It appears that the distribution and not the absolute levels of body fat that is most important in determining female attractiveness. This explains the importance of restoring waist definition. Singh in his investigation of temporal changes in absolute levels of body fat for beauty pageant contestants showed that despite temporally dependent changes in beauty ideals, the preferred ideal waist-to-hip ratio has stayed roughly the same at 0.7 [18].

Many techniques have been proposed to correct truncal contour deformities, especially those involving the waist area. Some of these techniques addressed the musculoaponeurotic layer of the abdomen. Psillakis [19] sutured bilateral external oblique muscles to the rectus sheath, thereby reducing the diameter of the waist. Later he modified his technique by dissecting the external oblique muscles and resuturing them in the midline, together with resecting cartilage from the 7th and 8th ribs to reduce the diameter of the upper abdomen in case of exaggerated anterior projection [20]. Although the author did not comment on the complication rate with that technique, we believe that the extensive dissection and rib resections carry a higher rate of complications. Jackson et al. [21] describe the waistline suture. After vertical midline plication, a horizontal fascial plication at the level of the umbilicus was accomplished to reduce further the resultant vertical fascial excess. Posterior rectus fascia plication with concomitant rectus muscle excision to treat severe diastasis has been described by de Pina [22]. Abramo et al. [23] proposed a combination of two horizontal plications of the musculoaponeurotic layer at the top and bottom of the vertical plication, thus creating an H-shaped pattern of plication. The horizontal plication not only minimized the musculoaponeurotic laxity but also brought the cutaneous flap downwards minimizing the tension on skin closure. Marques et al. [24

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