Hi thanks for your enquiry. According to the pictures, in my opinion the most suitable option should be tummy tuck (Abdominoplasty) and Vaser liposuction on flanks and possibly back area. I am Vaser lipo surgeon and not specialist in abdominoplasty procedure however I work in collaboration with plastic surgeons specialised in this procedure. The key here is to understand what you would like to achieve, what are your expectations. In my clinical practice, if a patient refuses to undergo for tummy tuck surgery, then after a careful medical assessment, they could be a possible candidate for Vaser lipo for the circumferential torso, abdomen, flanks and lower back in order to improve the overall silhouette and body contour. The combination of Vaser lipo with J plasma- Renuvion will allow to increase the probability of skin tightening. My experience is not only fat removal but also body contouring. Compression garments, manual lymphatic drainage sessions after the surgery and healthy diet and exercise can also help. However, your saggy/excess skin and in the abdomen and possible "mucle separation" will not improve and so if you are unhappy after 4-6 months then you should consider surgical treatment to remove the excess of loose skin. The above approach (Circumferential body Vaser lipo) is an option for many women who want to improve their body contour/silhouette with less scars and avoid tummy tuck. I would strongly suggest to make a consultation with an expert Vaser/ body contouring surgeon for a medical/surgical assessment in order to consider the best suitable treatment. Hope this helps, Best Wishes, Mr Giuseppe Fiore