10 months post op and stomach is still protruding - what can be causing this? (photos)

It is obvious that there is still more fat that needs to be removed. It probably is because you had it done under general anesthesia and the doc did it the old fashioned way by using too big of canulas. Under local, the doc would have stood you up and fine tuned it right then and there and seen that more fat would have needed to be removed. The smaller the canula, the more fat can be removed since the doc can get right up under the skin and remove more fat. Bigger canulas, can't get close to the skin without worrying about poking a hole in the skin since they are more traumatic and less precise.

Besides diastasis or visceral "eminent domain" from fat, organs, and/or the shape and dimensions of your peritoneal cavity, it may just be your abdominal wall musculofascial anatomy and intra-peritoneal to extra-peritoneal pressure relationships. The fact that contracting your muscles sucks it in flat argues against visceral fat or organs as a cause. If you had a diastasis, you would feel that on exam (supine, with active head or legs elevation). The bulge happens in relaxation, so intraperitoneal pressure against existing abdominal wall resistance produces that shape. Your ribs and pelvis are rigid, so do not manifest change, although their anatomy may contribute to it.