I'm fit but I still have a protruding stomach, what is the best way to reduce the belly? (Photos)

Question

I have had two children and I am 35 years old. I exercise and I'm in great shape however my stomach does not seem to go down. I can feel that my muscles are tight however my belly is still protruding. From what you see, could I benefit from liposuction?  I am hoping liposuction will do as I do not have stretch marks or loose skin. I am not open to a tummy tuck and coolsculpting is way too expensive.

Jason Emer, MD · Answer

you need weight loss including hormonal therapy (see link to dr jill hormonal optimization).  This will help with weight loss, as most of this weight is internal or called visceral fat.  liposuction can also help with some of the external weight but not hte internal.  Please see an expert. Best, Dr. Emer.

Daniel Barrett, MD · Answer

Dear alexistrav,
based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. I would suggest you to consult a board-certified plastic surgeon because 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

Gary M. Horndeski, MD · Answer

Your abdomen is protruding anteriorly and liposuction will not correct this.  If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement.  The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.Best Wishes,Gary Horndeski, M.D.

Mark T. Boschert, MD · Answer

I think that you have very good hips and I agree that Coolsculpting would not be a good choice for you.  It does appear that you have muscle laxity and is require muscle repair or tightening.  The way to do that is with an abdominoplasty.  The muscles can be tightened back to their original position and the excess fat and skin can be removed.  I would suggest seeing a board certified plastic surgeon in your area who can do an exam and give you specific suggestions.  I would be happy to see you for this.  Best of Luck! Dr. Boschert Renaissance Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

You are correct in avoiding cool sculpting but not because of its price.
When we make an assessment on someone’s abdomen for aesthetic reasons there are four variables we look at.
These are skin laxity, subcutaneous fat, muscle separation from previous pregnancies and excess visceral or intra-abdominal fat.
Skin laxity is fairly self evident. Subcutaneous fat is the fat layer you feel when you push against your skin until you feel your underlying muscle.
Muscle separation is best demonstrated by pushing against muscle while or tightening your abdominal muscles.
If it takes force to push your abdomen flat like if you’re pushing it in with your hand then most likely you have excess visceral fat that’s pushing back on the back wall of the muscle.
It’s hard to assess the difference between the visceral fat and muscle separation on a picture.
It’s fairly easy to differentiate through an examination.
You simply do what I said above. Push on your abdomen until it becomes flat. If that requires a lot of pressure or you feel like it pushes up against your diaphragm then there is excess volume Inside the abdomen because of excess visceral fat.
In your case you could probably lose a few more pounds which will help shrink visceral fat. Liposuction will probably take off about an inch but you’ll still bulge after.
The big question is how much of this is from your previous pregnancies and how much is because of visceral fat.
If your belly bulged before your first pregnancy then it’s more likely visceral fat and weight loss is the number one treatment.
If this changed dramatically despite weight from pregnancies then it’s more related to muscle separation and a tummy tuck is the best and appropriate treatment.
Because cool sculpting will not address muscle separation or visceral fat and is dismal in regards to efficacy in the first place it is a complete waste of money in your case.
I suggest having several in person consultations with local board-certified plastic surgeons.
If weight loss helps flatten your abdomen then the problem is more visceral fat than muscle separation.
The correct treatment is indicated by making a correct diagnosis.
I called this making an assessment.
It’s done through and examination during an in person consultation.
Some plastic surgeons may make an issue of doing a full tummy tuck because of your previous open gallbladder surgery scar.
I think most plastic surgeons would still be comfortable doing a tummy tuck if indicated as long as you’re not an active at cigarette smoker.
Plastic surgeons are hyper vigilant about blood flow and parallel scars can create issues of limiting blood flow.
A tummy tuck would in essence create a parallel scar with your gallbladder scar.
All things to be discussed during a consultation.
Best, 
Mats Hagstrom MD

Arian Mowlavi, MD, FACS (license on probation) · Answer

Liposuction would not resolve this issue, as the problem is not excess fat it is an abdominal protrusion. You would benefit from an ultra high defintion tummy tuck. The tummy tuck procedure would comprehensively remove excess skin and fat in the abdominal region. The abdominal muscle would also be 'tightened' to create the appearance of a flatter stomach.  A Skype or FaceTime consultation with a tummy tuck specialist will help you get an accurate recommendation and pricing.
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

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