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

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.