The Complete Guide to Six-Pack Abs by Bruce J. Nadler, MD

Who would like to have that defined abdomen? Six-pack abs are not only sought by men, but women as well who want that defined look. Many people would come to my plastic surgery office requesting "the look." Unfortunately, most had not done their homework first. They were suffering from HKD or "Hypo-Kinetic Disease." In other words, they wanted to be well-defined couch potatoes.

I would suggest that they diet and seek out the services of a personal trainer for 12 weeks and return to me after they had reached to point maximized by the diet and exercise. To my disappointment, some came back little changed from when I had previous seen them. Their body fat percentage and body measurements were practically the same. Others reported back that their trainers told them if they worked hard enough, they wouldn't need the surgery. I decided that the only way to correct these problems was to offer a totally integrated approach.

To get six-pack abs, naturally you usually have to have developed rectus muscles and get your body fat percentage below 9% or less. You have to know how to properly develop these muscles and how to safely decrease body fat. You have to have the ability to do this without losing too much mass in the rest of the body.

What doesn't work? Anorexia is not a good idea. You need proper nutrition for the body to be able to exercise. Proper nutrition does not mean bouncing from one fad diet to another. These diets make the news either because they are ghost written for some celebrity who never really ate that way or the media thinks it can sell magazines and books featuring it. Proper diet means having an individualized plan of eating for the rest of your life; one that allows sufficient nutrients for a healthy lifestyle. Your individual caloric needs should be determined and a safe time of transition should be planned.

First, exercise should include resistance training to build those muscle bellies and aerobic activity to shed as much body fat as is possible. Now, the worst thing to do if you want the six-pack look is do 500 sit-ups daily. The rectus abdominus muscles respond to exercise just like every other muscle. Would you do 500 curls a day if you wanted to build your biceps? You want to stimulate the fast twitch IIa fibers for the abdominal muscle to become visible. High repetitions stimulate the slow twitch type I fibers. Just compare the appearance of a marathon runner (slow twitch individual) with a sprinter (fast twitch individual). Muscle size increases with temporary muscle failure at 10-12 repetitions. I repeat: temporary muscle failure with proper form. This means you can't do another repetition no matter how hard you safely tried. But it also does not mean just stopping at 10-12 repetitions.

The function of the rectus abdominus muscle is to decrease the distance between the rib cage and the pubic bone. Put one hand on the pubic bone and the other on the lower end of your sternum or breast bone. Now try to get to touch. Any useful exercise will bring these hands closer together. What does work? Crunches, reverse crunches, placing your elbows on the arm of the weighted ab machine, adjusting the line of action of the cable crunch and the abdominal wheel are some exercises that properly stimulate these muscles. Allow 6 weeks to build these muscles and then start increasing your aerobic activity to start burning the fat. The increased muscle mass will also help boost your metabolism. Exercise to the point that you are happy with the rest of your body except for the stubborn areas on the abdomen.

Now is the time for the surgery. Yes, there are areas of diet and exercise resistant fat. This can now be safely removed with the proper liposuction. The body has already created all of its fat cells. If you mechanically remove fat cells, the body will not replace them in that area. Liposuction decreases the density of the fat layer by creating multiple tunnels criss-crossing to form a mesh-work. It is the compression of this mesh-work that slims the person. In the abdomen, there are two separate layers of fat. There is a deeper layer over the muscle that contains most of the fat. Traditional liposuction is limited to this layer.

There is a more superficial layer of fat just beneath the skin. Liposuction in this layer shapes the skin. With the precision of using PAL (power-assisted liposuction), fat can be precisely removed along the rectus muscle borders, over the center and over the horizontal inscriptions to define the six-pack. Training can then be resumed after two weeks with a properly progressive program. You can now have that elusive six-pack.

Bruce J. Nadler M.D. is a plastic surgeon who specializes in aesthetic plastic surgery of the fit. He is also a competitive bodybuilder and both A.C.S.M. and I.S.S.A. certified personal fitness trainer. He is the founder of M.D. Fitness-Personal Training Systems. You can address questions to For more info, call (631) 786-5854