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Background:  The waistline is both an anatomic human feature but also a somewhat artificial one as well. Anatomically the level at or below the belly button crossing at the level of the iliac crests to the back separates the pubic, hip and buttock regions from the stomach and back. But the use of clothing and how it is worn can also create an indent or waistline often lower than the actual anatomic one. Rarely is the artificial waistline higher than the anatomic one.

Whether it is the anatomic or induced waistline this is the level where excess skin and fat stop and often hang over it. When the the tissue excess is significant enough and run does hang over the waistline it becomes known as a pannus and often occurs in patients who are significantly overweight. The excess tissue that develops in more weight appropriate patients does not hang over the waistline and develops as a roll. This roll is often called a ‘tire’ and is still held up against the waistline by the more modest tissue excess and the better quality of the overlying skin.

Whether it is a pannus or a tire, people do not like it either way and it is a waistline problem that is not usually going to respond to weight loss and exercise alone.

Case Study: This young female developed a distinct waistline tire after mustiple pregnancies and some weight gain. The roll wrapped around her sides and into the back.

Under general anesthesia a full tummy tuck was performed (cut out above the belly button) combined with flank liposuction into the back. In essence most of the abdominal tire was cut out and liposuction helped create a smoother transition into the back.

By definition an abdominal tire is associated with some skin excess. The amount and quality of the skin all determine whether liposuction alone will suffice or some form of a tummy tuck will be needed as well.


1) The ‘tire’ or a prominent skin roll around the waistline in women occurs due to a combination of pregnancies and weight gain.

2) When excess skin is present around the waistline, liposuction alone is not an adequate treatment.

3) The combination of a full tummy tuck with liposuction is the optimal treatment for the removal of the waistline ‘tire’.

Dr. Barry Eppley

Indianapolis, Indiana

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