**3. Patient evaluation and marking**

Ideal candidates for abdominal and trunk liposuction are patients who present with localized areas of adiposity with minimal to moderate skin laxity. Patients with significant skin excess or those with minimal adiposity are better suited to excisional procedures. A pinch test should be performed to delineate subcutaneous versus intraabdominal fat. Patients should be counseled that intraabdominal fat will not be addressed or improved by liposuction. A history of any intraabdominal procedures should be elicited and the patient should be examined for any abdominal scars or hernias. Imaging is typically reserved for patients with questionable abdominal wall defects or hernias. In these cases, a computed tomographic scan of the abdomen and pelvis with oral contrast should be performed prior to surgical intervention.

**Figure 1.** *Standard abdominal series. Includes anterior and posterior trunk.*

**Figure 2.** *Example of topographic marking for circumferential trunk liposuction. Thin areas are marked in red.*

A standard series of photographs are taken prior to marking the patient (**Figure 1**).

The areas for liposuction are then marked topographically with care to delineate zones of adherence and other areas where liposuction should be minimized. The areas where fat removal should be avoided are typically marked in red (**Figure 2**). For patients undergoing abdominal etching, the muscular anatomy of the rectus abdominis muscle and external obliques are palpated with the patient flexing his or her abdominal muscles. The linea alba, linea semilunaris, and transverse rectus abdominis muscle inscriptions are marked. The rectus abdominis muscle inscriptions typically begin at the level of the umbilicus and continue with two or more inscriptions superiorly. Any excessive flank adiposity is marked topographically as well.
