A six-pack abdomen is the result of 2 things:Well-developed rectus abdominis musclesA thin layer of fat between the skin and underlying muscle As a surgeon performing an abdominoplasty, I have control over several factors in making a six-pack abdomen. I can assure that the rectus muscles are brought together in the midline of the abdominal wall, and have some control of the thickness of the overlying fat layer. With my tummy tuck technique, the surgical scissors are used to thin out the fat of the abdominal wall. Unlike using liposuction which cannot safely be done over the rectus muscles, thinning the fat with scissors allows me to be aggressive in this area without damaging the blood supply of the tissues. Thinner tissues will tend to allow the underlying muscles to be visible, thus giving you back your six-pack. Obviously, the patient is in control of the remaining factors, such as diet and exercise. If the fat layer is thin, but the muscles are not well developed, then guess what?; No six-pack. Likewise, even if your muscles are ripped, if the fat layer is too thick, you won’t be able to appreciate it visually.I hope this helps answer your question. Good luck to you!