Generally speaking, loose skin, fat deposits and separated muscles (diastasis recti) are common in women who have had multiple pregnancies. While exercise may help, women often find that exercise and diet alone cannot improve the appearance of their midsection. You can try, but if it doesn't work you may want to consider a tummy tuck.
This would get rid of fat, loose skin and correct separated abdominal muscles to give you a flatter stomach. It may also be able to get rid of some of your stretch marks.
Exercise might tighten your muscles, but will not remove excess skin as posed in your question.
Often after a pregnancy, there can be permanent separation of the vertical muscles in the abdomen. It is essentially a hernia and in that case excercise will not put the muscles back where they were. Instead, a surgical procedure can be performed to tighten the muscle and remove excess skin at the same time.
Small amounts of excess skin seem less excessive if you enlarge the underlying muscle by exercise. Unfortunately the abdominal area after multiple pregnancies does not fall into this category. Unlike a bicep upper arm muscle the abdominal muscles do not enlarge to the same extent. You would basically have to get pregnant again to fill the envelope of excess skin.
Also, the pregnancy process stretches the abdominal muscles and the connection between the strap like rectus muscles on either side of the abdominal midline. When these muscles move apart the hourglass figure is lost and no amount of exercise can improve the situation as exercise alone cannot bring them back to the midline. That is why abdominoplasty works -- the excess skin is removed and the muscles are surgically tightened by suturing them together across the midline.
Without a careful examination it would be difficult to say for certain, but if what you are bothered by it truly the loose skin and laxity of the muscle layer that so often results from pregnancy, there is unfortunately no amount of exercise that will correct the problem.
Exercise could reasonably be expected to assist with weight loss (a problem it doesn't sound like you have) or with development and strengthening of the muscles, but fundamentally what occurs in mothers is a separation of the muscles in the center of the abdomen- this cannot be improved without surgery, no matter how vigorously or frequently you exercise.
I would visit with a Board Certified Plastic Surgeon and discuss your goals with them. Here's some information on finding a situation that's right for you:
In a previous entry, I described how common it is for patients who contact my Orlando plastic surgery center to make the mistake of thinking that:
Anyone offering a plastic surgery procedure MUST be appropriately trained and certified to perform that procedure; this is, unfortunately, not the case.
All plastic surgery training is equal, and so shopping for the best price is the best way to choose a surgeon
In that previous entry, I explained how not all people offering plastic surgery are Board Certified Plastic Surgeons, and in fact, many are not even plastic surgeons! There are now many doctors in other specialties offering to perform plastic surgery procedures without the benefit of the years of training a plastic surgeon receives, convincing their patients that a few weeks of training is sufficient for them to learn what we learn in YEARS.
I explained the potentially dangerous error of choosing based on price.
Finally, I explained how to properly choose not only a surgeon, but also the importance of choosing the facility in which the procedure will be performed and also the anesthesia provider.
For today's entry, we'll assume a healthy understanding of these issues. Having done your homework, and ascertained that the surgeons you are considering are all plastic surgeons Board Certified by The American Board of Plastic Surgery, the facilities in which they operate are all certified by the AAAASF or JCAHO, and the anesthesia providers are all well-qualified, how do you make the final decision?
Here are my recommendations:
Consider the relative quality of the surgeon's medical school educations. While it is true that most medical educations will cover the basics, there is a reason that some institutions grow international reputations and perpetually fight for the best students.
A medical school education among these "Best and Brightest" students and educators could reasonably be expected to produce (and historically has produced) America's finest doctors and surgeons. Ranking lists of medical schools take these things into consideration and are a useful resource. The most respected list, from US News and World Report, can be found here:
Find out where the surgeon completed his/her Plastic Surgery Residency. This is the critical and years long process of going from a medical student to a qualified plastic surgeon, where we learn to do plastic surgery by gradually taking on more responsibility under the watchful eyes of other, already trained and experienced surgeons. Just like medical schools, not all training programs are equal in the breadth, intensity and quality of training offered.
Generally speaking, those programs associated with the best medical schools also provide the best training, as they will be able to attract and retain the best, most experienced and reputable professors of plastic surgery- and the quality of our training will depend on the quality of those training us. For example, I completed my own Plastic Surgery training at Washington University in St. Louis, one of the top 5 medical schools in the United States- and it also happens to be the birthplace of American Plastic Surgery.
It bears repeating that you should be absolutely sure that the surgeon you are considering is Board Certified by The American Board of Plastic Surgery. This is easily done at the Board's site:
Know that surgeons who claim to be "Board Eligible" in plastic surgery are NOT board certified. This may be because they simply have not taken the examinations- but this is doubtfully the true explanation, as The American Board of Plastic Surgery specifically prohibits claiming ANY status with The Board until and unless you have passed all examinations. Much more likely is that they were unable to pass the examinations (or simply never took them), but realize they may lose patients if they don't find a way to fool them into thinking they have status with The Board. Are you starting so understand that not all doctors have integrity?
Spend some time thinking about the interactions you have had with the surgeon and his/her staff. You should realize that having a plastic surgery procedure is NOT a singular interaction, like buying a new handbag, in which once the bag is purchased (or the surgery completed) the interaction can be considered to be complete. Rather, you are choosing to enter into a very important relationship with your surgeon, the critical portions of which should be expected to last at least a few months beyond the date of your surgery, as you recover and heal. This very important relationship should therefore be approached with the same care you would give any other... think about whether you think the surgeon will be responsive to your needs and concerns, whether your personalities will allow healthy interaction, the approachability of his/her staff, etc...
Remember- you don't only want to have achieved a great outcome when all is said and done... you want to have had an uplifting and positive experience you can look back on and smile! You can have this in the best practices.
Finally, never forget that what you are really looking for is the very best OUTCOME you can achieve. Sometimes when I'm asked by friends and family how to sort through all the claims some surgeons make of being the best choice because they (the surgeon in question) were voted "the best" by some magazine, or because the surgeon simply says they are "the best", I am reminded of the first Clinton presidential campaign, in which the slogan "It's the economy, stupid" helped Mr. Clinton win the White House. Once you've done the homework outlined above, it's all about the OUTCOME...
Ask to see photos of the surgeon's previous work- and ask yourself if you would be pleased if you looked like the photos they show you. Think about how many good photos they show you. Do most of the outcomes just look funny, with only a few that you think are attractive and natural, or are all of their results pleasing and attractive, even if every one may not be what you specifically want? If the surgeon can't show you at least a few outcomes you find attractive and pleasing, you should look elsewhere.
Be sure to ask directly whether the photos you are being shown are the surgeon's own work (believe it or not, some actually do try to attract patients by showing them the work of others!)
I also always recommend communicating with a few of the surgeon's prior patients who have had the same procedure they are recommending for you. You can ask the surgeon's staff for a list of patients who may have agreed to be called, or find testimonials online at one of the many plastic surgery websites now available. My favorite, because it is objective, free (surgeons cannot pay to be listed higher, so more credibility exists), and allows you to get a feel for the surgeon's manner and personality, is RealSelf:
I know it seems like a huge amount of work, but after you've read this (as well as my prior post) a few times, you'll have a great understanding of the best way to proceed, and it will feel very comfortable and natural to you. Use the resources I've outlined, and use your gut- there are many great surgeons out there- with these guidelines you should be able to attain the outcome and experience you desire.