Anatomy of the waist for an hourglass shape

One of the common procedures that I perform is to create an hourglass shape. During this procedure, it is crucial to diminish your waistline as much as possible, but there are anatomical limitations. You need to understand that how much your waist is going to decrease in size will depend on your anatomy. Some patients bring pictures of other patients who have very small waists and request the same waist size, but this may not be possible.

To understand why not everybody can get an extremely small waist, you need to have a clear idea of the anatomy of the abdominal wall. The abdominal wall is made up of muscle and the fascia that surrounds the muscle. On top of this muscle, there is subcutaneous tissue—in other words, the fat. When I perform the surgery, I do liposuction to diminish the thickness of this layer. When we reach the abdominal wall, it is like hitting a wall. You are not going to be able to suck the muscle out, so once we reach the abdominal wall, that is how small your waist is going to get.

However, we can certainly do other things to diminish your abdomen further, particularly in patients who have had babies. Suturing the abdominal wall at the midline to correct abdominal wall weakness essentially recreates and diminishes the waistline, by tightening the muscle and pulling the sides of the abdominal walls toward the midline. Let’s go back to the diagram; if we suture your abdominal wall, the transverse dimension of your abdomen will decrease.

By understanding your anatomy, the surgeon can determine before surgery how small your waist is going to be. You cannot pick and choose the waist size that you desire. The only thing the surgeon can do is make your waist as small as possible based on your anatomy and other factors.