The Surgical Waist: Defining the Zones of the Waist via Selective Liposuction or Fat Grafting to Improve the Female Silhouette.

BACKGROUND: An "hourglass" waist is often valued as a sign of health and beauty. Despite this, methods to achieve the 3-dimensional anatomy and aesthetics of the waist remain underexplored. Selective liposuction or fat grafting of the waist transition aesthetic unit influences shape, depth, and proportions, regardless of adjunct surgical techniques to reduce the transverse plane of the waist. This study describes a technique using selective liposuction or fat grafting to refine the waist. METHODS: The primary author's technique using selective liposuction or fat grafting is described. A retrospective study of patients treated between November 1, 2016, and January 30, 2025, was conducted to assess safety and efficacy. Medical records, photographs, and insurance claims were reviewed. Progress photographs were taken preoperatively and at postoperative time points. A photometric analysis was performed. RESULTS: A total of 1999 consecutive cases were performed during the study period. The median age was 36 (interquartile range, 31-42) years, and the median body mass index was 29 (interquartile range, 26-32) kg/m2. Complications included hematoma (4, 0.20%), pulmonary embolism or deep vein thrombosis (4, 0.20%), postoperative anemia requiring transfusion (11, 0.55%), and surgical site infection (24, 1.20%). Six patients required excision for skin necrosis (0.30%). Skin hyperemia occurred in 458 cases (22.91%), resolving in most but leading to permanent hyperpigmentation in less than 1%. CONCLUSIONS: Selective liposuction or fat grafting is a safe, reliable technique and serves as the first surgical intervention in our surgical protocol to enhance the waist. Addressing this area helps achieve a more balanced feminine profile.