Abdominal Etching: clinical and technical measures for achieving predictable outcomes
Aldo Benjamin Guerra, MD
INTRODUCTION: Abdominal Etching is a procedure used to enhance the appearance of the abdominal wall musculature. As originally described, the procedure was advocated in athletic males and was associated with a high success rate and low complication rate. While this procedure continues to have advocates, many surgeons offering abdominal etching have noted a lack of reproducible results and, in some cases, poor outcomes. The most common complaints relate to: (1) the inability to create the correct degree of etching with a failure to enhance the muscular appearance; (2) the creation of skin contour deformities not in-line with abdominal muscles; and (3) the need for revision surgery to correct contour problems. The author reviewed his own series of patients to identify which factors lead to improved results while reducing complications.
METHOD: In order to understand the steps involved in achieving a more predictable result with abdominal etching, the author retrospectively reviewed a series of etching procedures including 32 cases over 4.5 years. The technique was carried out on 24 primary and 8 secondary cases. Factors considered for this study included; 1) surgical markings, 2) medical history and physical examination characteristics, 3) instrumentation, 4) technique, and 5) complications.
RESULTS: Results indicate that when accurately performed abdominal etching can lead to a successful enhancement of the muscular appearance (Figures 1-4). The keys to successful outcomes include: (1) Patient Selection. A careful medical history should be obtained and exclude patients that are or have been heavier than 20% of ideal body weight. A pinch test is very important and should be performed on all patients. The pinch test should demonstrate at least 1 cm but no more than 2 cm of fatty deposits. The abdominal skin should be healthy, strong and fairly immobile. Hypermobility may suggest the inability of the skin to completely retract after etching; (2) Technique. All patients were marked using the natural abdominal landmarks. A natural result is best achieved when etching is completed asymmetrically. Therefore, the finishing touches when marking include allowing for certain individual characteristics. The markings should never be exact mirror images as this could result in an unnatural looking abdomen after surgery. A series of liposuction cannulas is used to achieve the appropriate level of etching. Etching begins over the midline with a 5 or 6 mm cannula to aggressively remove fat from the deep layer. The inscriptions and semilunaris lines are similarly treated. The surgeon should switch to a 2 mm cannula to remove fat from the superficial layer. A Gilliland cannula is used to complete the operation; (3) Clinical judgment. This is critical in achieving the desired results and avoiding complications. The fat tissue between the etching lines can be liposuctioned when indicated. Not all patients require liposuction of the fat tissues between etching lines. One should avoid liposuction in the intervening tissue in patients with a history of abdominal liposuction. Experience guides the surgeon in determining when the etching effect has been attained. Post-op management includes compression of the area. Seromas are common, small, but capable of affecting the abdominal contour and requiring treatment. Cortisone injections help to alleviate lumps of fatty necrosis often seen after surgery.
Complications included seroma (6), hypertrophic scars (3), and contour depressions requiring revision (2). All patients reported an improvement in the appearance of the abdominal musculature and satisfaction with the procedure was high (86%).
CONCLUSIONS: The author concludes that abdominal etching is a viable procedure with the potential for associated complications. Abdominal etching can be carried out with a high likelihood of success by most seasoned surgeons.
REFERENCES:
1. Ersek RA, Salisbury AV. Abdominal etching. Aesthetic Plast Surg 21:328-31, 1997.
2. Mentz HA 3rd, Gilliland MD, Patronella CK. Abdominal etching: differential liposuction to detail abdominal musculature. Aesthetic Plast Surg 17:287-90, 1993.
3. Gasperoni C, Salgarello M. Rationale of subdermal superficial liposuction related to the anatomy of subcutaneous fat and the superficial fascial system.
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4. Bolivar de Souza Pinto E, Erazo I PJ, Prado Filho FS, Muniz AC, Salazar GH. Superficial liposuction. Aesthetic Plast Surg 20:111-22, 1996.
Figure 1. Preoperative AP view for abdominal etching.
Figure 2. Postoperative AP view after abdominal etching.
Figure 3. Preoperative view of abdominal etching patient.
Figure 4. Postoperative view of abdominal etching patient.