No fewer than six of the last nine covers of Men’s Health have featured cavernous, chiseled abs — November, October, August, July, May and April. But just as Barbie’s dimensions are wildly unrealistic for a real-life woman (she would stand 6 feet tall and weigh 100 pounds, with 36D breasts, a 19-inch waist and the hips of a prepubescent boy), the average man’s eternal quest to imitate He-Man (or Brad Pitt in Thelma and Louise, or Trevante-Rhodes in Moonlight) is a bit of a fool’s errand.
As Houston plastic surgeon Henry Mentz explains, natural washboard abs are a product of constant, intensive exercise while maintaining 6 or 7 percent body fat, which is nearly impossible. Most men can only sustain the kind of uncompromising diet required (a daily limit of nine calories per pound, or 1,759 calories for the average American man) for about three months before reverting to normal eating, at which point the definition is almost immediately lost.
And so, in the early 1990s, Mentz created a cheat — a procedure called abdominal etching, which runs between $7,000 and $12,000, depending on the complexity and additional areas the patient wants treated.
The first step, liposuction, is currently the most popular form of plastic surgery for men: 51,370 guys hoovered fat from their bodies in 2015, up 27 percent from 2014. “We anticipate another increase this year, as fat-grafting procedures become more popular among men as well,” says Leigh Hope Fountain of the American Society for Aesthetic Plastic Surgery. The liposuction unveils muscles underneath the fat, Mentz explains, allowing him to shape what remains. That’s where the second step comes in: etching the abdominal muscles like a Roman sculpture to appear more well-defined. It’s now practiced nationwide. “Etching has become the most popular procedure among men in our practice,” says Miami plastic surgeon Constantino G. Mendieta.
As part of our ongoing series on entrepreneurs in male insecurity, we talked to Mentz and others involved in the earliest days of ab etching, which all started with a request from an actor in Texas back in 1991…
Mentz, Plastic surgeon and partner at the Aesthetic Center for Plastic Surgery in Houston, inventor of abdominal etching: An actor from Austin came to me before a photoshoot and said, “I don’t need much fat removal; I’d just like to get my abs to show because I’ve never been able to get them to unveil. Can you just etch it in there?” He worked out a lot but couldn’t quite get his six-pack to show. We talked about it for a bit and I thought, Well, I could just liposuction the grooves. And so, we did that. He looked exceptionally great. I did maybe 10 more with my partner at the time before publishing an article about the procedure in 1993. It was the beginning of an evolution in plastic surgery with liposuction.
Benjamin Marshall-Ruiz, early Mentz patient: I call Dr. Mentz the patron saint of plastic surgery. I came to him for pec implants and he said, “I also have this new procedure I’m doing to create a six-pack.” Well, I was obsessed with trying to get my abs to show. I could get maybe a slight hint if I took the right breath or exhaled the right way and didn’t eat any carbs for a week. But who wants to live life like that? I wanted to be able to have some carbs every now and then or have a drink and still look good when I took my shirt off. To me, a six-pack is the benchmark of looking fit. Calves, too. You either have big calves or you don’t. (That was another thing he did for me: calf implants.) He asked me to go work out to make sure that I was training my abs good for six months to give him a benchmark to follow.
Mentz: It’s one of the most satisfying male operations I can do. They come in looking soft, and they leave with a six-pack. If breast implants make women feel sexier, giving men a six-pack does the same thing — it’s the great liberator. Men fly in from all over the world. We have a couple “substitute mothers” who set everything up with them online beforehand.
Joy Mojica, “substitute mother”: I send them an idea of what to pack. Like, “Bring pajamas that open in the front. And no T-shirt.” I also say, “No salt!” More salt means more water retention. More water retention, more pain. More bleeding. Water retention is difficult for walking, because I need to make them walk. And then I tell them: Drink water! A lot of hotels [where patients stay during recovery] will provide a small refrigerator and microwave when we tell them we will be there for six or seven days for health reasons. They will give a discount, too.
Mentz: They come in the day before, and we meet to discuss everything. They stay at a local hotel, and the next morning they taxi to the surgery suite. The surgery takes about an hour.
Marshall-Ruiz: Sometimes after a plastic surgery procedure, you worry you won’t get the result you want right away because it looks worse before it gets better. That’s not the case with abdominal etching. The same day of the surgery, Dr. Mentz pulled away the compression foam just enough so I could see. That was my “aha” moment. I was like, “Wow, this is going to look great.” The results were amazing… and fast!
Mentz: I tell most guys that it feels like your first day of football practice. It’s sore, it’s difficult to move and it’s a little uncomfortable. That’s why the substitute mothers stay with them for as long as they need.
Mojica: After the surgery, I pick them up from the hospital. I always tell the men, “You have to accept my caring, because I am a woman and that is my nature.” Some men don’t want this. They’re in pain. And I say, “You have to be open with me like you are with a very close friend. You must accept my care!” I am like a mother, but a tough mother. But also pampering. I say, “It’s okay, sweetheart. That’s just a side effect from the medicine. Everything will be okay, sweetheart.” I treat them like a child. But I am 72 years old. Everyone is like my child!
The first use of suction to remove fat was done in Paris by Dr. Charles Dujarier. It was a rocky start. One of Dujarier’s early patients was a model and dancer looking to change the shape of her knees. That she did. Gangrene set in, and the leg was amputated. The ensuing publicity halted any form of suction-assisted fat removal until 1978 when another French physician, Yves-Gerard Illouz, further developed it, though it was designed solely to remove fat. Today, three-dimensional sculpting procedures are designed for all parts of the body and meant to transform average Joes into Greek gods.
