MH Investigates the Rise of Ab Tweakments
Carl still remembers that day. He was sore and bruised, held together by a compression garment. It hurt to undress. But when he did, he was left speechless by what he saw. ‘It was like being in someone else’s body,’ he recalls. Carl was marvelling at his new six-pack, the result of muscles being surgically ‘etched’ on to his abdomen the day before.
He had only told his mum and close friends that he was having the procedure – but afterwards, seeing his newly sculpted stomach, Carl felt like spreading the word. ‘I started telling people because I was amazed at the results,’ he says.
‘It’s one thing seeing it on Instagram – it’s another actually unveiling, unwrapping the thing and thinking, “Oh my god, this is my body.”’
Mere decades ago, plastic surgery was the preserve of the rich and famous; an outlandish indulgence as likely to inspire pity as envy. Today, such enhancements have lost much of their charge – positive or negative – to become almost as unremarkable as teeth-whitening and fake tan.
Celebrities who used to strenuously deny having had work done now freely discuss their nose jobs, for example. And so-called ‘tweakments’ such as anti-wrinkle injections are accessible on every British high street, sometimes for less than a hundred quid, while many of us know someone who has come home from Turkey with a new hairline.
An enduring cosmetic surgery boom has been reported on both sides of the Atlantic, despite fears of recession and a decline in consumer spending. The British Association of Aesthetic Plastic Surgeons (BAAPS) reported that more than 31,000 procedures were performed last year, a 102% increase compared with 2021 and over 3,000 more than before the pandemic – indeed, it was the highest annual rise since the BAAPS’s record-keeping began in 2004.
In the US, the upwards trend reaches further back. Between 1997 and 2007, the American Society for Aesthetic Plastic Surgery (known as The Aesthetic Society) recorded an increase of nearly 450%. Sixteen years on, the numbers are still climbing, even for the more intrusive ‘body procedures’ such as liposuction and abdominoplasty, which drove the rise between 2020 and 2021.
It’s not just women, either. The latest BAAPS figures showed a 118% increase in the number of male patients in the year to 2022.
‘It’s been democratised,’ says Alex Karidis,a cosmetic surgeon and the medical director of the Karidis clinic. Now based at the St John & St Elizabeth Hospital in north-west London, Karidis has been in private practice for 26 years, in which time his patients have gone from 20% men to 40%. What’s more, he tells me, it’s all types.
Karidis specialises in gynaecomastia surgery, targeting the area regrettably better known as ‘man boobs’, which can cost at least £5,000. It used to be that the men who sought him out were wealthy and well educated; now he finds it’s everyone – from bankers to labourers, and taxi drivers to lawyers.
‘Honestly, I’m simply not surprised any more,’ Karidis says. ‘I’ll see a guy come in with “heating supplies” on his T-shirt and he’s a plumber.’
But while more people might feel free to pursue surgery than was previously the case, not everyone feels comfortable disclosing it. According to surgeons, many male patients never reveal that they’ve had work done.
‘A lot of them won’t come clean – they’ll keep it hidden,’ says Karidis. ‘There’s still perhaps a stigma among men about “cheating”.’
Six-Packs For Sale
This tension – between self-acceptance and self-improvement, transparency and trickery – is a sign of the times and our chronically confused body standards. As 2000s-era fatphobia meets 21st-century technology, the pressure to look, do and be one’s best is all-pervasive.
For Carl, now 42 and based in Liverpool, there had never been a question in his mind. ‘I’ve always been open to having stuff done,’ he says. ‘If I didn’t like something and I could afford to change it, I’d do it.’
In 2020, before there were restrictions on international travel, Carl flew to Turkey for a hair transplant. He’d started with Botox when he was 21: young, even according to guidelines for ‘preventive’ use.
Today, plastic surgeons use social media as a shopfront, allowing anyone with an Instagram account to browse their work and DM questions. A recent study, assessing 18 years of Google Trends data, found a ‘significant increase in public interest’ in aesthetic procedures after Instagram gained popularity in April 2012*.
Carl followed individual surgeons and their #beforeandafter transformations on social media for years before making an enquiry himself. The tipping point was multi-pronged, he says. He was coming up to his 40th birthday, he wasn’t seeing the results he wanted at the gym and he’d just been invited to a wedding on Necker, Richard Branson’s private getaway in the British Virgin Islands.
‘I kind of thought, well, you only live once,’ says Carl. ‘I didn’t want to spend another holiday being self-conscious.’
