Any options for step off or shelf after tummy tuck? (Photos)

This is a common problem when the traditional priorities of 'getting the hole out' bumps into insufficient upper abdominal skin laxity; the result is a scar that is placed way too high. He's right, liposuction alone would not do much to the transition that exists at the scar, and if the doctor is not very experienced, might lead to irregularities. However, if you combine liposuction with scar revision that involves lowering the scar by even an inch, you'll get a better scar placement and a better contour. I'm not saying your surgeon is bad or did something wrong, actually he did something that is considered standard of care. The problem is that it's wrong from a visual/aesthetic perspective. The hole I refer to is the defect in the abdominal skin after it has been released from the belly button. Surgeons are taught that it needs to be removed with the excess skin, and for many the only way to do that is place the incision too high. Instead, placing the long incision where it is least visible (even when naked), at the border between the thigh and abdomen laterally, and 1.5 inches above your labial cleft centrally, you would have an uninterrupted abdominal contour. If the hole can't come out, then it is closed vertically. A small, vertical scar that is visible above a standard bikini is much more inconspicuous than a long horizontal scar that highlights a contour step-off from belly skin to upper pubic skin.

Dear jacqui83,
it is hard to tell for sure without an examination. Based on your photos, it looks like you would benefit from liposuction. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery