The hourglass shape means that the waste is the narrowest portion of the anatomic body. The main factor affecting this type of shape is the anatomy of the patient, to begin with. The waist has to be noticeably and significantly smaller than the hips or bust area.
Oftentimes, a combination of a tummy tuck with a possible vertical component as well as aggressive liposuction of the flanks and hips can create an hourglass look. Or, fat transfer can be performed at the same time.
Not everyone can have an hourglass shape figure. This is because the hips and bones underlying the soft tissue may not lend itself well to this type of surgical outcome. Aggressive liposuction of the lateral thighs may help contribute to achieving the hourglass look. If the pelvic bones do not support the hourglass appearance then its achievement is in doubt.
There are some procedures whereby ribs can be removed in order to facilitate the hourglass look. This has its inherent risks and should be performed with great care and caution. Therefore if the patient has straight hips, then the hourglass shape appearance may not be feasible.