What Is the Hourglass Body Type and How Can It Be Identified?

The hourglass body type is the ideal anatomical form in which shoulder and hip widths are equal or very close to each other, while the waist area is distinctly separated between these two lines with a pronounced slimness and deep curvature. Considered the gold standard of the feminine silhouette in aesthetic surgery literature, this appearance is defined not merely by thinness but by perfect body proportion. While its primary determinant is the volumetric balance between the upper and lower body, its focal point is always the waist indentation, the narrowest part of the body. This silhouette represents the most desired morphological structure at the peak of aesthetic perception, where genetic heritage, bone structure, and fat distribution converge in a specific symmetry.

What Is the Hourglass Body Type and Why Is It So Desired?

The criteria we use to define the hourglass body type are actually based on mathematical symmetry. We are referring to situations where the upper and lower body balance each other in width, while the waist area has a circumferential measurement far below this width. In this form, the waist is the focal point of the body and acts not as a divider that splits the silhouette in two, but rather as a bridge that unites it with a fluid transition.

The roots of the admiration for this body type go much deeper than we might think, extending all the way to our evolutionary codes. Anthropological studies show that a wide pelvic structure accompanied by a slim waist has historically been perceived at a subconscious level as signals of “fertility,” “youth,” and “health.” When our brain sees these proportions, it gives a biological “approval of suitability.” In today’s world, however, this perception has evolved; the hourglass form is now associated not only with fertility but also with fitness, feminine strength, and aesthetic attractiveness.

In aesthetic surgery practice, our goal is to create smooth transitions rather than sharp angles in the patient’s body. Instead of a flat, shapeless thinness, we aim to achieve this form where fullness and slimness meet at strategic points. The hourglass silhouette can be described as the most defined and most aesthetic manifestation of a woman’s body contours.

What Are the Anatomical Foundations That Determine This Body Form?

Just as the solidity and shape of a building depend on its steel framework, the main determinant of our body form is our skeletal structure. For an hourglass appearance to form, the bone structure must be suitable for it, or this illusion must be created surgically. At this point, two main skeletal structures come to the forefront: the pelvis and the thorax, or rib cage.

A pelvis with wide wings allows the hips to appear naturally wider. This width increases the distance between the waist and hips, creating the basis for a slimmer-looking waist. If the pelvis is narrow, that dramatic curve may not form no matter how slim the waist is. On the other hand, a narrow lower rib cage increases the depth of the waist indentation. In some individuals, the rib structure is wide and descends straight toward the waist; in such cases, the waist indentation is less pronounced.

Muscle structure is also an important variable in this equation. Well-developed gluteal muscles, in particular, support that rounded and prominent appearance when viewed from behind. The condition of the abdominal muscles determines the tightness of the waist. However, our genetic heritage is not limited to bone and muscle; the genetic codes that determine where our body gains weight also influence whether we can approach the hourglass form. Some fortunate genetics store fat directly in the hips and breasts, while others tend to store it around the abdomen.

The anatomical components of the hourglass form are as follows:

• Wide pelvic structure
• Narrow rib cage
• Slim waist vertebrae
• Strong gluteal muscles
• Sufficient breast tissue
• Subcutaneous fat distribution
• Firm abdominal wall
• Elastic skin structure

How Does the Waist-to-Hip Ratio Define the Hourglass Type?

While looking in the mirror is often enough to understand whether someone has an hourglass form, in medicine we rely on objective measurements rather than subjective opinions. The most fundamental parameter we use at this point is the “Waist-to-Hip Ratio” (WHR). This ratio is not only an aesthetic criterion but also provides serious clues about a person’s overall health status.

This calculation is actually something anyone can easily do at home. Using a measuring tape, you need to measure the narrowest point of your waist (usually just above the navel) and the widest point of your hips. When you divide the waist measurement by the hip measurement, the resulting number is the mathematical representation of your body type.

In aesthetic surgery literature and popular culture, the ratio generally accepted as “ideal” is around 0.7. In other words, your waist circumference should be about 70% of your hip circumference. The closer this ratio is to 0.7, the more pronounced the hourglass form. If this ratio exceeds 0.80 or 0.85, the body approaches what we call the “apple type,” indicating increased fat accumulation in the waist area. When planning, we surgeons aim to achieve or get as close as possible to this 0.7 ratio, taking into account the patient’s height and overall structure.

How Do Hormones Play a Role in the Hourglass Appearance?

It would not be wrong to say that the sculptor of our body is actually our hormones. The endocrine system is the main command center that determines how and where fat tissue is stored in the body. The formation or deterioration of the hourglass form is directly related to our hormonal balance.

The hormone estrogen is the chief architect of feminine contours. From puberty onward, increasing estrogen levels cause fat tissue to accumulate especially in the hips, thighs, and breasts. This condition is called “gynoid,” or female-type fat distribution, and forms the basis of the hourglass silhouette. As long as estrogen is dominant, the waist area generally tends to remain slimmer.

However, on the other side of the coin are hormones such as cortisol and insulin. Cortisol, released during chronic stress, changes the fat storage command and causes fat to accumulate around the abdomen and even around internal organs. This fills in the waist indentation and eliminates that elegant curve. Similarly, with the decrease in estrogen during menopause, body shape begins to change.

