Not sure if this is diastasis recti, anterior tilt or visceral fat. What procedure/procedures would you recommend? (Photos)

There are four tissue variables that determine what the abdomen looks like.
By understanding, which one of these four variables is primary, secondary, tertiary, etc. helps determine what the best course of action is.
In order, the four tissue variables are abdominal skin laxity often due to previous pregnancies or significant weight loss.
The second variable is excess subcutaneous fat.
The third variable is muscle separation from previous pregnancies.
I don’t recommend assessing muscle separation based on fingers between the restless muscles.
Muscle separation shows by having a bulging abdominal wall.
If the abdominal wall isn’t straight, then it’s bulging.
The fourth variable is excess visceral fat.
This also causes abdominal wall bulging and can have a very similar appearance to muscle separation.
When there is abdominal wall bulging, it’s important to differentiate if this is due to visceral fat, muscle separation, or both.
There are a few techniques to differentiate.
One is to see what your abdomen looks like when you lay on your back.
If it’s all muscle separation, and no visceral fat abdominal wall should come in and become concave.
It should drop off your chest wall and come in and be more than just flat.
If it isn’t completely flat or slightly concave when you lay on your back, then visceral fat may be contributing.
The other way to do this is during an examination or if people have experience, they can do it themselves.
If with one hand, you push the abdominal wall until it’s straight The amount of pressure it takes to hold that position gives an indication if there is visceral fat, pushing against the abdominal wall from the inside.
For reference a straight abdominal wall should make a B line between the sternum and the pubic bone.
Patients can do this themselves by taking their non-dominant hand and holding the abdominal wall until it lines up with what should be a straight abdominal wall.
If it takes a fair amount of pressure and your arm starts getting tired by pushing with your non-dominant hand you definitely have a visceral fat issue.
It takes some experience to differentiate between the two. And paragraph plastic surgeons will vary in their ability to make an accurate assessment regarding which variable is Primary, etc.
In regards to treatment options, it breaks down in the following way.
Liposuction reduces subcutaneous fat only.
A full tummy tuck primarily treats, abdominal skin laxity, and muscle separation.
Visceral fat can only be reduced with weight loss.
Individuals who have significant excess visceral fat may still bulge, even after a full tummy tuck with muscle tightening.
If visceral fat is an issue then weight loss has to happen in order to have a better outcome.
This is true whether you have surgery or not.
In your case, my best guess is the breakdown of ideologies for the appearance of your abdominal wall is the following.
I definitely think you have both muscle separation and visceral fat.
You have the moderate amount of subcutaneous fat and the least contributing variable in regards to the shape of your abdominal wall is skin laxity.
Pregnancies do not create a change in fat distribution.
Pregnancies only create excess visual, fat, and muscle separation.
One way to have an understanding if visceral fat is an issue is to compare your body now to pre-pregnancy.
If you’re the same weight as you were before your first pregnancy and your abdominal wall was flat pre-pregnancy Then visceral fat is less likely to be an issue.
If you’ve gained weight since your first pregnancy and your bro Wall did not bulge, but it does now then visual fact may be part of it.
If you always had a slight bulge of your abdominal wall before your first pregnancy, then visceral fat is most likely a contributing issue.
In regards to procedures or options, I will tell you the following.
If you wanna flat abdominal wall and muscle separation is causing you to bulge then you need a full tummy tuck for muscle tightening.
You don’t necessarily need a tummy tuck for skin tightening.
Because visual fat may be a significant contributing variable. You may want to consider addressing that before contemplating surgery.
You can get a clear understanding of the impact of visceral fat by comparing your appearance at different weights.
To do this, I suggest you take a standard set of pictures the way plastic surgeons take before and after pictures.
Use the timer on your camera or preferably have someone else take the pictures for you.
For abominable bulging, lateral or sideways pictures are the most helpful.
Make sure your arms are in the same position for your pictures.
Start by taking pictures at your current weight.
Document your weight and save those pictures.
For example, you can take the pictures including your current weight and email them to yourself.
If you find yourself going up or down and wait, even a few pounds retake the pictures and compare. And
If your abdominal wall varies significantly with weight fluctuations than you know, the impact of weight loss and visceral fat.
If you’re able to lose enough weight that your abdomen goes flat then you’ll know what weight you need to be at to be happy with your appearance.
If despite weight loss, you don’t see a change in the contour of your abdominal wall then it’s more likely muscle separation is a contributing factor.
My best guess is that visceral, fat and muscle separation are probably contributing equally.
Because of that weight loss may give you a pretty good change.
Maybe easier said than done, but you may want to consider trying and getting an objective comparison.
Well done, Liposuction can also potentially give you some nice improvements.
That said finding the right provider for Liposuction is not at all easier straightforward.
Average plastic surgeons do average work and average Liposuction results are not always all that impressive.
To find someone who is mastered, Liposuction is going to require finding an exceptional provider for this procedure.
As a general statement, I find patients are not particularly good at provider selection.
To find the right provider for whatever procedure you choose I suggest always bringing pictures of yourself to use as a reference during the consultation.
Consider always having several consultations before selecting a provider.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had very similar body characteristics to your own.
Don’t rely on memory, but instead have pictures of yourself to use as reference.
Having only one consultation, more or less eliminates the ability to choose a better provider.
In the end provider selection is the most important variable.
And the hands of the right plastic surgeon you’ll get an accurate correct assessment, the right procedure will be recommended and the chance of a high-quality long-term outcome without disappointment is more likely.
This response was dictated.
My apologies for grammatical errors.
All the very best,
Mats Hagstrom MD