How can I get my flat stomach back? Surgical and non surgical options? (photos)

Question

I am 41 years old, never had children yet my stomach under my belly button is starting to bulge forward. I don't think I have much fat but maybe I do? I regularly exercise and lift weights. What are my surgical and non surgical options to get back my tight, flat stomach from my 30s.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and for sharing your history and photos. Based on your photos, you appear to have muscle weakness, particularly in the lower abdomen, which could explain the bulging appearance. This is not uncommon, even in individuals who exercise regularly, as factors like genetics, age, and core muscle strain over time can contribute to this issue. Let’s explore your options.

A mini tummy tuck could be a great surgical option for you if the muscle weakness and skin laxity are limited to the area below your belly button. This procedure involves a smaller incision compared to a full tummy tuck and focuses on tightening the lower abdominal muscles and removing excess skin in that region. The recovery time is generally shorter than with a full tummy tuck.

If the muscle weakness extends above the belly button or if you desire a more comprehensive correction, a full tummy tuck may be the better option. This would involve tightening the rectus abdominis muscles from the ribcage to the pubic area, addressing any separation or laxity, and removing excess skin for a smoother and flatter abdomen. This approach offers more dramatic results and is ideal for individuals looking to fully restore abdominal contour.

As for non-surgical options, treatments like Emsculpt can help strengthen your abdominal muscles by using high-intensity electromagnetic energy to contract the muscles beyond what you can achieve with exercise. However, these treatments won’t address muscle separation (diastasis recti) or excess skin. If your goal is a truly flat stomach and tightened muscles, surgery is the most effective route.

Since you’re active and already at a healthy weight, your surgical results are likely to be excellent. I recommend consulting with a board-certified plastic surgeon to discuss your goals, have your abdominal muscles evaluated, and determine the best approach for your specific needs.

Sincerely,
Dr. J. Timothy Katzen, MD, FASMBS, FICS

Patrick Felice, MD · Answer

You demonstrate a weakness of the lower abdominal muscles. I would recommend Accufit electromuscular stimulation for a few treatments to see if this corrects the problem. In addition I would recommend specific Pilates type leg exercises to strengthen the obliques.If this does not work, the lower fascia can be tightened surgically.Hope this helps.

Morad Askari, MD, MBA · Answer

Thank you for your question. Given that you’re thin, active, regularly exercise, and lift weights, the slight bulge under your belly button could be due to mild abdominal wall laxity or small fat deposits, even if you don’t feel like you have much fat. Consultation with a plastic surgeon will help determine if muscle laxity or fat deposits are causing the bulge. If you have mild lower abdominal skin laxity or a slight separation in your abdominal muscles, a mini tummy tuck might be the best option. This procedure focuses on tightening the lower abdominal wall and removing excess skin or fat below the belly button. If the bulge is caused by localized fat deposits, liposuction could help remove the fat and smooth the area to get your flat stomach back.

Gregory Lakin, MD · Answer

Thank you for your question. Since you're thin, have a good skin tone, and maintain a regular exercise routine, it sounds like the slight bulge you're experiencing could be due to mild abdominal wall laxity rather than excess fat. Non-surgical options include Emsculpt, Radiofrequency or ultrasound treatments. Surgical options include liposuction and a mini tummy tuck that can tighten the lower abdominal muscles and remove a small amount of excess skin, resulting in a flatter, more defined stomach.

Leila Kasrai, MD, FRCSC · Answer

A board certified plastic surgeon will need to assess you to determine what is causing the bulge. It may be excess fat (subcutaneous or visceral) and/or abdominal muscle separation. If it is only visceral fat, exercise and diet is the most effective option. If it subcutaneous fat and/or abdominal muscle separation, you may consider a tummy tuck. A mini tummy tuck may be sufficient if the area you’re concerned about is only below your belly button.

Chet Mays, MD · Answer

Thank you for your inquiry! Surgical options could be Liposuction with Renuvion. Non-surgical option would be Morpheus8 in a series of 3 which helps tighten the skin. Schedule a consult with a Board-Certified Plastic Surgeon like myself to create a surgical plan based on your goals.

Robert M. Wald, Jr., MD · Answer

Non invasive laser therapy such as the sculpsure device would help with extra fat in the abdomen. Some skin shrinkage will occur. With age, the abdominal muscles weaken and some protrusion of the abdomen can occur. I would suggest a good trainer to help strengthen these muscles. The only other way is to do surgery and directly tighten these muscles.

Gerald Minniti, MD, FACS · Answer

You can start by contracting your abdominal wall; it not only will improve your abdominal contour but also protect your spine. You are lean and the lateral aspect of your recti and medial aspect of your external oblique heads are visible with definition of the linea semilunaris between them and the upper most inscription of your recti near your ribs. You might have a small amount of fat around your belly button and lower recti, which can be carefully suctioned. To avoid irregularities it's important to go to a true liposuction expert though.

Gary M. Horndeski, MD · Answer

You appear very thin and it is not likely to be fat. It most likely that you have a weakened abdominal wall. I recommend you begin doing sit-ups, planks and pilates. If after these exercises you do not get the result you are looking for then you will need surgical repair of the abdominal wall. The mechanical strong layer of the abdominal wall is called fascia. The fascia is the envelope that surrounds your muscle. Building up the muscle can strengthen the wall but you may need the fascia repaired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ramin Behmand, MD, FACS · Answer

Based on your photos, it doesn’t seem like you have excess fatty tissue that would require liposuction—in fact, you appear to be quite fit. There are a couple of potential explanations for what you're noticing. One factor could be your posture. As we age, increased curvature of the upper back can lead to a more pronounced lower abdomen. In this case, focusing on upper back and core exercises may help. Starting with physical therapy and then transitioning to a skilled fitness instructor could be a great approach.

Another possibility is that, even though you haven't had a pregnancy, the fascia around your abdominal muscles may have loosened slightly over time. While I wouldn't immediately recommend surgery, it could be an option if this becomes a significant concern. This would be done either through a tummy tuck incision or via an endoscopic approach. If a pregnancy remains an option for you, then you should refrain from doing anything surgical at this time.

Dr. B.

How can I get my flat stomach back? Surgical and non surgical options? (photos)

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