Options to get a flat stomach, and smaller waist? (Photo)

I think that a tummy tuck with liposuction of the sides and back would produce a nice result for you.  Seek out a plastic surgeon who has performed these procedures hundreds of times and has a great number of reviews and before and after pictures.Kenneth Hughes, MDBeverly Hills, CA

Liposuction has its limitations, but one should be able to remove a substantial amount of fat from abdomen, waist and hip liposuction. This should flatten your abdomen to some degree, depending on how much intra-abdominal fat you have.

Dear 86classicAs a general rule, liposuction can reduce the fat under your skin and therefore will give you a flatter tummy and shapely waistline. It will not improve the quality of your abdominal skin. From what I see in your photographs, Lipo will help you look, fit and feel better in clothing. Your stretch marks are not going to improve. A tummy tuck would help you with that however would give you an additional scar. Look for an experienced and well trained plastic surgeon, certified by the American board of plastic surgery.  See more than one consult and make a well informed decision. 

With all body contouring patients we always discuss lifestyle, body fat, and overall appearance. You may want to consider diet and exercise first to achieve what you believe your best self- then with the help of a Board Certified Plastic Surgeon- you can explore the surgical options for continued improvement. That said, if you believe you're at that point now-- then you may be a good candidate for abdominoplasty provided your child bearing days are over

Hi and thanks for posting your question and photos on RealSelf!Based on the photos you posted, you appear to have extra skin on your abdomen and some excess tissue in the waistline area. Your best result would probably come with a combination tummy tuck and liposuction of the waist and hip areas. Removing excess fat from underneath stretched out skin just leaves extra skin and doesn't improve the appearance of the abdomen. I would urge you to seek a consultation with a board certified plastic surgeon and have your areas of concern assessed in person. Only then can the BEST recommendations be given to reach your goals!Best wishes!

Without an examination none of us can tell about the thickness of your abdominal fat overlying the muscles and whether you have an underlying muscle separation.  If the muscles are strong and the problem is extra peritoneal fat (on top of the muscle) then a non-surgical consideration is cryolipolysis (CoolSculpt) widely available in the Bay area --not as thorough as liposuction but less invasive  and a good stopgap measure until you can consider whether you are ready for the definitive procedure of an abdominoplasty.

Assuming that you have already tried exercised and diet,
that your weight is stable, that you have no underlying medical conditions that
would be a contraindication to surgery, and based on your age and the possibility of having additional children, liposuction of various areas that
could include including your abdomen, flanks, back and thighs would be a
reasonable option.There are a variety of procedures that can produce a good
cosmetic result in the appropriate patient: liposuction alone, a mini tummy
tuck, a modified tummy tuck with an umbilical float, or a variety of a full
abdominoplasty. All of the tummy tuck options may, or may not, include
tightening of the muscle and liposuction of selective areas. Most plastic surgeons suggest that you finish
having children, get your weight within 10 pounds of your ideal weight, and
have a BMI less than 30 before undergoing an abdominoplasty with repair of the
stretched out abdominal muscles and liposuction of selective areas, in order to
achieve the best long term cosmetic result with the least potential
complications.
Keep in mind that following the advice from a
surgeon on this or any other website who proposes to tell you what to do based
on two dimensional photos without examining you, physically feeling the tissue,
assessing your desired outcome, taking a full medical history, and discussing
the pros and cons of each operative procedure would not be in your best
interest. I would suggest you find a plastic surgeon certified by the American
Board of Plastic Surgery and ideally a member of the American Society for
Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You
should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Dear Ms. 86classic,Thank you for your story, questions and photos."Best" is difficult to determine and depends on a personal exam and discussion of the benefits and the limitations of the particular technology.Hopefully you will find the following information helpful.For clarification body contouring can be divided into two major categories:I. Non surgical fat reduction There are various technologies that are non surgical and they include but are not limited to: 1) ultrasound (Ultrashape)2) freezing (Coolsculpt)3) Radio Frequency (RF) Topical (Vellashape III, Thermi Smooth) Injectable (Thermi Tight)4) injectable (Kybella)5) topical laser (Zerona)I personally use Ultrashape , Vellashape III, Thermi, Kybella for those patients who after discussion would like a non surgical alternative. Depending on the anatomical area and only after clear and realistic expectations will we proceed.II.Surgical A) Liposuction is the "Gold Standard" for fat removal. There are various types, including but not limited to:Liposuction 1)suction asst. Liposuction (SAL)2) ultrasonic asst. liposuction (UAL)3) power asst. liposuction (PAL)4) laser asst. liposuction (LAL) 5) water asst. liposuction (WAL)They are all effective and are secondary to the experience of the Plastic Surgeon with the particular liposuction technology.In addition to liposculpting many of us have added non surgical methods "to shrink skin" after liposculpture using Radio Frequency(RF)devices. Two such devices I personally use are Vellashape III and Thermi Tight.B)Abdomioplasty there are four types of abdominoplasties. A-C All have horizontal incisions and D has a significant vertical compotent.1) mini- muscle tightened below umbilicus to pubic bone2) standard- muscle tightened from breast bone to pubic bone3)extended as in standard but incision longer to excise excess skin/fat in outer thigh area 4)fleur de lis- same as standard but in addtion excess skin/fat excised in a vertical directionEach of the two categories (and the various sub groups) have their benefits and limitations and need a personal examination and discussion with a experienced Plastic Surgeon who utilizes both categories and has the various technologies.I recommend that you make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).I wish you my best and success,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600

Liposuction alone can help contour the abdomen, but with the pregnancy damage tto the skin that is seen in the photo, the liposuction will likely leave the skin looking looser. Best bet, and far cheaper at this time would be a gym menbership and a trainer for better eating habits and good core exercise. Then do the TT if you still feel the need.