All his life, Carl had struggled with what he calls his muffin top – stubborn belly fat that was easy enough to ignore beneath a T-shirt, but left him deeply uncomfortable without one. No amount of exercise nor ‘eating like a rabbit’ seemed to make a difference, he says. Even when he was in his twenties, he had never been able to get abs.
Carl’s online research suggested he was a suitable candidate for ‘abdominal etching’, a sort of targeted liposuction, reducing and shaping fat to imitate well-defined muscle. ‘I thought I’d try this out, because I’d tried every other option,’ he says.
He got as far as a consultation with a surgeon in nearby Manchester before finding reviews online warning against him. Carl winces to recall the near miss. ‘I was very, very close to signing the forms. You really need to research… I’d hate to be one of those people who saves up all the money, goes through the process then looks worse than they did before.’
Carl found Dr Leo via a sponsored post on Instagram. He laughs, a bit shamefaced at having been so easily read by the algorithm. ‘It got me.’
As soon as they met, Carl could tell that he was in safe hands. His friends had told him he didn’t need liposuction. ‘You do feel a bit silly saying, “Well, there’s this little bit of fat just here,”’ says Carl. But when he showed Dr Leo his ‘problem areas’, he felt validated. Dr Leo took his self-assessment seriously and saw his potential. ‘I knew from his Instagram that he had an eye for whatis aesthetically pleasing,’ says Carl.
For Dr Leonardo M Fasano, Carl was the perfect canvas.
The Artist’s Eye
An Italian native, Dr Fasano studied medicine in Romania, then worked in the NHS before pivoting to aesthetics and private practice. It was a better fit for his entrepreneurial spirit, Dr Fasano tells me. ‘I always felt a bit desolate working in the NHS.’
Dr Fasano studied liposuction under the Insta-famous Colombian surgeon Alfredo Hoyos, and earned the title of ‘Total Definer Master’. When we speak by phone he is jet-lagged, having just returned to the UK from further training in Bogotá.
‘Every surgeon has something that suits them most,’ Dr Fasano says. For him, it’s ‘body sculpting’: not just reducing the fat by volume, but shaping the area to emphasise (and replicate) muscle.
With so-called ‘360 surgery’, it’s possible to ‘drastically change the shape of a man or woman’, Dr Fasano explains – ‘and that translates to a completely different outlook on life.’ He talks about his work as a sculptor might, as an artistic endeavour and a source of great personal satisfaction.
‘I’ve always been a visual person, with an artistic eye,’ Dr Fasano agrees when I put this to him. Most cosmetic surgeons are the same, he says, though his family in Italy is full of painters, art historians and photographers – Dr Fasano himself likes to draw in his spare time.
And just as any artist might, he has a preference in subject. ‘I particularly like treating men,’ says Dr Fasano. Indeed, his clientele has gone from 70% women and 30% men before the pandemic to, now, a roughly even split.
‘When you see that six-pack and those arms, those legs, all super-etched and defined…’ Dr Fasano gives a happy sigh. ‘It just satisfies me.’
A full-body makeover – moving fat from the belly to the upper chest, then injecting it into the deltoids to create broader shoulders; creating muscle definition in biceps, triceps, flanks and back – can be done in one session.
‘It’s a hell of a lot of work,’ he says. ‘I end up exhausted at the end of the procedure – but it’s very satisfying.’
For his patients, it may be even more than that. ‘Many people seeking these procedures, they’ve dreamed of having a [body] like that, but they never would have [attained it].’
Body sculpting isn’t an option for everyone, and not just because of Dr Fasano’s estimated price tag of between £6,000 and £10,000. When consulting at his clinics in London and Birmingham, he spends close to an hour with potential patients, assessing their muscle tone, skin quality and body fat, as well as making checks on their lifestyle and mental health. ‘I make sure that they open up,’ he says.
His aim is to confirm that a new patient has realistic expectations and is approaching the operation not as a ‘shortcut to a six-pack’, but as a reset – ‘an opportunity to take better care of their body’, he says.
According to Dr Fasano, for those people with the will and the means, body sculpting is a reasonable indulgence – even an investment. He’s exasperated by the frequent charge that it is ‘cheating’, a workaround for diet and discipline.
He lets out a heavy sigh. ‘Can we just not use this language? A man wants to have a six-pack – let him have it. Who says that we can have a six-pack, but only if you go to the gym and only if your body is keen to develop one?’
