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Dr. Barry Eppley

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Posts Tagged ‘abdominal etching’

Case Study – Abdominal Etching Liposuction

Saturday, November 21st, 2015


Background: A well shaped and toned abdomen is a goal of both men and women of all ages alike. While some have it naturally, particularly at a young age, most have to work to maintain or create it through some regular diet and exercise.  A trim waistline and a flat abdomen is a reasonable and attainable goal for many people and would make most happy. But there are a few others that have more loftier desires for their abdominal shape, an abdomen that has visually evident muscular outlines.

Abdominal Muscle Anatomy Dr Barry EppleyThe so-called six pack or eight pack abdomen is one that has a midline vertical linea alba between the rectus muscles as well as their horizontal inscription lines evident. These are most commonly seen in young teenage boys and dedicated athletes and body builders. The one common denominator that they share is a very low percentage of body fat which results in such a thin subcutaneous layer of fat that the outlines of the abdominal muscles are seen.

But some patients, usually men, desire to have a well defined abdomen even if they can not create it by a low percentage of body fat and exercise. The artificial approach to creating this abdominal effect is known as abdominal etching or six pack abdominal surgery. This is a unique form of liposuction that removes a linear layer of fat over the vertical and horizontal muscle lines. This allows the overlying skin to indent inward along the lines of fat removal creating the muscle outlines rather than the muscle enlarging to achieve it.

Case Study: This 52 year male has lost fifty pounds and had gotten himself into a much improved shape through his own efforts of better eating and exercise. While he had made major improvements with a near flat abdomen and better waistline, he wanted to improve his abdominal result even further through a surgical approach.

Abdominal Etching Basket Cannula Dr Barry Eppley IndianapolisAbdominal Etching dressing intraop front view Dr Barry Eppley IndianapolisPrior to surgery he had markings made for the vertical midline and the vertical outer borders of the rectus muscles as well as the three paired horizontal inscription lines. Under general anesthesia, a 4mm basket cannula on a powered-assisted liposuction device was used to aggressively remove fat along all linear markings through small incisions. At the completion of the procedure linear strips of foam were placed along the etch lines and covered with a compression garment.

LW Abdominal Etching result front viewLW Abdominal Etching result oblique viewLW Abdominal Etching result side viewAt six weeks after the procedure his abdominal etch lines were becoming apparent as the skin contracts down to the reduced linear subcutaneous fat layers. Further definition in the abdominal etch lines would be expected to continue to develop up to three months after the procedure.

Middle Aged Male Abdominal Etching results Dr Barry Eppley IndianapolisAbdominal etching is a linear liposuction technique that does something liposuction is normally not intended to do…remove fat to deliberate create a focused skin indentation. Abdominal etching works best and looks the most natural in those patients who are already thin with a low percentage of total body fat.


  1. Abdominal etching strives to create the midline linea alba and the horizontal inscription lines of the abdominal muscles.
  2. Abdominal etching is a specialized form of liposuction that uses a linear line of maximal fat removal to create its effect.
  3. The best results in abdominal etching come from those who have a thinner subcutaneous fat layer over their abdomen.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies – Abdominal Etching Techniques

Saturday, October 10th, 2015


Liposuction of the abdomen is the single most common body site in which fat is surgically extracted. Most people are happy with some reduction of their abdominal fullness with the hope of being as flat as they can possibly be. An overall better abdominal shape is the goal and most patients would define abdominal shaping as seeing a more defined waistline.

But more extreme types of abdominal liposuction do exist and they are predicated on achieving a ‘supernormal’ abdominal result. The best illustration of that concept is abdominal etching. Designed to create a six or eight pack look, horizontal and vertical lines are created through a linear liposuction technique. Mimicking the abdominal wall inscriptions and the inner and outer edges of the rectus abdominus muscle, a properly selected patient can look like that have extremely fit and well toned abs. Some may call it cheating but surgical six pack and eight pack abdominal surgery does exist.

