Hello, thank you for your questions regarding your concern about stubborn fat around abdomen, abdominal fullness and whether you need a tummy tuck or liposuction. Thank you for your history and your pictures. First, we should analyze your pictures to determine the best procedure for you. You have cutis pleonasmus (excess skin) and dermatocholosis (loose skin) of your abdomen. You also have striae or stretch marks; perhaps from weight loss? Given your history, age of 50, striae, excess skin, and fat, most plastic surgeons would recommend an extended abdominoplasty (tummy tuck) with liposuction of the love handles. A tummy tuck will remove and predictable tighten your abdominal and love handle skin better than liposuction. A tummy tuck is performed under general anesthesia. Excess abdominal skin and fat are removed. The skin and fat from the top of the pubic region to the bottom of the belly button are removed. The rectus abdominis is tightened, and the belly button is repositioned. The tummy tuck procedure takes about four to five hours to complete. Drains are usually removed after 7 to 10 days, depending on the output. Most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say. I hope I have answered your questions about stubborn fat around the abdomen, abdominal fullness, and whether you need a tummy tuck or liposuction. If you have any more questions regarding tummy tucks, abdominoplasties, or abdominal liposuction, contact an experienced plastic surgeon. Since the tummy tuck surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing tummy tucks. Do your research. If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)