Objective To explore the effect of extracorporeal shock wave therapy on abdominal three-dimensional volume and waist line definition in patients with abdominal obesity. Methods A total of 90 patients with abdominal obesity admitted to the Department of Plastic Surgery, Hengdian Wenrong Hospital from July to September 2024 were selected, and they were divided into the control group and the study group by the random number table method, with 45 patients in each group. The control group received conventional lifestyle intervention, and the study group was given additional extracorporeal shock wave therapy on the basis of the control group. The abdominal three-dimensional volume, waist line definition, aesthetic improvement and abdominal appearance satisfaction were compared between the two groups. Results The abdominal three-dimensional volume of the study group at T1, T2 and T3 was lower than that of the control group, and the waist line definition score was higher than that of the control group (P <0.05). The GAIS scores of the study group at T1, T2 and T3 were higher than those of the control group (P <0.05). The VAS scores of the study group at T1, T2 and T3 were higher than those of the control group (P <0.05). Conclusion Extracorporeal shock wave therapy shows good efficacy in body shaping for patients with abdominal obesity. This treatment not only effectively reduces the abdominal three-dimensional volume, but also makes the waist line clearer and smoother, thereby improving the overall body aesthetic ef fect and patients' satisfaction with their appearance.