Dear nwmommy, Thanks for submitting your picture. It would have been quite helpful to see your side view picture as well. From observing your picture, you appear to have significant skin and muscles laxity from the upper abdomen to the pubic bone with diffuse stretch marks. Tummy tuck will be one of the best investments in yourself, since it will remove most of the stretch marks, give you a flat stomach and narrower waists. Your confidence will increase and shopping will be fun again... As far as liposuction, I do not think that you will need it after the tummy tuck because it will shape you up so nicely and most likely you will lose few pounds due to the tightening of the muscles, that will reduce the amount of food that you can eat and your sense of hunger. In regard to fat injection, it is a total waste of your time and money. because it will disappear completely or almost completely after few months or even sooner. I have seen it on many patients who came to my surgery center for butt implants surgery after their big disappointment from the fat injection to the butt surgery that was done by other surgeons. In my experience of performing butt implants on over 500 patients, I found that hip implants are unnecessary, because the sub fascia technique with wide ultra soft oval round silicone implants, my patients are delightfully getting nice and round hips due to the filling of the hips indentation. You have to realize that not all results are same for tummy tuck and butt implants, because experience, skills and aesthetic eye are critical for good and safe outcome. So, do your due diligence and choose wisely. Always, consult with experience board certified plastic surgeons who do lots of tummy tuck and but implants surgery in accredited surgery center for your safety. Most importantly, check the before and after picture to make sure that they are numerous, consistent and attractive. Check also the reviews at 'realself' for ratings and positive experience reports. Best of luck, Dr Widder