Focus is reducing overall puffiness & smoothing out contour of lower stomach “shelf.” Vaser lipo 360 or tummy tuck?

Your photos suggest that your tissue excess and skin laxity would make you a better candidate for a tummy tuck rather than additional liposuction. You didn't mention if you have had children. In general, women who have not had children can get by with liposuction. In you case however, the weight loss has seemingly simulated skin changes of pregnancy making the tummy tuck the preferred procedure.

You have excess loose skin along your lower abdomen. The shelf you are noticing will likely get worse with liposuction because if you remove the tissue underneath it, it will become looser and more wrinkled. The best option for you to address your concerns is a tummy tuck.

Hello and thank you for your question. From the pictures you have provided, you have some striae (stretchmarks) present throughout your lower and mid abdomen, and a moderate amount of excess subcutaneous fat and skin throughout this region, extending to the sides into your flanks, with that notable "shelf," as you mentioned. There is some upper abdomen adiposity (excess skin/fat) as well. Given your young age, I would also like to avoid a more invasive procedure if possible, while still achieving your goals. Unfortunately, the striae indicate that you have poor quality skin in those regions, which has lost its ability to stretch and recoil properly, and therefore likely will not fully contract if you were to do some form of liposuction alone (without resecting any of the excess skin). This would result in a very deflated appearance and ultimately require another procedure to resect the excess skin and tighten the overall contour.
Based on all this, you would benefit from a traditional abdominoplasty (tummy tuck) with liposuction of your flanks to best help improve your abdominal/trunk contour. 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 and symmetry of your flanks, and would be done at the same time as your tummy tuck procedure for the best possible single operation results.
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. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Thank you for sharing your pictures. Given your age, current weight, and primary objectives, it sounds like you might achieve your desired results without a tummy tuck. Considering your goals of reducing puffiness and achieving a smoother contour, Vaser liposuction is an excellent option as it can precisely target and remove stubborn fat areas. Renuvion skin tightening is also be strongly recommended to tighten the skin. However, it's essential to consult with a board-certified plastic surgeon.

I would start with liposuction and minimally invasive radiofrequency skin tightening to help tighten your abdomen.

Hello. Thanks for your question and photos. By your pics, you are a candidate for Full Tummy Tuck. With the full procedure, you'll get rid of saggy skin under your belly. Consult a board-certified plastic surgeon in your area. Good Luck!

If you are planning no future pregnancies the best result would be a tummy tuck with liposuction for contouring. This would remove excess fat and skin giving you a flatter, tighter tummy. You will have some improvement with liposuction alone if you are planning future pregnancies. J Plasma may be an option for you to aid in skin tightening.

To make an assessment we really need to see before and after pictures from your first liposuction procedure. If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Secondary liposuction typically delivers far less than the primary procedure.
Skin laxity is one of the major reasons patients failed to get quality results from Liposuction. To choose the correct procedure. It’s important to first have a clear understanding of what the underlying problem or ideology is. There are four tissue variables that determine what the abdomen looks like. The four tissue variables are abdominal skin laxity, excess subcutaneous fat, muscle separation from previous pregnancy, and excess visceral or intra-abdominal fat.
You didn’t include the information, but I’m going to assume that you don’t have children(no previous pregnancy). It looks like you still have some subcutaneous fat, but skin laxity is going to limit what Liposuction can do. You can differentiate and get a better understanding of how much skin laxity contributes by pulling your skin tight and having someone take pictures or while looking in the mirror.
If you don’t have muscle separation(no previous pregnancy), then you could do a skin on the tummy tuck, which has a far is your recovery in regards to pain.
I suggest having multiple in person, consultations with local plastic surgeons in your community. It’s important to differentiate primary versus secondary liposuction potential because the results are going to be strikingly different depending on how much fat was removed from the first procedure. If the first liposuction procedure was done conservatively then there may still be sufficient fat to remove to get impressive results. My best guess is your Liposuction results are limited because of skin laxity.
There is no Successful treatment for abdominal skin laxity other than surgical excision.
Best,
Mats Hagstrom, MD