Concerns about the appearance of the abdomen are very common among patients consulting with a plastic surgeon. Just like every patient is different…so too is every abdomen. Different problems require different solutions. Your board certified plastic surgeon is uniquely trained to identify the problems as well as the appropriate solution. The abdomen is commonly addressed via liposuction or abdominoplasty (“tummy – tuck”). Which procedure is best is dependent upon the source of the problem. Excess fat deposits underneath the skin can be addressed via liposuction. Liposuction will not address any other issues and may worsen the situation if there are other factors at play (such as skin excess and muscle laxity, see below) Commonly patients concerns are centered around issues of excess skin as well as fat. A third factor, which is often overlooked by most patients is abdominal wall muscle laxity (typically seen in post partum mommies). The tummy tuck, also known as abdominoplasty is a surgical procedure designed to eliminate excess skin and fat and tighten the muscles in the abdominal wall to create a smoother and slimmer contour. The tummy tuck is designed to target areas of the abdomen that have not responded to diet and exercise, making it particularly popular among people that have a lot of loose or sagging skin around the abdominal area due to significant weight loss, as well as women with excess skin and stretched abdominal muscles following pregnancy and childbirth. With regards to your specific question, while both interventions will play role, the choice of order is dependent upon your goals. If you contract your abdominal muscles maximally (i.e. "suck in"), you will be able to assess the available fat for suction (without the laxity and skin excess factoring in). There will be an improvement but not necessarily the flattening you may have in mind. Additionally, liposuction in the setting of skin excess will (at least temporarily) worsen the appearance of the abdomen. Thus you may want to consider BodyTite or other RF heating modality as an adjunct to minimize/mitigate some of this risk. As always discuss your concerns with a board certified plastic surgeon (ABPS). Donovan Rosas MD Board Certified by the American Board of Plastic Surgery Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons RealSelf Top 100 RealSelf Hall of Fame