Between work and family pressures, as well as the ‘inexorable passing of time’, it can feel like it’s getting harder and harder to maintain the body you want, Dr Fasano says.
‘Then you decide to get liposuction, to get rid of this thing that is bothering you – but people think you’re cheating.’ He laughs. ‘Just let them live!’
High Maintenance
To some extent, a ripped physique has long been a luxury, symbolising the investment of time and money. Surgery rankles by packaging it explicitly as a product, seemingly making available off the peg what others work hard to achieve.
But that minimises the process, which – aside from the risk of going under the knife (minimal with a reputable practitioner, but impossible to eradicate entirely) – is costly and involved.
It may not have been at the gym, but there is no question that Carl suffered for his six-pack. ‘It’s not just that you book in, get it all sucked out, then the next week you can eat what you want,’ he says.
He had been warned that the recovery would be tough. ‘I’d watched every YouTube video, I’d gone on all the forums – I knew what I was in for.’ But he was still taken aback. The day after surgery, Carl says, ‘I felt like I’d been in a car crash.’ The incisions on Carl’s torso had been fitted with small plastic catheters (surgical drains for his wounds), which had to be emptied. He struggled to put his shoes on, or even to get out of bed. His mum had to come round to help him in and out of his foam compression garment, and to wash. In addition, Carl hired a masseuse to make a house call every other day to help with the swelling.
While the drains were removed after a week, he had to wear the ‘corset’ day and night for one month, then part-time for another four weeks. All told, the recovery took about 12 weeks. And, after all that, Carl still has to go to the gym.
Contrary to popular perception, body sculpting is not a silver bullet; if you don’t eat healthily and exercise – if you gain weight – it’ll show. And etched abs, in particular, can easily be misjudged mid-op; Dr Fasano likens the effect to a ‘laced sausage’.
He will only carry out the procedure on men with relatively low body fat to begin with, and will sometimes tell prospective patients to come back when they have lost weight. Otherwise, he says, ‘the rest of the body doesn’t look like a six-pack belongs there’.
It raises the question: if cheating with surgery doesn’t get you out of working out and watching your diet, why bother? Instead of a workaround, surgeons speak of it as an ‘enhancement’; another tool in the arsenal for achieving a personal-best physique.
Dr Fasano says surgery can be a turning point in his patients’ lives, with the cost, the painstaking recovery and their satisfaction with the results all acting as incentives for them to make healthier choices. ‘The idea of gaining fat again in other areas scares them,’ he says.
In Carl’s case, his six-pack offered an immediate and enduring boost to his self-esteem. ‘It’s not just my body – it’s my mind as well,’ he says.
Alongside his day job working with young offenders, Carl is an actor. Previously, when he landed a part that required him to show skin, he would crash-diet and exercise daily. Carl used to beat himself up over everything he ate. ‘It was that little voice in my head that I was battling with,’ he says. And that’s gone since surgery? ‘Yes, and that’s why it was worth it.’ Any question of cheating is besides the point, Carl adds. ‘My body is now shaped how I wanted it – and I could never, ever, ever have done it without Dr Leo’s help.’
It highlights a paradox of plastic surgery. The goal, for practitioners and patients alike, is a ‘natural’ look – yet the results achieved by surgery are not always possible by diet and exercise alone.
‘The level of definition I achieve, I wouldn’t say so,’ agrees Fasano. Body shape and composition are partly determined by genetics. Even if yours does support rock-hard abs, maintaining them can feel like a full-time job, he says. It’s telling that even Hollywood actors – with all their access to advice and assistance – can only hang on to their superhero build for a short while.
In a 2021 YouGov survey of 2,270 Britons aged 16 and over, 62% said the media promoted unrealistic body images, while 40% of male respondents agreed that they felt pressured to have the ‘perfect’ physique. Now, the steady rise in plastic surgery patients suggests that more men than ever are prepared to go to drastic lengths to achieve it.
Extreme Measures
This is more evident in the US, where it’s not just liposuction and sculpting on the menu, but silicone implants (seldom done on men in the UK).
For Alex, an entrepreneur based in Colorado, the boom is part of a broader cultural shift towards self-expression. ‘Post-pandemic, people are just choosing to live with more authenticity,’ he says. ‘When I think about plastic surgery for myself, I don’t see it too differently from someone getting a piercing or a tattoo.’