Mentz: Nowadays it’s more liposculpture rather than liposuction…
Constantino G. Mendieta, Miami plastic surgeon, butt-augmentation specialist: There’s something I’m doing I call The Adonis Procedure. Not only do I sculpt the abdomen, but I take the fat and inject it into their shoulder and pectoral muscles, which increases both and gives them a six-pack, too.
Mentz: Back in the early 1990s, liposuction was really just a de-bulking operation. So it was pretty good for love handles. We were using larger cannulas, or suction tubes. People bruised a lot more because we were a little more brutal. There was very little finesse involved; it was basically just to make waistlines smaller and thighs smaller. But it’s evolved into elegant contouring.
Mendieta: The Adonis Procedure has become very popular among men. I’m using their own fat to reshape it to look like muscle. I etch the shoulder, I etch the pectoral area, I etch the abdomen — it completely transforms their body shape. These guys have never had the kinds of bodies I give them. They’re not living in a gym. These are your average guys who hit the gym every once in a while but just can’t seem to get into shape.
Mentz: Every year there are little adjustments. Like on the back, it’s nice to see that groove right at the spine, and those dimples right above the buttocks. It’s very beautiful. Some guys want a little edge to show, some want a hard edge, some want a little reduction — everybody’s looking for a little different tailoring, which makes it much more fun. An operation that was relatively boring from a creative perspective is much more exciting now. You see guys in magazines that have their natural six-packs, and they’re hardly ever exactly squared and the same on the right and left. There’s not a whole lot in nature that’s exactly symmetrical, so there has to be a little right-left asymmetry to make it look natural.
Mendieta: The problem is, if you just etch the abdomen and don’t do anything with the chest or the shoulders, it looks out of proportion, like a bottle cap that doesn’t quite fit on the bottle. That’s why it’s important to think about the body in a three-dimensional way. What some guys are doing, and I had this done myself, is take their love handles and inject them into the butt. Men start to lose butt fat after the age of 35, so you either need a thicker wallet or you gotta actually put fat in the butt. So guys’ fat, this dreaded thing, becomes their best friend.
There are, of course, risks, which for abdominal etching include infection, bleeding and excessive scarring. Recovery, however, is relatively swift, if a little leaky.
Mentz: We leave the puncture sites in very discreet places, so they’re way down low in the pubic area in the middle of the crack in the buttock. Sometimes those are still leaky, so they’ll wear a Depends diaper on the plane, and for maybe four days when they get home. The diaper thing is a little weird and might chase some patients away, but it works really well.
Marshall-Ruiz: I experienced minimal leaking for about a week or so. I hate to say it, but I had a tampon, well not a tampon, a maxi pad, to absorb the leak.
Mentz: They stay in town for two days. Sometimes they’ll keep the substitute mother overnight; most of the time they’ll send her home. We send a nurse to their hotel to check in. Patients are sore and require pain medicine usually for three days. By the third day, most guys fly home. They usually go back to work on day five. They start working out on day seven to day 10.
The hardest things to recover from are impact exercises like basketball, volleyball, tennis and jogging because the heel strikes when you’re running and that impact hurts. So my runners usually start slower and with non-impact exercise like a stationary bicycle a week out. After the third week, they might start to jog. It’ll take them about six weeks to get back to their regular mileage.
Mojica: The pain isn’t important to them after seeing themselves every day with what they like. The goal is to look nice. The pain isn’t something that will disturb that goal.
Mentz: One of the questions guys always ask is, “What happens when I get old?” When I presented ab etching back in Paris and New York in 1993, even the inventor of liposuction, Dr. Yves-Gerard Illouz, said, “I don’t think I want to do that, because I think if patients get fat, they’re gonna look lumpy.” But he’s still alive, and he’s picked it up now. I’ve definitely had guys who’ve gotten heavier, and they still look better than their before picture. I’ve had guys continue to lean out, too, and they look better still.
Marshall-Ruiz: Dr. Mentz has had me come in on several different occasions to take some pictures to show how well the procedure holds up. His colleagues all want to know: What does it look like in a five-year, 10-year and 15-year timeline? It’s held up very well for me. Twenty years later, it looks the same as the first day after I had it done. Coupled with a decent workout program and lifestyle, I think you can keep these results into perpetuity for the rest of your life. I’m 51 now. I don’t have to be the person who eats five times a day and reads Men’s Health all day long. My lifestyle has become more manageable in terms of working out and life in general. All the while, I still look physically fit and am able to maintain my abs. So it’s not like you have to go at the gym really hard to maintain what Dr. Mentz did.
Mojica: I just had two swimmers who are very important in their sport. I say, “You have a perfect body, what you doing here?!” And they tell me, “No matter what I do, it stays fat. I try and try and try. It doesn’t work. I need to remove it.”
Marshall-Ruiz: I like when people comment on my abs; that’s always super cool. I may have never been able to achieve abs that look like this without some kind of crazy crash diet of carb depletion that body builders do. Have you ever seen the faces of those guys? Their body is crazy shredded, but they have no facial fat and they’re so gaunt with deep lines around their mouth. And trust me, they won’t be able to keep that crazy lean look. Because they’re not happy, they’re hungry! So the abdominal etching has been able to give me a shredded abdominal appearance that doesn’t come with a carb-depletion diet and a gaunt face.
I don’t have a problem telling people that’s how I got them either. Some people are very secretive about their plastic surgery. But if I have something that makes me happy, I want to share it. For instance, when people see my calves, they always say, “Man, you have the most kickass calves. How did you get them? You must play soccer or run a lot.”
My response: “Neither, they’re not real.”