There’s a reason tummy tucks are among the most popular plastic surgery procedures: by removing excess skin and fat, tightening stretched muscles, and repositioning the belly button, they can deliver total abdominal rejuvenation. This includes creating a more hourglass figure, where your waist is slimmer compared to the dimensions of your shoulders and hips.
Even when people don’t specifically ask for one, this type of curvier silhouette is often a goal for patients undergoing a standard abdominoplasty. “They don’t always say ‘hourglass figure,’ but it’s not uncommon for patients to touch their sides and show me a curve that they want there,” says Dr. Jerome Edelstein, a Toronto-based board-certified plastic surgeon who specializes in surgery of the breasts and body. Creating an hourglass figure is a goal for surgeons as well; “you don’t want to give someone a square shape,” he says.
To make clear what they strive to deliver, some surgeons offer a so-called Hourglass Tummy Tuck, a type of surgical body contouring. While more than one surgeon claims to have created the Hourglass Tummy Tuck, the term is trademarked by Dr. Wilberto Cortes, a board-certified plastic surgeon in Houston who goes by the moniker “Dr. Hourglass.” Over the past 14 years, he’s perfected his Hourglass Tummy Tuck technique, which is essentially three different procedures on the abdominal area, along with the standard removal of skin and fat from the area below the belly button to above the pubic area—the reason for the telltale hip-to-hip scar that extends across the lower abdomen. “It’s a more advanced and complete procedure that gives a much better result,” says Dr. Cortes, who will present a series of 1,200 cases at two upcoming plastic surgery meetings.
Key components of a curvier shape
Traditional tummy tuck surgery, including the Hourglass Tummy Tuck, first removes excess abdominal skin and then typically include two components that specifically help to trim the waistline and midsection:
Liposuction
In addition to performing liposuction on the abdomen to reduce stubborn fat during a tummy tuck, “you have to liposuction the flanks very aggressively,” says Dr. Edelstein. “That’s one thing that really helps to curve in the sides of the body.” Without liposuction of the flanks, the abdomen can look flat but squared.
Luckily, the skin in this area is very forgiving. “In some areas that you liposuction, if the skin elasticity isn’t great, you can end up with skin irregularities,” says Dr. Edelstein. “That doesn’t happen in the flanks, so you can be very aggressive.”
This aggressiveness is key, says Dr. Cortes. “You can have lipo during a tummy tuck, but the question is, is the goal to make you as curvy as possible or just to decrease the thickness of the abdomen? It’s two different things.”
Depending on a person’s anatomy, an hourglass shape may require circumferential truncal liposuction (aka 360 liposuction), particularly of the back, love handles, and flanks, to fully contour the waist and torso. Performing lipo on the lower back also makes the butt look rounder and fuller, a plus for those who want to enhance their behind—but not necessarily make it bigger, à la the Brazilian butt lift (BBL) or butt implants.
When consulting with plastic surgeons, be sure they’re skilled in performing liposuction in combination with a tummy tuck, because these procedures together can increase the risk of complications of wound healing if the surgeon isn’t careful.
Muscle tightening
When it becomes stretched due to dramatic weight gain (such as from pregnancy), the lining, or fascia, that surrounds and connects your abdominal muscles can contribute to the look of a wide waist. This is why most tummy tucks include what’s technically called a rectus plication, or the stitching back together of the fascia with strong, internal sutures that run vertically up the center of the abdomen (think of it like “lacing up” sneakers). “That fascia runs from the front of the tummy around the sides, and as you pull it together, it also pulls in the sides, effectively acting as a corset to create a slimmer waist and more hourglass shape,” explains Dr. Edelstein.
The Hourglass Tummy Tuck difference: using fat to create more curves
Hip augmentation via fat transfer, where you use the excess fat removed during liposuction to add volume to the hips and improve the waist-to-hip ratio, isn’t a new procedure, but tacking it onto a tummy tuck isn’t widely done. It is, however, an integral part of the Hourglass Tummy Tuck. “I do fat injections on almost everybody,” says Dr. Cortes. “If you don’t address the hip aesthetic unit, you can get a smaller waist but still look boxy in the hip area.” Even those who already have an hourglass silhouette are usually candidates for fat transfer, he says, since they may have slight areas of indentation or the transition between the hip and waist isn’t optimal.