Abdominal Etching pattern Dr Barry Eppley IndianapolisAbdominal etching employs a technique that is the antithesis of what is normally done in liposuction surgery. In order to avoid irregularities and dimpling in traditional liposuction (regardless the type of device used) some thickness of fat needs to be left on the underside of the skin. Abdominal etching is based on doing the opposite…creating a specific linear line of maximal fat removal to create an indentation.

Abdominal Etching Basket Cannula Dr Barry Eppley IndianapolisTo help remove maximal fat on the underside of the skin in abdominal etching, I have found that a small basket cannula to be very effective. A basket cannula is usually used to break up fat and fibrous tissue. It is a very aggressive cannula tip and is not used for fat extraction. But is aggressive capability due to the basket tip not only removes fat but is used to scrape the underside of the skin. This helps contribute to skin adhesions down to the abdominal fascia to help create well-defined abdominal etch lines.

Abdominal Etching dressing intraop front view Dr Barry Eppley IndianapolisAbdominal Etching dressing intraop side view Dr Barry Eppley IndianapolisAnother useful abdominal etching technique is compression foam placed at the end of the procedure. Placed in a herring bone pattern with linear strips of foam placed along the etch lines, it helps the skin to stick down along the created indentation lines.

Dr. Barry Eppley

Indianapolis, Indiana

Postoperative Foam Dressing for Abdominal Etching Liposculpture Surgery

Saturday, February 7th, 2015


Abdominal contouring is commonly done using liposuction. Most of the time this is fat debulking or overall volume reduction to get rid of larger volumes of fat. But in thinner patients, almost always men, they desire a more refined type of liposuction described more appropriately as liposculpture. This is the removal of smaller amounts of fat that are bothersome to the more athletic or thinner body frame patient.

One unique type of abdominal liposculpture is that of abdominal etching. Often called ‘six-pack’ surgery, this is a liposuction technique that creates linear lines to create the appearance of cut abs. This is usually a midline vertical line and several (usually three) horizontal lines. In essence these are artificially created anatomic replicas of the underlying abdominal wall inscriptions. While it may be called cheating by some, it can be an effective surgical technique in the properly selected patient.

Abdominal Etching Foam Dressing side view Dr Barry Eppley IndianapolisAbdominal Etching Foam Dressing front view Dr Barry Eppley IndianapolisAbdominal etching is a small cannula linear liposuction technique that achieves its result by creating a dermal-fascial adhesion. By removing the fat that lies between the skin and the abdominal wall, indentations or grooves are created in the overlying abdominal skin. To help hold the initial linear lines that are created by the etching method, I like to use linear strips of compressible foam along the newly created etch lines applied right after the problem. When a wrap around abdominal binder is applied circumferentially, it helps push the skin down in the fat removed lines and prevent fluid from building up under them. The patient keeps the foam strips on with the binder for two days after the procedure when they can be removed.

Abdominal Etching result Dr Barry Eppley IndianapolisAbdominal etching works best in thinner patients and, although it is not really ‘natural’, looks best when it is not overdone with lines that go beyond the locations of the actual abdominal inscriptions. But no matte how they are made, they will not appear at all or will be very shallow if the fat removed under the lines fills with fluid and does not scar down properly. This strip foam dressing method is one technique that I have found useful in abdominal etching that adds no expense or extra effort for the patient.

Dr. Barry Eppley

Indianapolis, Indiana

Six-Pack Abdominal Etching Liposuction

Saturday, February 15th, 2014


When it comes to the ‘abs’ most people think of having a six-pack. And many work hard to try and get it. But not many can for a variety of reasons…not working hard enough, too much abdominal fat from poor diet and not the right body type. Getting six-pack abs really comes down to genetics and hard work.

Abdominal Muscle Anatomy Dr Barry EppleyActually everyone already has a built-in six-pack, known as the abdominal inscriptions, which are part of the rectus abdominus muscles. The rectus abdominus muscles are a set of paired vertically oriented muscles that extend between the bottom of the rib cage and extend down into the pubic area. Throughout their vertical course, they are crossed by three fibrous bands called the tendinous inscriptions. They are usually three such horizontal crossings, one at the level of the belly button, one up high near the bottom of the rib cage below its central xiphoid process and a third one about halfway between the two.

