6-Pack Surgery Is Becoming More Popular With Men — But What Is It?

When you strive to have six-pack abs, you might hit the gym religiously and stick to a strict, super lean diet. But you may still struggle to achieve a chiseled physique. If so, abdominal etching surgery might help.

Ab etching is a type of liposuction that involves strategically removing fat around the abs to create the “lines and shadows in the body that gives somebody that toned, defined, athletic look,” explained Dr. Josef Hadeed, a plastic surgeon in Beverly Hills, California, and former chair of the Patient Safety Committee of the American Society of Plastic Surgeons, or ASPS.

Liposuction, in general, has been the most popular cosmetic surgical procedure for years — and while most people who get lipo are women, it’s becoming more common for men, according to ASPS. Ab etching is performed for both men and women, but Hadeed said he’s seeing more men interested in it.

“One of the biggest reasons is, they just want to feel good about themselves,” he said. “We hear from a lot of men: They go to the gym all the time. They eat right. They take care of themselves. It’s just stubborn areas of fat that they just can’t seem to get rid of, no matter what they do.”

Some men mention wanting a “more youthful appearance” to maintain their career edge and to look good with their shirts off at the beach or pool, Hadeed added. People are also just more aware of ab etching than they have been in the past, he said, as it’s commonly talked about on social media.

If a six-pack is your goal, here’s what plastic surgeons want you to know about ab etching, including the best candidates for the procedure and what results you can expect.

Ab etching is a type of high-definition liposuction — it differs from traditional lipo, which focuses solely on removing fat. Ab etching is more strategic, explained Dr. Lyle Leipziger, the chief of plastic surgery at North Shore University Hospital and Long Island Jewish Medical Center in New York.

Surgeons mark a grid pattern on the abdominal wall and discuss the results you’re trying to achieve. Then, fat is selectively removed in certain areas to make the muscles look bigger, Leipziger said. In some cases, fat may be injected in other areas to further enhance the appearance of muscles.

“It’s like peaks and valleys,” Leipziger said. “You want to maintain certain areas to create the semblance of a muscle bulge, and then you want to remove fat in other areas to give a valley between those areas to make the muscles look more enhanced.”

Ultimately, the goal is to create more muscle definition based on a person’s natural anatomy. “The same way you would chisel out a sculpture out of a big piece of stone, that’s what we’re doing with high-def liposuction,” said Dr. Christopher Costa, the founder of Platinum Plastic Surgery in Las Vegas.

Ab etching may be done under general or local anesthesia, depending on the case. Costa said tiny incisions are made to insert liposuction devices, and the procedure can take two to three hours.

Some men get ab etching when they just want to contour their midsection, Hadeed said. But often, they also want more definition on their chest, back, shoulders and arms, and get high-definition liposuction in those places at the same time.

It’s all about ensuring a proportionate look, Hadeed said. “Anytime you do high-definition lipo, you want to make sure you’re addressing the body as a whole because you want the results to look as natural as possible.”

People who are already physically fit and have existing muscle tone are best suited for ab etching, said Dr. Jason Emer, a cosmetic dermatologic surgeon in Beverly Hills.

“They work out all the time and they look really good, but their body just doesn’t let them have the abs showing or their chest as defined,” he said. They might have loose skin, or their six-pack may be hidden underneath a layer of fat.

Ab etching is not considered weight loss surgery. Ideally, men should already be close to their ideal weight, Leipziger said. “We’re talking about people that diet, exercise, take good care of themselves and are generally healthy,” he noted.

This can help ensure that they’ll maintain their six-pack results, which would be “lousy” if they skipped the gym, forwent a healthy diet or gained weight after healing from the procedure, Hadeed said.

According to a study published in 2019 in the journal Plastic and Reconstructive Surgery, ab etching is safe and effective, with patients experiencing an acceptable rate of complications and generally feeling satisfied with the procedure.

Still, it’s elective, and any surgery can bring risks, like infection, bleeding or scarring, Leipziger said. In general, other risks with liposuction include bruising, rippling or loose skin, irregularity and asymmetry, changes in skin sensation or pigmentation, and the need for revision surgery, according to ASPS.

Swelling is common after ab etching. Hadeed recommended lymphatic drainage massage, a type of gentle massage, for about a week after surgery to help get rid of excess fluid and reduce swelling. Sometimes, patients wear drains to remove fluid.

Patients also need to wear a compression bodysuit for about six weeks after the procedure, Hadeed said. This ensures that the skin conforms to the contours of the body and that everything heals well.

Patients can usually return to work after about a week, Hadeed added, noting that they can resume light cardio after four weeks and weightlifting after six to eight weeks.

Because ab etching requires strategy and attention to detail, doctors say it’s crucial to seek out a board-certified plastic surgeon who’s experienced performing the procedure. Costa suggested getting two or three different consults, looking at each surgeon’s before-and-after photos, and making sure the doctors accurately discuss the recovery process.

Emer said he often performs revision surgeries on men who went to inexperienced doctors and got results that simply don’t look good. For instance, a man may have gotten six-pack surgery without any contouring of the chest or shoulders, meaning that the overall look is off. Or their abs may look too feminine; Emer said some doctors are more experienced performing the surgery on women, and suggested asking about their ab etching work on men before signing up.

Ab etching is meant to be a “one-and-done procedure,” Costa said.

It may take two or three months to fully heal and see the final outcome of the surgery, Leipziger said. But as long as you follow your doctor’s postoperative orders, continue to work out and maintain your weight, you can expect results to be “pretty long-lasting and permanent,” Hadeed noted.

However, gaining weight could affect the contouring of your abs, and you might end up with loose skin if you lose weight — both of which will change the final look, Costa said.

You may need touch-ups after a few years if you want “super strict definition as time goes on,” Emer noted. People lose muscle mass and experience skin sagging with age, which can change how your abs look.

The main thing, Leipziger emphasized, is to have realistic expectations and discuss them with your surgeon.

“It’s not a quick fix,” he said. “This procedure, if performed for the right reason in the right patient, could provide nice aesthetic results. But it’s up to the patient to really maintain those results by maintaining a healthy lifestyle and diet and exercise.”