The hip can be a challenging area to sculpt with fat, according to Dr. Cortes. It starts at the front and blends with the buttocks from the back, so you have to blend the aesthetic units to make it look youthful and balanced. “You have to address both sides of the anatomical unit,” he says. “A lot of people just do half, so from the back view, patients look curvy but from the front view, you can still look square.” Another issue: Unlike the buttock, which is pretty well-defined, “the hip has different contours and shadows—some areas need lipo, others need to be expanded and augmented,” Dr. Cortes explains.
To enhance someone’s curviness enough, a significant amount of fat needs to be injected—350 to 400cc (around 1.5 cups of fat) for each hip. You have to inject more than you think you’ll need, understanding that some will get resorbed. “I’ve seen patients years after surgery, and the fat is still there,” says Dr. Cortes.
Anatomical challenges to achieving the hourglass shape
The good news about tummy tucks: usually everyone can develop more of an hourglass figure with the procedure. The bad news: “There are some people whose anatomy may make it harder to get a classic hourglass figure,” says Dr. Edelstein.
According to Dr. Nelson Castillo, a board-certified plastic surgeon in Atlanta, there’s a greater chance of creating a boxier appearance in patients who have a short distance between their lower rib cage and pelvic bone. “It’s difficult to create an hourglass shape if there isn’t sufficient space between these bony structures to produce an inward curve,” he explains.
Another limiting factor, says Dr. Cortes, is the quality of a person’s skin. For instance, patients with very tight skin, such as very athletic patients, don’t have as much stretch to their skin, “so you don’t get as much hourglass shape. You can still get some shape, but not everyone can have a very curvy figure with just one surgery,” he says. (It’s one instance, where having slightly more loose skin can actually be helpful.) In these cases, he recommends serial fat expansions, where patients are injected once, to maximally expand the hip, and then injected more on subsequent visits.
An hourglass shape is also more likely to be achieved by those who are in the range of their ideal body weight prior to surgery, without notable intra-abdominal fat. “Some patients with a higher BMI and a greater concentration of visceral fat can look wider after surgery,” says Dr. Castillo. “The muscles flatten the stomach, forcing the internal abdominal contents more toward the sides of the body.”
Because he finds that the surgical results just aren’t that good if someone’s BMI is high, Dr. Edelstein has certain cutoffs. “In a typical patient, I want the BMI at or below 25,” which is considered the healthy range. In massive-weight-loss patients, he raises it to 30 or below, the overweight range.
The Hourglass Tummy Tuck recovery process
While two to six weeks is the typical recovery time for a traditional tummy tuck, this may skew slightly toward the higher end with an hourglass tummy tuck, simply because more liposuction may be required, as well as the additional fat transfer. (And the same rules apply in terms of not lifting anything heavy, wearing a compression garment, etc.) However, hourglass tummy tuck scars aren’t any different than those of a regular tummy tuck. The only real scar you’ll have is the one that stretches from hip to hip, which is the case with any abdominoplasty. Keep in mind too, that, if you’re pairing this procedure with any other— i.e. as part of a mommy makeover and also undergoing something like a breast lift or breast augmentation—your overall healing process may take longer.
Hourglass Tummy Tuck cost
According to RealSelf members, the average cost for a standard tummy tuck is $9,903. Given the additional fat transfer and/or liposuction required in the case of a hourglass tummy tuck, expect this cost to increase, potentially by several thousand dollars.
What to look for in Hourglass Tummy Tuck before & afters
As is the case with any tummy tuck before and after photos, an inconspicuous scar (it should be very low and easily hidden with underwear) and natural-looking belly button are key. But the contour of the abdominal wall is especially important to pay attention to in this case. An hourglass tummy tuck is more of a body contouring procedure than its traditional counterpart, so you’ll want to look for photos where the waist is notably smaller and more narrow as compared to the hips, and that hourglass shape is clearly visible.
