Background: Waistline reduction is effectively achieved by good weight control and exercise for the majority of people. Those with more difficulty in helping reduce the waistline may resort to surgical approaches from liposuction, a tummy tuck or some combination there of. These traditional abdominal surgical approaches will produce very satisfactory waistline improvements in most everyone.
Various maneuvers in both liposuction and tummy tuck surgery can help achieve waistline reduction. Aggressive and focused liposuction at the side of the waistline/flanks can help create a more inward shape. Rectus muscle plication and Scarpa’s fascial advancement performed during a tummy tuck can help pull in the sides of the waistline also.
But for those women seeking a maximal waistline change who already are at good weight and don’t need a tummy tuck or a lot of liposuction, resorting to ribcage modification is the end-stage surgical approach. The bottom lower three ribs do have a role to play in the width of the anatomic waistline. The oblique orientation of the free floating ribs (#s 11 and 12 in particular) can serve as an ‘obstruction‘ to the creation of a more hourglass waistline shape.
Case Study: This 33 year-old female presented for waistline reduction surgery. She had prior abdominal and flank liposuction which provided some improvement but not to the degree that she wanted. A plan was devised to do additional liposuction with emphasis on the v-shaped sides of the abdomen as well as supplementing that result with multiple lower rib removals.
Under general anesthesia she initially had full abdominal, back and flank liposuction done removing an additional 1800 of fat aspirate. In the prone position through a 6 cm long oblique incision on each side of the back, the end portions of ribs #10, 11 and 12 were removed.
It could be seen during surgery after removal of one side of the ribs how the abdominal contour was already further inward with the partial loss of outer bony support.
At the removal of her liposuction cannula entrance sutures and the taped dressings over the back incisions, improvement in the waistline could already be seen. With the resolution of all of her swelling in the next 6 to 8 weeks after surgery, very evident waistline reduction will be seen.
Highlights:
1) Maximal or extreme waistline reduction requires a combined liposuction and rib removal techniques.
2) Liposuction is done in both the supine and prone position to maximize the reduction along the sides of the waistline.
3) Subtotal rib removal of #s 10, 11 and 12 provide further waistline reduction over what fat removal alone can do.
Dr. Barry Eppley
Indianapolis, Indiana