as you pull it together, it also pulls in the sides, effectively acting as a corset to create a slimmer waist and more hourglass shape.

The Hourglass Tummy Tuck Difference: Using Fat to Create More Curves

Hip augmentation via fat transfer, where you use the fat removed during liposuction to add volume to the hips and improve the waist-to-hip ratio, isn’t a new procedure, but tacking it onto a tummy tuck isn’t widely done. It is, however, an integral part of the Hourglass Tummy Tuck. Even those who already have an hourglass shape are usually candidates for fat transfer, since they may have slight areas of indentation or the transition between the hip and waist isn’t optimal.

The hip can be a challenging area to sculpt with fat. It starts at the front and blends with the buttocks from the back, so you have to blend the aesthetic units to make it look youthful and balanced. Another issue: Unlike the buttock, which is pretty well-defined, the hip has different contours and shadows—some areas need liposuction, others need to be expanded and augmented.

To enhance someone’s curviness enough, a significant amount of fat needs to be injected—350 to 400cc (around 1.5 cups of fat) for each hip. You have to inject more than you think you’ll need, understanding that some will get resorbed.

Anatomical Challenges to Achieving the Hourglass Shape

The good news about tummy tucks: usually everyone can develop more of an hourglass figure with the procedure. The bad news: There are some people whose anatomy may make it harder to get a classic hourglass figure.

There’s a greater chance of creating a boxier appearance in patients who have a short distance between their lower rib cage and pelvic bone. It’s difficult to create an hourglass shape if there isn’t sufficient space between these bony structures to produce an inward curve.

Another limiting factor, is the quality of a person’s skin. For instance, patients with very tight skin, such as very athletic patients, don’t have as much stretch to their skin, so you don’t get as much hourglass shape. You can still get some shape, but not everyone can have a very curvy figure with just one surgery,” he says. In these cases, he recommends serial fat expansions, where patients are injected once, to maximally expand the hip, and then injected more on subsequent visits.

An hourglass shape is also more likely to be achieved by those who are in the range of their ideal body weight prior to surgery, without notable intra-abdominal fat. Some patients with a higher BMI and a greater concentration of visceral fat can look wider after surgery. The muscles flatten the stomach, forcing the internal abdominal contents more toward the sides of the body. Surgical results just aren’t that good if someone’s BMI is high. Ideally, the BMI should be at or below 25, which is considered the healthy range. In massive-weight-loss patients, the limit can be raised to 30 or below, the overweight range.