May 15, 2000 -- If only a few hours in the operating room could substitute for years of dietary discipline and hard work in the gym. While that would be nice, reality is somewhat different.

"Killer abs" are the combination of strong abdominal muscles and taut skin with very little fat under it, so that the underlying muscles are readily visible. The thicker the fat layer beneath the skin, the less you see the muscle layer. How much fat you have under your skin depends primarily on your genes and secondarily on your diet and changes due to aging. Some men have very little fat, even without watching their diet. With exercise they can easily develop an attractive abdomen. Others are born with a thick blanket of fat covering their muscles, making it difficult to see even the best-toned musculature.

Liposuction may help individuals with too much fat under their skin look leaner. By itself, however, it won't create the "six-pack" look that you see on models and champion bodybuilders.

And liposuction isn't for everyone. The technique works best in someone who is young, has good skin elasticity, works out regularly, and has only a limited degree of localized excess fat. It doesn't work well in those who are middle-aged or older (when decreased skin elasticity becomes an issue) or who have a significant amount of excess fat.

What's more, liposuction isn't perfect. In some cases, it can result in loose skin and some surface irregularities (for example, dimpling). A "tummy tuck" (abdominoplasty), or lower-body lift, may be necessary if the skin layer and abdominal muscles have become too loose and need tightening beyond what is possible through exercise.

Fortunately, the rate of serious complications from liposuction is very low. The most frequent complaints usually come from patients who expected better results than could be achieved through the surgery. Like any other cosmetic or elective surgery, it's important to develop realistic expectations with your surgeon beforehand.

If you are thinking about liposuction, I'd recommend a careful, individualized evaluation by a qualified surgeon certified by the American Board of Plastic Surgery; check the surgeon's certification at www.certifieddoctor.org. Make sure you discuss possible outcomes and any alternatives. Remember, your commitment to a careful diet and regular exercise provides significant aesthetic and health benefits and should be the cornerstone of any quest for "killer abs."

Stephan Baker, MD, FACS, is a member of the American Society of Plastic Surgeons and a past president of the Miami Society of Plastic Surgeons. In addition to his private practice, he serves as a volunteer clinical associate professor in plastic surgery at the University of Miami School of Medicine.

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