Will I be able to achieve a toned and sculpted abdomen with an extended tummy tuck, muscle repair and liposuction? (photos)

Hello and thank you for your question. From the pictures you have provided, you have some striae (stretchmarks) present throughout your entire abdomen and extending to your flanks and around to your back. This is associated with a moderate/severe amount of excess subcutaneous fat and skin present diffusely throughout your trunk. There are skin folds across your lower abdomen extending to your flanks, and at least on your right mid back. It would be safe to assume that there is also a significant component of internal/visceral fat as well, which would not be correctable with any surgical procedure. Having had 4 kids, you most likely have some degree of diastasis (separation) of your rectus abdominis muscles located centrally in your abdomen (the "6 pack" muscles). Based on all this, you would definitely benefit from an abdominoplasty (tummy tuck- includes muscle repair) and 360 liposuction to best help improve your abdominal/trunk contour.
The difference between a "standard" and "extended" tummy tuck is just how far your incision extends to the side, and this is based on how much excess skin and fat needs to be removed to produce an aesthetic contour. They are essentially the same procedure, so no need to be concerned here. Generally, every surgeon tries to keep their incisions as short as possible so they can be easier hidden, but the goal here is improved body contour at the expense of scars, so this is important to keep in mind throughout the process. Regarding the transverse lower abdominal scar, it should be well hidden within your bikini or underwear, and if you adhere to proper scar care and sun avoidance after surgery, it should eventually heal to be minimally noticeable.
Liposuction is a great adjunct which would definitely provide additional benefit, particularly to the contour of your flanks and back, and can be done at the same time as your tummy tuck procedure for the best possible single operation results. Keep in mind that for you, given that there are stretchmarks and a skin fold present on your back, you likely have lax excess skin on your back which is not addressed with the 360 liposuction. This excess skin can become more noticeable and even appear deflated after liposuction, as it does not have the proper ability to fully recoil after the underlying fat is removed. Therefore, you would likely need another procedure to address your excess back skin at some point in the future, to further improve your overall trunk contour.
With all that said, it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from any photos and descriptions provided. You already have a surgeon and reasonable sounding operative plan, which is great- one less thing to worry about! I hope all this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Dear mrs.davis19,
based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

It is difficult to give you an opinion without an in-person assessment. However, it does appear that your mid-section protrudes somewhat, indicating that visceral fat is a concern. It would be a good idea to show a wish pic to your surgeon to determine whether your goal is achievable.