Loose Skin or is It Fat?

I am 37 years old and had 2 children 18 months apart. My youngest is now 5 years old.

I just completed a year of training with a personal trainer 3 times a week, but did not lose any of my belly fat below my belly button; it almost seems worse than when I first had my children. I also did not lose any weight but gained muscle and lost body fat.

My legs, hips, and arms are a couple of inches smaller, but my belly seems bigger than ever and is the same size. I'm considering whatever it will take to get rid of this pouch of fat - or loose skin. I'm not sure what it is, but it's gotta go!

Doctor Answers 25

There are many causes for abdominal fullness

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Don't worry, you have a common concern. There are many problems leading to abodominal fullness. First is fat, but you seem to be exercising well without any change in your abdomen. The second is diastasis of your abdominal muscles. When you have children the fascia holding your rectus muscles (six pack) together becomes loose and the abdomen has a round appearance despite exercise and weight loss. In this case, you may require a surgery (abdominoplasty or "tummy tuck") to tighten the muscles back together and to excise any extra skin. This is a common operation. The incision can be hidden in your waist line and the surgery can be combined with liposuction to help define your flanks and remove any excess fat.

The best way to tell if you have fat, extra skin, or diastasis of your muscles is to feel your belly.

If you can "pinch and inch," then there is fat which may be improved with liposuction.

If all you feel is loose skin, then it is likely a skin issue requiring abdominoplasty.

If your abdomen remains round despite tightening your muscles (six pack), then you likely have diastasis requiring tightening.

Good luck.

The excess contour could be abdominal wall laxity, skin or fat or a combination

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There are several components of extra fullnes or contour in the lower abdomen.

There can be excess contour from laxity of the abdominal wall (it was stretched out during pregnancy), or excess skin, or excess skin and fat.

A board certified plastic surgeon will be able to ascertain upon examination of your abdomen what is causing the fullness you don't like and advise you.

John E. Gross, MD
Los Angeles Plastic Surgeon

Loose skin and excess fat after pregnancies

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Congratulations on being so faithful to your exercise regime. You must be in great shape. Unfortunately it is very difficult, if not impossible, to get rid of loose skin concentrated in your midsection. You can wait for a while to see if your skin tightens but generally this does not happen as it is worsened by the aging process. A tummy tuck is the only procedure that can dramatically improve the contour of your midsection  by removing loose skin and extra fat. Because you're in such great shape your results will be even better than someone who is not in good shape.

Hard to tell with out an examination of abdomen

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Hard to say with examining you. An in person visit would be best to give you the right information. It can be either loose skin and muscles that would require a Tummy Tuck/Mini Tummy Tuck surgery. It sounds like you have been very good about exercise and if surgery is recommended you will be better prepared due to your good physical condition. Strong abdomen muscles is good to have during the recovery and you will get a great result in whichever procedure you need. A Board certified Plastic Surgeon will make this determination after a complete examination.

Z. Paul Lorenc, MD
Manhattan Plastic Surgeon
4.6 out of 5 stars 34 reviews

Likely good tummy tuck candidate

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Thank you for your question.  Your set of complaints is a very common one.  The laxity in your lower abdomen is likely more than simply extra fat and/or skin - it is the stretching of the tissues that make up the abdominal wall due to pregnancy.  These are all issues that are corrected with tummy tuck:  removal of excess skin and fat from the lower abdomen, as well as tightening of the abdominal muscles and fascia with corset plication.  In the hands of an experienced, board-certified plastic surgeon, the result is a beautifully flat tummy and a sculpted waistline.

Tough to tell

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whether you'd be better suited for liposuction or a tummy tuck. Often that pouch of extra fat after childbirth (or before) is amenable to liposuction. Good luck.

Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 43 reviews

Tummy tuck!

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This is most likely because what you are talking about is skin excess. You have done the right thing by working out.  Instead of getting frustrated and giving up, it may be time to have the skin excised and the muscles tightened with a tummy tuck.

Tummy Tuck & Liposuction Following Pregnancy

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                  It’s not unusual to see women who have concerns about the appearance of their abdomen following pregnancy.  Most of them have tried diet and exercise and despite this have been unable to solve their problems.  These patients have difficulty finding clothes that fit properly and feel that people stare at them.  This often results in lowered self-esteem, self-image and self-confidence.

                   A variety of changes can occur in the abdominal wall following pregnancy.  These include the development of excess skin, weakened abdominal muscles and fat accumulation.  For these reasons, a comprehensive evaluation is essential to obtain an optimal result. 

                  Depending on the results of this evaluation, multiple options are available for treating abnormalities of the abdominal wall.  Two of the most commonly used procedures are tummy tuck and liposuction.  These procedures have different levels of complexity, pain, recovery, and cost. 

                  When isolated fat is present, liposuction can be performed under local or general anesthesia.  It has a relatively short recovery, is affordable, and has a low complication rate.  The procedure involves passing a canula through the subcutaneous tissue while applying suction which ultimately removes fat cells.  High satisfaction rates are associated with this procedure.  Its major drawbacks include less effectiveness in patients with weak abdominal muscles, loose skin, and large amounts of fat.

                   Abdominoplasty tightens the abdominal wall muscles and removes excess skin and fat.  When severe deformities are present abdominoplasty is the treatment of choice.  High satisfaction rates are associated with this procedure, but it is more expensive, has a longer recovery and a higher complication rate.

                   For patients with severe abdominal wall deformities, it’s essential that the appropriate procedure be chosen to correct the problem.  For this reason it’s important to consult a board certified plastic surgeon who can perform this evaluation.

Loose Skin or is It Fat?

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The question cannot be fully answered without a formal physical exam but seems to suggest that there is muscle weakness in the lower abdomen.  I find this to be very common after multiple pregnancies and correction with a mini or full tummy tuck has been very successful.  

For more information, please go to my website at:

Tummy tuck for persistance fat accumulation in the lower abdomen following pregnancies

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 It is quite possible that the lower part of your abdominal muscles has been streched out or separated as a result of multiple pregnancies, therefore some of the intra abdominal fat is protruding through the midline. A careful clinical examination would be helpful to diagnose this condition which could be fixed during a modifid tummy tuck. If that is not the case liposuction/liposelection is a very effective procedure to address your concerns.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.