Is This Loose Skin or Fat Around my Stomach? (photo)

Thank you for your question. Based on your photos it look you have loose skin and some stretch marks, and you will get better results after tummy tuck with intense liposuction. I would suggest to be treated by board certified PS with experience in this procedure, to get the best desired results.Respectfully,Dr. Emmanuel Mallol Cotes.-

It appears that you have loose skin along with fat, and liposuction may not achieve the results you want. A tummy tuck may be more suitable. You can try exercising and dieting to see if it helps.

There are only two mistakes one can make along the road to truth; not going all the way, and not starting. -The Buddha

The correct answer to your question, Katie, is actually predicated on what your expectations are. In your post, you spoke of your desire to "get a flat stomach". However, examination of your pictures reveals that you have significant striae of the abdominal skin, meaning that this skin has been stretched beyond the point of its normal elastic recoil during your pregnancy.  

An honest answer to your question would have to include the advisement that, contrary to what you wrote, there is no way to "tone it up naturally." Additionally, the profile view of your abdomen suggests that your pregnancy has caused a diastasis recti and a weakening of your abdominal wall. Of course a complete physical examination would be required to confirm this.

Certainly, a well-conceived and carefully executed program of diet and exercise is never a bad idea, and no doubt it would improve your overall health, and your silhouette as well. For those areas where fat loss is recalcitrant to your diet and exercise program, liposuction may be helpful. Laser liposuction may also give you some additional degree of skin contraction, which in your case would be particularly helpful.

And, of course, you may not want to undergo an abdominoplasty until you are finished having children. But the bottom line in your case, when you speak of your desire to have a "flat stomach", is that the only procedure that will deliver a result that meets that standard, and will deal with your diastasis recti and stretched, redundant abdominal skin is an abdominoplasty.