Top Articles

Background: Liposuction is now an ‘old’ fat removal procedure that has always had several basic principles for an effective and uncomplicated result. While the technology of liposuction has changed many of these basic principles remain the same. The goal is an even reduction of the subcutaneous fat layer to create a smooth external contour without irregularities or indentations. Whether it is in the face or the body this remains a constant aesthetic goal.

There are certain aesthetic indications, however, where these liposuction principles are ‘violated’ to create the desired effect. The most noteworthy of these is abdominal sculpting or etching. In this aesthetic procedure the goal is to create a visible vertical midline linea alba as well as horizontal inscription lines to form a wash board or six-pack abdominal look. In doing so a deliberate effort is made to remove fat along these linear lines to create indentations which allow the muscle to be pronounced or defined.

While there are some variations as to how abdominal etching is performed the most important consideration is before surgery in patient selection. Those who get the best results are in good general shape and are leaner. It is ideally for the patinet who works out (to some degree), is thin, and despite these efforts can not expose the outlines of the rectus muscles. 

Case Study: This male was lean, worked out but could just not get a defined abdominal musculature. Thus he sought an abdominal etching procedure.

Preoperatively the etching markings were made which included a midline vertical line (line alba) and six paired horizontal inscription lines.

Under general anesthesia and through five small midline incisions (3 above the umbilicus and 2 within it),the linear lines were created using 3 and 4mm basket cannulas with a power-assisted liposuction machine.

The goal is to remove as much fat as possible so that the skin will stick down to the abdominal fascia along these linear lines. The small incisions were closed with 5-0 plain suture. 

Dressings consisted of thin layers of foam placed along the surgically created linear indentations with an overlying wrap for compression of the foam into the lines.

Such compression is left in place for 48 hours after surgery at which time the foam is removed and only an abdominal wrap is used thereafter for an additional week. It will take 4 to 6 weeks to see most of the etch lines to become evident and a full 3 months to see their complete depth and symmetry between the sides.

Abdominal etching is an effective muscle defining procedure in the properly selected patient. Its long term effects will depend on how stable the patient’s weight is. Weight gain will not make the etch lines disappear but it could create an unnatural appearance if fat accumulates and bulges between the etch lines.  It is also important to remember that this is an aesthetic procedure that is very difficult, if not impossible, to completely reverse.  

Key Points:

1) Abdominal etching is a liposuction procedure designed to create a more defined muscular appearance of the abdomen.

2) Etching liposuction is a unique form of liposuction based in principle changes not technology. (linear unidirectional aspiration with the intent of creating indentations) 

3) Postop linear foam dressings help the skin to stick down into the created etch lines. 


Dr. Barry Eppley

World-Renowned Plastic Surgeon

Top Articles