Hormonal factors that affect body shape include:

• Estrogen level
• Cortisol balance
• Insulin resistance
• Thyroid function
• Androgen hormones
• Growth hormone
• Progesterone effect
• Leptin sensitivity

How Is an Hourglass Silhouette Created with Aesthetic Surgery?

If your genetic heritage does not support the hourglass form or if you have lost this form over time, modern aesthetic surgery comes into play. The procedure we perform is generally called “Body Contouring.” This process requires treating the body as a whole and reshaping it as if sculpting a statue.

The basic philosophy here is not simply to make the body thinner or to enlarge just one area; the main issue is to establish proportion. We generally apply “combined surgical” methods. Fat is removed from areas with excess (usually the abdomen, waist, and back) and transferred to areas lacking volume (usually the hips and thighs).

In this process, the patient’s own fat tissue is used as the most valuable filler material. Enhancing contours with one’s own tissue, without using a foreign substance, yields the most natural result. However, each patient’s anatomy is different. In some patients, slimming the waist alone is sufficient, while in others it may also be necessary to establish upper body balance with breast aesthetics. The surgeon’s vision is to see the most ideal version that can be created on the patient’s existing anatomy.

Which Technologies Are Used to Slim the Waist Area?

The key point of the hourglass silhouette is undoubtedly a slim and curved waist. To shape this area, we utilize advanced technological devices that go beyond classic liposuction methods. Our goal is not only to remove fat but also to prevent skin laxity and give the area an artistic form.

One of the most frequently used methods in this regard is ultrasonic liposuction technologies (such as Vaser). In this technology, sound waves are used to gently break down fat cells without damaging surrounding tissues, turning them into a liquid state. This selectivity is very important because when blood vessels, nerves, and connective tissue are preserved, recovery is faster and bruising is less common.

When working on the waist area, it is not enough to remove only the sides. The lower back, namely the area just above the tailbone (the lumbosacral area), must be deeply thinned. In addition, the side fats known as the “love handle area” must be completely removed. When these procedures are performed, the waist circumference narrows and the upper part of the buttocks becomes more prominent, revealing the famous “S” curve. These technologies, which stimulate collagen production under the skin, also help the skin adapt to its new form and tighten.

How Are the Hips and Thighs Shaped?

For a slim waist to gain aesthetic value, there must be a hip structure just below it that widens and projects outward. If the waist is slim but the hips are flat, the hourglass image does not form. This is where we bring into play the fats we have taken from other areas of the body. This procedure is popularly known as BBL (Brazilian Butt Lift) or gluteal fat transfer.

The fats collected by liposuction are passed through special filtration processes to become a pure, viable, stem-cell-rich substance. This “golden liquid” is injected into the points where the hips need volume, with millimetric calculations. The aim here is not simply to enlarge the buttocks; it is to shape them.

One of the most important details that disrupt the hourglass line is the “Hip Dips,” the indentations on the sides of the hips that many women complain about. With fat injection, these indentations are filled, ensuring that the line descending from the waist to the thighs is uninterrupted and rounded. In addition, fillers applied to the upper part of the buttocks give the hips a “lifted” appearance. In this way, a complete hourglass silhouette is achieved when viewed from behind and from the side.

Why Is Upper Body Symmetry Important for the Hourglass?

Although the waist and hips come to mind when one thinks of an hourglass, the upper framework of this form is created by the shoulders and breasts. If the hips are widened but the upper body remains narrow and frail, the body shifts toward a “pear shape” rather than an hourglass. In aesthetic surgery, the goal is always to achieve balance.

The shoulder width and hip width should be close to each other. If the patient’s shoulders are narrow or breast volume is insufficient, breast aesthetic procedures may be included in the plan to establish this balance. In a patient with small breasts, breast augmentation (with implants or fat injection) contributes to making the waist appear slimmer by widening the upper body.

Similarly, sagging breasts after childbirth or weight loss pull the body silhouette downward and cause an aged appearance. By repositioning the breasts to their ideal position with breast lift operations, the upper torso appears more dynamic and proportionate. Full and lifted breasts are one of the most important complementary elements that emphasize waist slimness in visual perception.

Is It Possible to Return to an Hourglass Form After Childbirth?

Pregnancy is the period during which the greatest anatomical changes occur in the female body. Separation of the abdominal muscles, loss of skin elasticity with sagging, and stubborn fat deposits cause many women to lose their hourglass form. For patients in this situation, combined procedures we call “Mommy Makeover” provide the most effective solutions.

Abdominal muscle separation (diastasis recti), which cannot be corrected with exercise and diet alone, is repaired with a tummy tuck operation. The abdominal wall is narrowed by internal suturing, which mechanically slims the waist. When excess skin is removed, a taut abdomen is obtained.

By adding liposuction and breast aesthetics to this surgery, the patient has the chance to completely renew her body in a single recovery period. It is possible to achieve an even more curvaceous and fit appearance than before pregnancy. Mommy Makeover is a powerful restoration process that restores lost self-confidence and reconstructs the hourglass silhouette.

