We have already discussed the health-related issues of having visceral fat. This fat accumulates around internal organs and causes multiple health issues, including inflammation, cancer, diabetes, and heart disease, among others. But the problem with this fat when it comes to surgery is that it is a unique fat that cannot be removed with liposuction. There are essentially two different types of fat when it comes to getting an hourglass shape. You have the subcutaneous tissue, which is the fat that you can grab in your belly, and then you have the deep fat, the visceral fat, which is the fat below the muscles and around the internal organs. When we gain weight, we gain weight proportionally all over the body, including in the subcutaneous fat and the deep visceral fat.The problem with visceral fat is that even when I perform liposuction, assuming that you have a lot of this fat, your belly is still going to look enlarged. Also, when the muscles are tightened during a tummy tuck, it is impossible to significantly decrease the width of your waist because the intra-abdominal space cannot be reduced due to the size of the visceral fat. The distribution of the visceral fat is unique and genetically determined. I have seen some patients who had 80% visceral fat and 20% subcutaneous fat; others have a more even distribution of both types. Patients who have mainly visceral fat are not going to be good candidates for any procedures that include enhancement of the abdomen.In essence, visceral fat is the anti-hourglass. I recommend losing weight by exercising, combining cardio and weightlifting, to diminish the visceral fat prior to surgery for a good outcome.