Dear 4423Anon Thank you for your great question regarding plastic surgery procedures to significantly reduce the waistline. There are two forms of plastic surgery that can reduce your waistline or torso. There is aggressive liposuction which can remove fat and establish an hourglass waistline. As the name implies, liposuction is great to remove fat. However, skin recoil potential is not guaranteed. If you have a lot of skin and fat I would not suggest waistline liposuction. The other alternative to waistline liposuction is a torsoplasty. Also, I call this term “hourglassing". During a hourglassing or torsoplasty, an incision is made along the waistline. This can be done in two locations. This torsoplasty can be done centrally in the abdomen from the zyphoid or between the breast to the pubic region. By making this midline incision, the abdominal skin and fat are gathered centrally, and the waistline is brought in much like a corset. Indeed, some plastic surgeon calls this a corset or central torsoplasty. The other incision pattern to achieve the hourglass waistline an incision from the axilla, or armpit, to the top of the hip. This is done on each side. An elliptical area of skin and fat is removed from each side, an hourglass waistline is brought in. The benefit of the incision on the side is that when your arms are held by your sides, the scar is hidden. For larger patients, the incision on the side may yield better results. The incision on the side can also remove excess skin and fat from the back. When considering a waistline surgery, please seek a board-certified plastic surgeon who is highly experienced. Thank you for your question regarding how to decrease waistline with liposuction, a torsoplasty or, an hourglass procedure. If you have any questions regarding waistline surgery or plastic surgery, call my office. Thank you, Dr. Timothy Katzen