Choosing the right surgery to contour the abdomen after pregnancy and weight loss is extremely important to make sure you achieve your aesthetic goals. The different components that have to be considered are the elasticity of the skin, the status of the abdominal muscles and the presence or absence of excess fat. If the problem is just redundant fat, and the skin tone and muscle are good, then sometimes simple liposuction is all it will take to flatten the abdomen. The fat cells are physically suctioned away to thin the fat layer and then the skin shrinks to match the new contour. Typically, this is the case with younger patients who have never experienced the stretching of pregnancy or severe weight fluctuations. If the skin is loose and we just take away fat, the skin will sag and look even worse. When a body undergoes the stretching of pregnancy or of weight gain and then loss, the skin loses its tone and cannot shrink back to its original form. The muscles of the abdominal wall also split apart in the middle and drift off to the sides. No amount of exercise or dieting can make those muscles return to their normal position and when they contract it creates a bulge between them. A tummy tuck is the right procedure to treat these problems. It removes excess fat and skin and also stitches the muscles back together so they can flatten the abdomen (and remove the bulge). The type of tummy tuck needed depends on your anatomy. If all of the problems are confined to the lower abdomen (from the belly button down to the groin fold) then a mini tummy tuck may be an option. With a mini tummy tuck, skin and fat are removed from the lower abdomen and sometimes a little liposuction is done to the upper abdomen. This is only indicated if the skin tone and muscles above the belly button are in good shape, otherwise the skin folds even worse and distorts the belly button. The full tummy tuck results in tightening skin and muscle all of the way up to the rib cage. It involves an incision around the belly button, pulling down the skin and making a new hole for it to come back through. Often we can remove all of the skin from the groin to the old belly button site. How far out to the sides the incision has to go depends on where the looseness ends. In some patients who have had major weight loss (>100lbs) the loose skin continues to create a roll all of the way around the midsection. In order to get the best contour in that situation, we have to continue the incision around as an extended tummy tuck or even a circumferential body lift. It is important to visit with a board-certified plastic surgeon experienced in these procedures in order to determine the method of body contouring that will best meet your goals and needs.