Alex first sought plastic surgery in 2019 as a way of reclaiming his body following a gruelling recovery from brain and thyroid cancer. Over a two-year process, planned with a spreadsheet, Alex got a tummy tuck, etched abs and implants in his pecs, delts and biceps – plus a gastric sleeve and veneers. He says it was the best decision he ever made. ‘It’s a lot easier to love yourself if you look good.’
That has spiralled outwards, from his new love of working out, to his boosted social confidence. ‘I don’t think it’s so much that other people treat me differently because I’m beautiful – but because I’m beautiful, I show up and I now carry myself in the world differently.’
Alex is transparent about the work he’s had done, but not all men feel able to be. When Stuart, a New Yorker working in publishing, told friends and family about his plan to get surgery, many tried to talk him out of it, pointing to the cost, the uncertain results and the danger of a ‘slippery slope’. He went ahead with liposuction on his abdomen and flanks, a hair transplant, an upper lip lift and implants in his cheek, chin, pec and biceps – a total of five operations, all within the same year.
Stuart believes that there’s a greater stigma for men who seek surgery than there is for women. ‘It’s perceived as an unmasculine thing to be doing, to be showing that much concern about your appearance, [though] most men do feel it privately.’
Stuart’s family has since admitted that he looks great, he tells me. Has he said ‘I told you so’? ‘I don’t need to say it,’ Stuart replies. ‘They know.’
Dr Fasano talks about one fifty something patient, whose sister was aghast to see he had a six-pack. ‘He just said, “I train a lot.”’ This illustrates how cosmetic surgery can not only support the desire for unattainable body standards, but compound it.
As Dan Roberts sees it, the rise of etched abs is an indication of the disconnect between what we expect of our bodies and the reality. Like Dr Fasano, Roberts bills himself as a body-transformation expert – except he achieves his results at his London gym, ‘by turning people into athletes’.
For an actor getting ready for a role, that might be their entire focus for five months – or at least until after their shirtless scenes are done. That’s how fleeting peak performance is, says Roberts. ‘If you took a photo of him two days later, it wouldn’t look as good,’ he says. Even the before-and-afters widely used by both personal trainers and plastic surgeons in their marketing often benefit from camera trickery such as lighting and angles.
Whether it’s plastic surgery or a buzzed-about fitness innovation, anything promising your best-ever body and quick results is bound to disappoint, says Roberts. With exercise, on the other hand, there are only pluses.
‘If you go to the gym because you’re vain, at least you’re also going to improve your bone health and get all these other benefits… and if you work really hard and change your body, and someone says, “God, you look amazing,” it will feel amazing – because you know you put the work in.’
A Balancing Act
Though Carl has no regrets about having had surgery, he understands the stigma against it, he says. In fact, it’s when he’s complimented on his body that he’s most conscious of the trade-off he’s made.
‘I have had people say, at the gym, “Oh my god, look at your abs, you must do a hundred sit-ups a day,” and I just try and laugh it off because I don’t want to be like, “Yeah, I had liposuction” – but also I don’t want to lie.’
Nonetheless, the procedure has made him more confident in his body. When he goes to post a shirtless holiday snap on Instagram, Carl says, ‘Half of me thinks, “Ugh, should I be posting this picture? It looks a bit poser-y…” Then I think, “No, don’t hide it away – that’s what you’ve paid for!”’
He remains so delighted with the results that he shot a promotional video for Dr Fasano. ‘I said in the video he changed my life and I did mean it.’ Carl recommends abdominal etching to anyone with the means and the desire. ‘If they’ve tried everything else and they’re really unhappy, just go for it.’
And he’s not ruling out more procedures. ‘I’ve toyed with the idea of getting my arms done because I want my abs to match everything else.’ But that, he admits, could be achieved at the gym. ‘I have to draw the line.’
Since his surgery, Carl has put on some weight, softening the lines of his six-pack, though not to a noticeable degree. ‘I can live with it going on my bum or my arms or somewhere,’ he says. In fact, he adds, his stomach looks more natural now than it did when he first got it done.
‘Obviously, you still have to eat well; you think, “Carl, you shouldn’t have that cookie” – but, at the same time, you’re looking in the mirror and you think, “Oh, yeah – I can have a cookie.”’
He gets one from Starbucks every day, for dunking in his caramel latte. That’s the freedom that the surgery has given him – to have a guilt-free cookie and his six-pack, too. ‘I think, I’ve still got to live,’ Carl says. ‘That’s the whole point of having it done.’
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