These inscriptions cause indentations or lines across the muscle to appear as they extend about halfway into it. Regardless of your weight and abdominal size, everyone has these inscriptions. The trick is having a thin enough fat layer between them and the overlying skin for them to be seen on the outside.

Abdominal Etching Six Pack Surgery intraop Dr Barry Eppley IndianapolisFor those who diet correctly, exercises regularly, and do a lot of abdominal work but can’t get the cut abdominal look they desire or others who just want to take a shortcut, there is a way. A plastic surgery procedure known as ‘abdominal etching’ or ‘six-pack’ surgery can create it. While often described as ultra-sophisticated liposuction, it is really a form of linear liposuction. Rather than removing fat over a broad surface, fat is removed along a very specific linear lines where the tendinous inscriptions lie. One vertical line is made down the center representing the linea alba between the rectus abdominus muscles through an incision inside the bellybutton. Then the horizontal lines are made from small tiny incisions placed in the middle from which the lines can be made out to the sides.

As much fat as possible is removed between the skin and the tendinous inscriptions to create permanent indentations in a six-pack fashion. While there is an artistic side to how much fat to remove and the location of the lines, it is a relatively simple technique of small cannula liposuction done along straight lines.

Abdominal Etching result oblique view Dr Barry Eppley IndianapolisLike all liposuction, it takes months after surgery to see the final result as the underside of the skin contracts down to the muscle. Such lines will likely be permanent since the fat cells will not return to the indentation lines. However, the number of fat cells outside of the lines are greater in number and will get bigger should one gain weight. Thus abdominal weight gain may create an unnatural look after etching, creating the ‘waffle look’ with fat ballooning up between the lines. It behooves one to maintain a healthy lifestyle and exercise program afterwards.

The best candidates of abdominal etching are those men and women who are already fairly fit and lean. The thinner the abdominal fat layer the more the inscription lines will show.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Humor – Non-Invasive Abdominal Etching

Saturday, July 6th, 2013


This is is the fastest way that I know that the ‘six-pack’ abdominal look can be achieved…even if it is not permanent. But what creates those stomach lines that many of us envy and would like to have and the fence wires have created? Those are known as the abdominal inscriptions. These are tendinous insertions within the rectus abdominus muscles that are usually at the level of the belly button, just below the sternum and about halfway between those two. If well defined, these can create a ‘six-pack’ look. In some people there is also a tendinous insertion below the belly button and this creates an ‘eight-pack’ look. The ability to have a six- or eight pack look is not only dependent on having good muscular definition but also a low body fat percentage due to either being an athlete or simply a young teenager with low body weight. What is the purpose of these tendinous insertions? They assist the rectus abdominus muscle with forward flexion of the lumbar region of the vertebral column, creating forward bending at the waist. If the rectus muscles did not have tendiinous insertions, forward bending at the waist would still be possible but just not as far. Without them one may not be able to bend over and pick up an object or stretch forward.

One can cheat to get a six- or eight pack abdominal look through liposuction. Small cannula liposuction can remove linear lines of fat along the horizontal areas where the inscriptions would be as well as a midline vertical line where the two paired rectus abdominal muscle meet. This plasic surgery technique is known as abdominal etching. It works best on thinner patients who do not have a lot of abdominal fat and have a fairly lean and more athletic build. And it looks better and more natural on this type of patient as well.

Dr. Barry Eppley

Case Study: Linear Liposuction for the Abdominal Six-Pack Look

Monday, December 10th, 2012


Background: The most common area for liposuction on the body is the abdomen for both men and women. It is done very successfully for making a round belly flatter and providing some shape to an often rotund waistline. While one can never make a round abdomen into a flat and sculpted athletic one, removal of a few liters of fat aspirate can go a long way to improvement that defies what most can not achieve with diet and exercise.

Some patients, however, want more than just a flattening effect and desire a muscular-looking result. A well-defined abdomen is one that not only tapers in on the sides but shows an outward appearance of the underlying abdominal muscles. The abdominals consist of 6 muscles that extend from the ribs to the pelvis at various locations. These are the internal and external obliques, the transversalis and the rectus abdominus. While all play important muscular roles, paired rectus abdominus muscles are the most superficial and it alone accounts for the ‘six-pack’  look that many desire.

