70, fit, BMI 21, tummy tuck & past lipo, I don't know if I should have muscle tightening? (Photos)

Yes I recommend you have muscle tightening with your tummy tuck as it will give you a much better result.
There are two major steps in tummy tuck (and many important minor ones) - removal of excess skin and tightening the muscles and you will benefit from both of these steps, in fact I wouldn't recommend doing the tummy tuck without the muscle tightening in your case, as you demonstrate very nicely in your photos the difference it will make for you.
I would have no concern doing a tummy tuck for you 20 years after liposuction, The scars in the areas treated with the liposuction will be soft now and won't present a problem. You have a smooth tummy now and can expect a smooth tummy after, unless you have a complication (for example, infection). Yes experienced plastic surgeons deal with this all of the time.
The only challenge compared to an average tummy tuck is that you are 70, and as we age, we don't bounce back from things as quickly as when we are younger. However, the fact that you exercise and have a BMI of 21 also goes a very long way to predict that you will have a good recovery. This comment on your age is a scientific fact, and not a judgement. My advice is make sure you get enough rest after surgery yet be sure to be up and about every day, and I expect you will do great.
I think it will be a good idea for you to do some more consults.
All the best to you,
Dr. Nancy de Kleer

Yes, prior liposuction does present an increased risk for complications after a tummy tuck. This is because the liposuction destroys some of the blood vessels under the skin. When we perform a tummy tuck we cut blood vessels in order to raise the abdominal skin flap. Because of the previous liposuction, there is scar tissue and traumatized blood vessels already present. So it's basically like a double whammy. It's still very reasonable to proceed and I have done many tummy tucks on prior liposuction patients. It's just that the surgeon needs to inform you of this slightly increased risk. Also, yes you should tighten your abdominal muscles as well because it will tighten up that lower protrusion of your abdomen. Hope that helps.

Good evening Firstkitty!Thank you for taking the time to upload your pictures for a better understanding of your needs!After 29 years of practice and multiple cases like yours, I would perform a circular tummy tuck. The results would be fantastic; you are definitely a candidate.

You are in great shape, muscle and skin laxity can be frustrating since they do not improve with vigorous diet and exercise (which does not mean you should not diet and exercise).

We routinely perform tummy tuck after prior liposuctions, you should be a good candidate. This allows tightening of bulging muscle and lax skin. As long as you are in good medical health.

An exam and further consultation with your/another plastic surgeon is recommended to confirm you are a candidate as well as better discuss your options and expectations.

Based on the photos you appear to be an excellent candidate for a tummy tuck. The muscle tightening would help the cosmetic result but does cause pain and increased downtime.

Thank you for your question. You are a candidate for a tummy tuck with muscle repair. The main consideration is old liposuction-related fibrosis, which can limit how smoothly the upper flap redrapes and slightly increase the risks of contour irregularity and seroma. However, this is manageable with careful adhesion release and preservation of vascular planes. Muscle repair will be performed if a true diastasis is confirmed during your examination (or ultrasound). Set expectations for a "flatter and smoother" appearance, not perfectly taut, due to age-related skin elasticity and scarring. During your consultation with a board-certified surgeon, he will confirm diastasis, map tethering, plan the incision and flap strategy, and decide whether to add limited liposuction.

Hello, thank you for your photos and questions. Your concerns are very understandable, especially given your health-conscious background and your doctor's comments. Liposuction, especially if done years ago and multiple times, can cause scar tissue to form in the deeper fat and connective tissue layers. However, based off your photos I would suggest you have a Tummy Tuck with repair to the muscle wall to get a better result and smoother look of the abdomen. Best of Luck!

Thanks for your question! You do have scar tissue from the liposuction, but I do think you can still get a nice result with a tummy tuck. Based on your photos, I would say yes to the diastasis repair. Good luck!

Thank you for providing this background — your question touches on an important but often overlooked detail in abdominal surgery planning.
Having liposuction 20 years ago can indeed leave behind scar tissue (fibrosis) beneath the skin. This fibrotic layer may reduce skin elasticity and make it harder for your surgeon to achieve even tightening or smooth contouring during a tummy tuck. It’s not uncommon, but it does add some complexity to the procedure.
Your surgeon is likely being transparent about managing expectations: • Skin may not redrape as smoothly as in someone without prior liposuction. • Some firmness or contour irregularities might remain despite a technically sound surgery.
That said, plastic surgeons routinely work with post-lipo scar tissue, especially in secondary or complex cases. It doesn’t automatically disqualify you as a candidate — it just means more meticulous dissection and realistic expectations about the final result.
Regarding muscle tightening (rectus plication), this depends on your abdominal wall tone. If your core muscles have separated (diastasis recti), tightening may enhance both function and appearance. However, if you’ve never been pregnant and have a strong core at BMI 21, your surgeon may determine that plication isn’t necessary — or only needed minimally.
You’re not alone in this scenario, and many patients with similar backgrounds go on to have successful results. A second opinion can help clarify if your current plan is the best fit.
— Op. Dr. Güray Yeşiladalı | Vanity Cosmetic Surgery Hospital

Thank you for your question and photos. I have performed many tummy tucks on women who previously had liposuction to their abdomens. Many women have poor results following liposuction, and a tummy tuck will release the scar tissue. This will improve your contour, and significantly smooth many irregularities caused by liposuction. This is a fairly common problem that can be corrected with a tummy tucki.

Dear Firstkitty,
Yes the lipo does pose some challenges during elevation of the skin flap. That just means the surgery goes more slowly and incrementally to stay in the right plane with cautery dissection. Other than that, you obviously have some laxity of the abdominal wall, particularly the lower. That will be corrected by bringing the rectus muscle fascia to the midline, from top to bottom to make it even from top to bottom.
Your skin may not be as stretchy in the vertical direction due to the previous liposuction, so be prepared for the umbilical donor site (hole) to be repaired as a small vertical incision in the lower abdomen. That will be determined at the time of surgery.
Your age is fine, no impediment to surgery.