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The general approach used for liposuction is much like reducing a mountain to a less convex or flatter shape. The goal is to remove fat in a manner that results in a smooth outer surface across the area being treated with a shape consistent to the body area being treated. For most body areas this means the goal is to reduce the size of the convexity as few body surface look good relatively flat with the exception of the abdomen and back.

Abdominal etching is a liposuction technique that has very different contouring objectives. Its goal is to create a non-flat shape that largely mimics the surface contours of the underlying musculature. This is better known by urban name of ‘six-pack abs’ which is well recognized term by the public. The techniques to obtain it and who may be a good candidate for it, however, is not well chronicled n the medical literature despite how frequently the procedure is probably performed.

In the December 2019 issue of the journal Aesthetic Surgery Journal an article was published on this topic entitled Abdominal Etching: Past and Present’. In this paper the authors review their extensive experience with abdominal etching surgery in over 500 male patients over a four-year period. In this group over 350 received modified abdominal etching (MAE) while 160 received full abdominal. etching. (FAE) The authors define FAE as a more extensive technique to obtain a six-pack using transverse inscription liposuction. These patients as those men that have good quality skin with a relatively thin subcutaneous fat layer and existing well developed abdominal musculature. MAE refers to a procedure that results in a more sculpted but softer abdominal shape with improved definition of the linea alba and semilunaris only and is for men who have a thicker subcutaneous fat layer. This distinction helps categorize men into realistic expectations based on what their anatomy can permit to occur.  Also half of these abdominal etching patients underwent concurrent chest liposuction and/or pectoral etching.

The patient population was diverse in ages (up to age 71), amount of fat removed and length of followup. They experienced no infections, seromas or any problems with skin healing. A small number of contour defects occurred (less than 1%) that were resolved with a revisional procedure. They point out that the periumbilical region is easy to overlook and can result in a ring of residual fat. (which is well known to also occur in any form of abdominal liposuction) They also mention that skin wrinkling can occur above the umbilicus and waviness below the umbilicus when skin laxity is not good.

Suffice it to say that 500 plus cases of any plastic surgery procedure is a significant clinical experience. The authors have provided valuable insights both technically but also in classifying two different types abdominal etching methods and candidates for it. Not every male can get six -pack abs and this is an important preoperative discussion. What its also relevant, like all liposuction surgery, is that the long-term result will only be maintained based on a stable postoperative weight. While in smoother contour liposuction surgery weight gain will just make the area bigger again. In abdominal etching, however, the consequences of weight gain will be more aesthetically adverse. At the least the definition of the result will be diminished. At worst an unusual appearance of an etched pattern on top of rounder abdomen will occur.

Dr. Barry Eppley

Indianapolis, Indiana

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