The vertically-oriented rectus muscle are joined in the midline by the confluence of their encircling fascial sheaths. There are fibrous bands that cross the rectus muscle at three specific locations, at the umbilicus, one below the xiphoid process and one between the two. These fibrous bands do not pass through the muscle but only indent inward into the encircling sheath. These tendinous insertions is what creates the ‘six-pack’ look and even an ‘eight-pack’ look can be created in people with very low body fat. The abdominal etching technique creates a similar look by removing the overlying fat along these bands, creating visible skin indentations where the underlying inscriptions lie.

Case Study: This 43 year-old male had lost signifincat weight and worked hard to develop a more muscular body frame. While his efforts were exemplary, he desired even more results and wanted a ‘sic-pack’ abdominal look. He felt he had done what he could and wanted to pursue a liposuction etching technique to get it.

Prior to surgery, the vertical and horizontal etching lines were marked. The vertical one is straightforward as it is in the middle. The horizontal lines must be marked with the patient sitting up and down to see where the skin creases naturally lie. It is important to not have horizontal lines that do not match the natural horizontal skin creases. In theory these should match the location of the underlying muscular inscriptions in the rectus muscles. The lower limit of the horizontal line is the umbilicus and not below in most cases.

During surgery, the midline vertical line is made from an incision inside the umbilicus. The horizontal lines are made by stab incisions in the skin in the midline. A small 3mm cannula is used to remove fat in linear motions only, pulling fat off of the fascia all the way up to the underside of the skin from each location. Linear strips of reston foam are applied at the completion of the procedure prior to the application of a circumferential abdominal binder for a dressing.

The foam dressings were removed two days later and the binder was worn for an additional week. While the abdominal lines were evident when the foam came off, it took an additional six weeks before maximal definition of the six-pack look was seen.

Case Highlights:

1)      Abdominal liposuction can be useful for more than just volume reduction, it is also a sculpting technique as well.

2)      Abdominal etching is a linear liposuction technique that over reduces fat along the inscription lines to create a ‘six-pack’ look.

3)      Abdominal etching works best and only looks natural on a patient who already has a fairly lean abdomen and wants more visible muscular outlines.

Dr. Barry Eppley

Indianapolis, Indiana

Liposculpture vs. Liposuction In Body Contouring

Wednesday, October 19th, 2011

The removal of unwanted fat through liposuction techniques is effective but has as its main complications that of irregularities and asymmetries of body contours. While taking down the size of fat collections, it does not always result in the desired body contours or a show of the underlying muscular detail. This has lead to a liposuction concept known as sculpting or liposculpture. What is liposculpture and is it really different? Is it a better at achieving natural body contours and a more attractive body shape? Who is it best used on?

Liposculpture moves beyond the removal of just localized areas of too much body fat to a more artistic approach to fat removal. Instead of using large bore cannulas which can indiscriminately remove fat rapidly and creates large diameter internal tunnels through the fat, smaller size cannulas are used. These tools are more selective about how much and where fat is removed. Smaller cannulas may also be combined powered liposuction equipment such as oscillating, ultrasonic and laser-assisted devices. Whether these energy-driven devices are more effective at liposculpture is a matter of debate.

But the most important element in effective liposculpture is that of the surgeon. There has to be an appreciation of what makes up natural and pleasing body contours. The tools used are only as good as the hands that are directing them in shaping new contours. There also has to be an understanding of what the structure of fat looks like underneath. In some areas there may only be a thin fat layer which can reveal an improved body contour through superficial cannula extraction. Such aggressive right-under-the skin fat removal must be applied carefully to avoid scarring and undesireable skin retractions. Areas such as the inner knee, neck, back rolls, axillary breast and flanks are good examples of where superficial liposculpture must be used to get good contouring results as there are not deeper fat layers.

Superficial liposculpture has also become well known because of abdominal etching. This is the most aggressive application of this technique. It is the deliberate removal of all fat possible between the underside of the skin and the underlying muscle layer. When done over abdominal areas that lie over the muscular inscriptions and outlines, one can achieve a ‘six-pack’ look. While achieving this desired look for some, it is actually creating an anatomic result that is almost always to be avoided in liposuction, skin retraction and scarring. Abdominal etching is reserved for those that are near their ideal body weight and have a thin layer of abdominal fat.

While liposculpture sounds appealing, it is not a method that is best for many liposuction patients. The most common liposuction patient has larger amounts of fat on the abdomen, waistline, thighs and arms. In these areas there are two distinct fat layers, superficial and deep. Extraction from the deeper layers is needed and should be the first layer that the cannula enters. Treating the superficial layers as well, while improving the amount of contour reduction, will increase the risks exponentially of surface contour irregularities. The abdomen, arms and inner thighs are particularly at risk for this problem with superficial liposculpture. The quality of the skin, its thickness and elasticity must be assessed to determine if it is wise to attempt removal of fat right under the skin.

While slick marketing and pictures of models attempt to attract prospective patients for so-called liposculpture surgery, it is important to remember that traditional liposuction methods with solely deep fat removal will satisfy most patients. Liposculture techniques should be applied judiciously and applied to areas that are best served by them. It is a liposuction technique that takes into account the anatomy of the fat and the contouring goals and not a method that replaces traditional liposuction for many body areas.

Dr. Barry Eppley

Indianapolis, Indiana

Getting Good Results with Abdominal Etching Liposuction

Saturday, July 24th, 2010

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

Indianapolis, Indiana  

Laser Etching for Abdominal Six-Pack Surgery

Friday, June 5th, 2009

Abdominal etching is a well known liposuction technique that is used primarily in male torso contouring. What was once used to shape and contour the abdomen in male body builders is now more widely used for  leaner males who desire what their own workout routinues can not give them. It is not a shaping technique for  more rounder and fuller abdomens where more generalized liposuction is first needed. Some may call abdominal etching a ‘cheater’s approach’ to a ‘six-pack abdomen’, but it does work in properly selected patients nonetheless.

Abdominal etching highlights the contours of the rectus muscle through linear liposuction of fat at very specific levels. These levels potentially relate to three vertical and three horizontal levels. These are the tendinous portions of the paired rectus muscles which are the vertical midline linea alba and the paired lateral linea semilunaris, and horizontal inscriptions which occur on both sides symmetrically at three level above the belly button.. Patients with adequately developed musculature chose full abdominal etching to get a complete ‘six pack.’ Patients who are not as generously  contoured to begin with are better off with less abdominal detail, known as modified etching, which only contours the linea alba and semilunaris.

Abdominal etching is done with small liposuction cannula that are used to remove as much fat as possible between the underside of the skin and these tendinous levels, creating an indentation or groove. This is not how liposuction is typically done where some fat needs to be left so that the skin does not stick down to the muscle. But this is exactly what you are trying to achieve with  etching.

In most cases, you can get good ‘six-pack’ detail with traditional liposuction cannula. It is not as impressive as what one sees on  a professional body builder (who has little to no abdominal fat) but it is still quite distinct. But in other cases, I have seen indentations that were not as well defined or as symmetric as I thought while making them. Recently, in my Indianapolis plastic surgery practice, I have used the laser probe from Smartlipo to do abdominal etching. The probe is narrow and is ideally suited to make these grooves. The heat from the laser helps remove or melt more fat that might otherwise be left behind from liposuction aspiration alone. Plus, heating up the underside of the skin over the groove may encourage it to shrink and scar down to the muscle. The results have been very encouraging and I believe this is an improved method for more consistent results in abdominal etching.

Dr. Barry Eppley

Indianapolis, Indiana

Pectoral Etching and Liposculpture in Men

Sunday, January 6th, 2008

Pectoral Etching and Liposculpture for Better Chest Definition


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 the Plastic and Reconstructive Surgery journal in December 2007, a report treating over 200 patients over the past three years with pectoral etching was published. 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

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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