There are four variables that determine what someone’s abdomen looks like. Each of these four variables is managed or treated in its own way. In other words if someone does like the way their belly looks it is always because of one or more of for different reasons. These variables are abdominal skin laxity, excess subcutaneous fat, muscle separation from previous pregnancies called Diastasis recti and lastly access intra-abdominal or visceral fat. It would be helpful to know if you have children. I’m guessing you do not so based on that I see mild bulging of your abdominal wall which I’m guessing is probably related to some excess visceral fat. Based on that a combination of weight loss and Liposuction should get you to where you need to be. Abdominal skin laxity is best treated with a tummy tuck either full or mini. To assess skin laxity pull on your skin until it’s tight and see if that changes the shape or contour. To measure subcutaneous fat gently push against the skin with the tip of your finger until you feel the muscle wall. I’m guessing your fat layer around your mid abdomen is probably 3/4 of an inch. A straight muscle wall should create a B line between your sternum and your pubic bone. If the muscle wall sits in front of that virtual line then the muscle wall is bulging. They can happen because of muscle separation from previous pregnancies or pressure from excess visceral fat pushing against the back of the muscle wall. It’s important to recognize if an individual has excess visceral fat because it will limit the results from Liposuction. To get a quality assessment you need a quality in person consultation. The following are some important points that are worth remembering. Delivering quality liposuction results on a consistent basis is more difficult than most people believe and this includes plastic surgeons. Mastering body contouring is a long steep learning curve that takes years and doing thousands of cases. Most plastic surgeons will say they’re good at Liposuction but the results don’t show that. Liposuction results vary in outcome purely based on who does the procedure more than any other surgical procedure I’ve ever seen. To get a quality assessment followed by a well done procedure requires being in the hands of someone who is extremely experienced and talented. The find those who are best at this procedure requires work and it isn’t easy. I suggest having lots of in person consultations. Whenever possible avoid virtual consultations. During each consultation make sure the surgeon is differentiating subcutaneous fat versus visceral fat. Ask each provider to show you their entire collection of before and after pictures for abdominal liposuction. Simply seeing a handful of pre-selected pictures which most likely represent the best results of their career is insufficient to get a clear understanding of what average results look like in the hands of each provider. For this reason you should ask the provider to show their entire collection of results or at least as many as they are willing to. Ask to see as many pictures as possible of patients with body characteristics similar to your own. Asked to see examples of excellent outcomes, average outcomes and less than outcomes. A typically moderately experienced surgeon should have no difficulty showing you 50 sets a before and after pictures of Liposuction of the Torso or Abdomen at a minimum. Highly experienced surgeons will have hundreds or even thousands of before and after pictures for this procedure for this anatomic area. Make sure you see pictures from all angles including from behind. Ask specifically what areas were included and where the Liposuction stopped. Personally I treat the entire torso when doing abdominal liposuction. Spot treating the torso or leaving part of the torso untreated leads to unnatural transition zone between treated and untreated areas. A full tour so includes upper abdomen, lower abdomen, love handles, waste, fullback and under arm. If indicated the pubic area and lower back should be treated as well. Treating the full torso leaves people within even natural thin fat distribution without transition zones from treated to untreated areas. The biggest mistake of this is treating the waist and then leaving the back untreated causing it to bulge and look wedge like. Lastly I recommend reading all reviews on various physician review websites avoiding providers with any significant number of justified negative reviews. The absence of justified negative reviews is more important and far more telling than having an abundance of positive reviews. Justified negative reviews are organic and typically always represent a true patient experience. Unfortunately the same cannot always be said for those who have an abundance of positive reviews. Avoid scheduling surgery, making a deposit or deciding to have surgery during the consultation. Always finish all scheduled consultations before making the decision. Stay local whenever possible for elective surgical procedures. When in doubt slow down and schedule more consultations. I cannot emphasize enough the importance of finding the most experienced and talented procedures for Liposuction. Liposuction results are permanent and irreversible. If done poorly this procedure leaves people disfigured. Being board-certified with a good reputation is insufficient to confirm someone has mastered body contouring. Without weight loss your results may be limited. it’s important to understand and be able to differentiate what represents visceral fat and what is subcutaneous fat. Only subcutaneous fat is removed with Liposuction and visceral fat can only be lost through weight loss. Patient will have both need both removed. This means Liposuction with weight loss for quality outcomes. Obviously with enough weight loss all fed will start to be reduced but to do Contouring Liposuction on its own only trades subcutaneous fat. If you have children with term pregnancies then you may have muscle separation and for that getting a tight muscle wall typically requires a full tummy tuck. Best, Mats Hagstrom MD