Procedures included in mommy makeover are as follows:

• Tummy tuck
• Breast lift
• Breast augmentation
• Liposuction
• Fat injection
• Genital aesthetics
• Laser lipolysis
• Scar revision

What Are the Safety Standards in These Operations?

When it comes to aesthetic surgery, the single most important thing beyond a beautiful result is patient safety. Although operations involving fat injection were associated with certain risks in the past, they have become extremely safe today thanks to strict international protocols. As a physician, my highest priority is to help my patient achieve their desired appearance without exposing them to risk.

According to the most current standards set by global plastic surgery authorities (such as ISAPS and ASPS), there are “golden rules” that must be followed when performing fat injections into the buttocks. Foremost among these is the rule that fat must never be injected into the muscle (intramuscular). Fat should only be injected into the subcutaneous layer. This technique protects vascular structures and minimizes the risk of fat embolism.

In addition, every detail—from the structure of the cannulas used during surgery to the amount of fat injected—is meticulously planned. Ultrasound-guided injections allow the surgeon to proceed while seeing exactly where the procedure is being performed. Thanks to these safety measures, body contouring operations are now carried out on a much more predictable and safe basis.

Who Are Ideal Candidates and Who Should Not Undergo These Procedures?

Not everyone may be a suitable candidate for hourglass aesthetics. For a successful result and a safe process, the patient must meet certain criteria. The first criterion we look at is Body Mass Index (BMI). In overweight patients, surgical risks increase and aesthetic results do not reach the desired level. Therefore, patients with a BMI below 30 are generally ideal candidates.

Skin quality is another determining factor. For the skin to recover after liposuction, it must have sufficient elasticity. If the skin is very stretched and loose, removing fat alone is not enough; tightening procedures may also be necessary. In addition, it is very important that the patient has realistic expectations. The extent of change permitted by the bone structure must be explained honestly to the patient.

Smoking is the most important factor that negatively affects the candidacy process. Smoking impairs microcirculation, delays wound healing, and reduces the survival rate of transferred fat. For this reason, quitting smoking before surgery is mandatory.

The suitable candidate profile includes:

• Individuals close to their ideal weight
• Those with good skin elasticity
• Non-smokers
• Those without chronic diseases
• Individuals with realistic expectations
• Those with sufficient body fat
• Individuals with stable psychological status
• Those who can comply with the recovery process

What Is the Recovery Process Like and How Permanent Are the Results?

Coming out of surgery is only half the job; the other half is managing the recovery process correctly. For the hourglass form to settle and be permanent, the patient must strictly follow postoperative instructions. This process requires patience but is a journey worth the result.

After surgery, your most important allies will be medical compression garments. These special garments (fajas) should be worn for approximately 4–6 weeks to suppress swelling in the liposuction areas and help the skin adapt to its new form. The garment acts like a mold, holding the body in place and allowing the shape to settle.

If fat transfer has been performed to the buttocks, the first weeks require extra care. To allow the transferred fat cells to establish blood supply and survive, pressure must not be applied to that area. Therefore, we recommend that our patients avoid sitting directly on the buttocks for 2–3 weeks, sleep on their stomachs, or use special BBL pillows.

As for the permanence of results: fat cells removed by liposuction do not return. Of the transferred fat, the portion accepted by the body (usually 60–70%) is permanent for life. However, these remaining fat cells are living tissue; meaning if you gain weight, they grow, and if you lose weight, they shrink. Therefore, maintaining a balanced diet and an active lifestyle is essential to preserve that remarkable hourglass silhouette.

Points to pay attention to during the recovery period include:

• Use of medical compression garments
• Sitting with a BBL pillow
• Prone sleeping position
• Adequate water intake
• Light walks
• Lymphatic massage support
• Salt restriction
• Avoiding smoking

Dr. Erman Ak

Op. Dr. Erman Ak is an internationally experienced specialist known for facial, breast, and body contouring surgeries in the field of aesthetic surgery. With his natural result–oriented surgical philosophy, modern techniques, and artistic vision, he is among the leading names in aesthetic surgery in Türkiye. A graduate of Hacettepe University Faculty of Medicine, Dr. Ak completed his residency at the Istanbul University Çapa Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery.
During his training, he received advanced microsurgery education from Prof. Dr. Fu Chan Wei at the Taiwan Chang Gung Memorial Hospital and was awarded the European Aesthetic Plastic Surgery Qualification by the European Board of Plastic Surgery (EBOPRAS). He also conducted advanced studies on facial and breast aesthetics as an ISAPS fellow at the Villa Bella Clinic (Italy) with Prof. Dr. Giovanni and Chiara Botti.
Op. Dr. Erman Ak approaches aesthetic surgery as a personalized art, tailoring each patient’s treatment according to facial proportions, skin structure, and natural aesthetic harmony. His expertise includes deep-plane face and neck lift, lip lift, buccal fat removal (bichectomy), breast augmentation and lifting, abdominoplasty, liposuction, BBL, and mommy makeover. He currently provides safe, natural, and holistic aesthetic treatments using modern techniques in his private clinic in Istanbul.