Explore Plastic Surgery - Dr. Barry Eppley

Abdominal etching is a specialized liposuction procedure used to enhance the appearance of the abdomen. It is a sculpting advancement over flattening of the abdomen alone with liposuction. The procedure has been historically used in athletic males and is generally associated with a fairly high success rate with few complications.

But abdominal etching is not always predictable for everyone and poor results do occur. The most common problems include inconsistent etching lines and lines that are unnatural or are not in line with the inscription patterns of the underlying abdominal muscles. Inconsistent lines can be improved by revisional surgery. Incorrect line placement is difficult to correct.

In performing this procedure, I have come to learn several important steps that lead to more successful results and happier patients. First and foremost is patient selection. A lean individual is paramount and these patients are fairly easy to select. In many ways, they select themselves. They are not only lean but are evident workout-aholics. They are trying to push their bodies to get the most definition. They certainly are  less than 15% to 20% over their ideal body weight. The quality of their skin and the skin-fat ratio is important. A pinch test of the skin should show no more than an inch or two of fat between the pinched skin. The abdominal skin should not be loose or having stretch marks. It must be able to shrink down into the etching lines.

Proper and accurate marking of the etched lines before surgery is done from multiple positions. Standing, sitting and tightening the abdominal muscles are all used to find the natural location of the muscle edges and the inscriptions. Any horizontal skin creases are helpful but they do not always coincide with the inscription levels. There is no pre-existing outline pattern or specific measurements for the location of the etch lines. Each patient is unique and is rarely perfectly symmetric.

From an abdominal contouring standpoint, etching can be done alone or part of an overall abdominal liposuction procedure. In general, the results are not surprisingly better when etch lines are put in alone. But most male patients need a combination of etch lines and liposuction between the etch lines to get their desired result. When done together, general abdominal flattening is done first. Etching should always start in the midline going up from the inside of the umbilicus with a long cannula. Then through horizontal stab incisions from the midline, the horizontal lines are put in with a bidirectional approach. No more than three horizontal lines are needed. Additional vertical lines may be put in near the outer edge of the rectus muscle but this is optional. It is important to not overdo the number of lines which can create an unnatural look. The use or deletion of these lines should be reviewed with the patient beforehand for their input. Most of the time I do not do them unless specifically requested.

Smart abdominal etching means that it is done with the use of the laser probe. The use of heat to create the lines does work but it is important to not run the laser probe directly on the underside of the skin. This may cause skin burns with ‘end hits’ while doing the horizontal lines and may cause the lines to develop some temporary thickening or hypertrophy.       

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana  

Pectoral Etching and Liposculpture in Indianapolis

Contouring of the chest region by pectoral etching helps provide better definition to the pectoral muscles and the shape of the chest wall. Borrowing the concept from abdominal etching, in which the use of linear liposuction is used to define muscular edges and definitions, a similar technique can be applied to the chest with equally good results.

By selective removal of fat (liposculpture) from the side and lower borders of the pectoralis major muscle, the muscular appearance of the chest wall can be improved. This virilizes the chest contour while creating few visible scars. By sculpting the borders, and leaving fat over the main body of the muscle, the pectoral muscle bulk appears greater. This pectoral etching technique provides better shaping than simple gross fat removal in an even unsculpted manner across the chest wall.

Pectoral etching adds visible and palpable pectoral inscriptions to the chest wall. In a recent study published in Plastic and Reconstructive Surgery in December 2007, Dr. Ruiz-Razura and colleagues report treating over 200 patients over the past three years.with only a few minor complications. (small hematoma, irregular contour, too conservative of a result) Their experience has been that the results have been maintained, even in the face of weight gain and skin loosening with age. When pectoral etching is combined with abdominal etching, a more muscular-appearing torso is achieved. The procedure is becoming very popular in non-athletic males whose physique may not get sculpted even with regular strength training.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Six-pack Abdominal Surgery

The ultimate abdominal definition is the visible outline of the underlying abdominal muscles. Known as the six-pack look, it is actually caused by the enlargement of the rectus muscles, the lack of fat between the skin and the muscles, and the outward appearance of the inscriptions of the rectus muscle (which actually creates the lines of the six-pack) It usually takes a great amount of exercise and dieting to create this sought after look. For some patients, it is just not possible to thin the fat out that much to reveal the inscriptions. For these patients, a surgical shortcut can give them this look.

Using liposuction techniques, the fat can be precisely removed along vertical and horizontal lines, mimicking the inscriptions. This liposculpture technique requires the use of small cannulaes to suck the fat out along these carefully placed lines. This creates troughs (etchings) underneath the skin so that the underside of the skin sticks directly to the muscle. Hence, the six-pack look is achieved. The key to a natural result with abdominal etching is proper patient selection (the patient should be thin, in athletic condition, and have made a good effort to achieve the look on their own) and careful placement of the etch lines so that they lie along natural lines. (the patient’s skin is marked with them sitting down and slightly bending over)

The one downside to the procedure is what may happen long-term. If the patient gains weight, fat will unnaturally bulge between the etched lines creating an unusual appearance. The procedure is not reversible or easily correctable by fat injections, so the patient must accept long-term responsibility for maintaining their physical condition and now allowing much abdominal weight gain.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis