Vertical Torsoplasty, AKA The Hourglass Procedure

By: Dr. J. Timothy Katzen



The human body undergoes significant changes throughout a lifetime. For many individuals, concerns arise due to excess skin and fat accumulating in the upper torso. Such changes can result from weight loss, aging, or genetic predisposition. These changes can lead to decreased self-esteem and body image concerns. In the realm of medical advancements, one procedure has emerged as a beacon of hope for those facing this challenge: the vertical torsoplasty. Because of it’s dramatic results, the vertical torsoplasty is also known as the hourglass procedure. This surgical procedure offers a chance for individuals to reclaim their natural, curvy body contour. For many, the vertical torsoplasty can restore aesthetic satisfaction.

What is a Vertical Torsoplasty?

A vertical torsoplasty is a specialized plastic surgery procedure that addresses excess skin and fat primarily from the upper torso. The vertical torsoplasty focuses encompassing the sides of the chest, upper back, middle back, lower back and love handles. The plastic surgery he surgical community has seen the evolution of many techniques to tackle body contouring. The vertical torsoplasty stands out due to its precise nature and effectiveness. The procedure commences with a strategic incision. The vertical torsoplasty originates in the armpit and extends downward along the side of the chest. The length and trajectory of this incision can vary, sometimes reaching the lower portion of the bra strap, inframammary fold, bra line, bottom of the ribs, or, in some instances, extending to the hip.

Contrary to some misconceptions, a vertical torsoplasty does not solely focus on skin removal. The primary aim remains to craft a smoother and more naturally contoured torso. Additionally, depending on individual needs, plastic surgeons may combine this procedure with others, such as tummy tucks, thigh lifts, butt lifts, or liposuction, ensuring a comprehensive approach to body sculpting.

The Procedure Explained

Performing a vertical torsoplasty involves meticulous planning, precision, and a deep understanding of the human anatomy. Here is an in-depth look into the intricate steps and considerations involved:

Pre-procedure preparations: Patients undergo a comprehensive evaluation before embarking on the surgical journey. Your chosen plastic surgeon will assess your skin's elasticity, identify excess skin and fat areas, and discuss your goals. To ensure optimal recovery, pre-operative instructions include stopping certain medications and if you smoke, you will need to stop.

The surgical process:

Incisions: The first and most crucial step in a vertical torsoplasty involves making the incision. The incision starts in the armpit and typically extends downward. The incision extends as far as the bra line, bottom of the ribs, or even the hip, depending on the individual's needs.

Once the first incision is made from the armpit down tissue, dissection is carried towards your back. Tissue dissection is carried along the fascia or just above the muscle. Once the skin is undermined, the skin is then pulled forward. This maneuver mobilizes the back skin toward the front. A large ellipse of skin and fat is created on each side. The excess back skin is then pulled forward and permanently removed.

Skin removal and contouring: Your plastic surgeon delicately removes the predetermined amount of excess skin once the incision has been made. This step requires precision to ensure the remaining skin can be redraped smoothly, providing a natural-looking contour. Your plastic surgeon will ensures symmetry between both sides of the torso.

Combining procedures: In some cases, the vertical torsoplasty can be combined with other procedures for a more complete transformation. Tummy tucks, thigh lifts, butt lifts, and liposuction are potential complementary procedures. These are discussed during initial consultations and decided upon based on your and the plastic surgeon's recommendations.

General anesthesia: The entire procedure is performed under general anesthesia, ensuring the patient remains unconscious and pain-free. From a surgeon's perspective, using general anesthesia is non-negotiable. This surgery requires complete muscle relaxation, which can only be achieved under general anesthesia. Using any other form of anesthesia could compromise patient safety and the quality of the results.

Your plastic surgeon's expertise and the patient's commitment to pre- and post-operative care are crucial in achieving the desired outcomes.

Recovery and Post-Procedure Care

Navigating the recovery phase is essential for ensuring optimal results after a vertical torsoplasty. A smooth recovery relies on adhering to post-operative guidelines and understanding what to expect. Here's a detailed breakdown of the post-procedure journey:

Post-procedure immediate care and aftercare stay: Once the procedure is complete, the patient is carefully monitored as the effects of the anesthesia disappear. Sometimes, an overnight aftercare stay might be recommended, especially if multiple procedures have been combined. Overnight monitoring allows the medical team to manage pain effectively, monitor for complications, and ensure patient safety in the immediate hours following the surgery.

Typical recovery timeline: Generally, the initial recovery phase spans approximately two weeks. Patients may experience mild to moderate discomfort, swelling, and bruising around the incisions. These symptoms progressively diminish, and most patients return to non-strenuous daily activities within this two-week window.

Importance and role of the compression garment: Upon completion of the procedure, surgeons will fit patients with a specially designed compression garment. This garment serves multiple purposes: it aids in reducing swelling, ensures the skin adheres to the underlying tissue properly, and supports the newly contoured torso. The garment should be worn consistently, especially in the first month. The garment should fit snugly but not restrictively, providing even pressure without causing grooves or indentations.

Activities to avoid and timelines for resuming them: Patients are advised to refrain from engaging in movements that place undue strain on the chest or the newly contoured areas for at least the initial two weeks. Routine activities such as driving, light housework, and socializing typically resume after this period, more physically demanding tasks require more time. Mild exercise, is best postponed until at least three weeks post-surgery. For intense physical activities, especially those involving lifting or straining, a waiting period of three months is usually recommended to ensure complete healing and minimize complications.

Final results timeline and what patients can expect: While some improvements are immediately noticeable, the full extent of the transformation becomes evident over time. As swelling subsides and the body adjusts to its new shape, the results of the vertical torsoplasty become more pronounced. Usually, one year after the vertical torsoplasty, patients can appreciate their torso's final, refined contour.

Recovery from a vertical torsoplasty requires patience, adherence to medical advice, and a commitment to self-care. Dedication to following these guidelines ensures a smoother recovery and maximizes the potential for outstanding, long-lasting results.

Benefits of a Vertical Torsoplasty

Choosing a vertical torsoplasty is not merely about removing excess skin; it's about physical and emotional transformation.

Removal of excess skin and fat: The primary objective of the torsoplasty is to eliminate unwanted skin and fat, resulting in a smoother, tighter upper, middle, and lower torso. This transformation enhances physical appearance and can significantly uplift one's self-esteem.

Scar concealment: A salient benefit of the vertical torsoplasty is the strategic placement of incisions. When arms rest at the sides, these incisions are often concealed, allowing patients to wear various clothing styles without concern for visible scars.

Enhanced body contour: Beyond removing the excess skin, the torsoplasty improves the body's silhouette. The result is a naturally contoured and aesthetically pleasing torso, enhancing overall body proportion and symmetry.

Personalization: Every individual is unique, and so are their requirements. The vertical torsoplasty is not a one-size-fits-all procedure. Plastic surgeons assess each patient's anatomy, listen to their desires, and tailor the procedure accordingly, ensuring personalized results that align with the patient's vision.

Above is our 51-year-old female patient, who weighed 325 lbs and lost 125 lbs following an RNY gastric bypass now, she weighs 200 lbs. She approached Dr. Katzen for a body lift, arm lift, and breast lift, laser, she opted for the vertical torsoplasty, also known as the hourglass procedure.

Horizontal vs. Vertical Torsoplasty

When considering a torsoplasty, patients often encounter a decision: the horizontal or the vertical approach.

Recap of the horizontal torsoplasty: The horizontal torsoplasty is also known as a braplasty, bra-straplasty, or braline back lift. This torsoplasty primarily involves an incision across the mid-back, focusing on maximum skin removal.

Main differences in incision direction and outcomes: The most evident distinction lies in the incision direction. The vertical torsoplasty involves an incision from the armpit downward, potentially extending to the bottom of the bra, ribs, or top of the hips. The horizontal backlift goes horizontally across the back. The horizontal torsoplasty results in a scar across the back. The vertical approach allows scars to be more concealed, especially when arms are at the side.

Which procedure is right for whom? The selection largely depends on your specific needs, the amount of skin required to be removed, and personal preferences regarding scar visibility.

Considerations and Potential Concerns

Embarking on the journey of a torsoplasty requires careful deliberation.

Insurance coverage considerations: Insurance coverage for a torsoplasty frequently depends on the particulars of the policy and your particular anatomy. It is vital to consult with the insurance provider to understand potential coverages and out-of-pocket costs.

The importance of choosing a qualified plastic surgeon: A successful torsoplasty relies heavily on the plastic surgeon's expertise. Ensure your chosen plastic surgeon has adequate credentials, positive patient testimonials, and a portfolio reflecting quality work.

Potential risks and how they are mitigated: Like all surgeries, a torsoplasty has potential risks, such as infection or unsatisfactory results. However, these risks can be significantly reduced by following post-operative care instructions and choosing a seasoned plastic surgeon.


The transformative potential of the vertical horizontal torsoplasty is immense, providing patients with renewed confidence and an enhanced body image. For those considering this surgical journey, a thorough consultation with a professional can pave the way for informed decisions and optimal outcomes. Dr. Katzen is available to schedule initial consultations for patients interested in a torsoplasty and other plastic surgery procedures. During your first consultation, he will provide expert recommendations tailored to your unique needs and goals. Dr. Katzen offers in-person consultations at his Beverly Hills, CA, Las Vegas, NV, and Dubai, UAE, offices. For those seeking a convenient and virtual option, appointments are also available via FaceTime, Zoom, WhatsApp, and Skype. To achieve the toned, sculpted upper body you desire through a torsoplasty, please don't hesitate to schedule your initial consultation by calling (310) 859-7770. Dr. Katzen and his team are committed to helping you look and feel your best.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.