Your situation is complex. Having had previous surgery has changed your anatomy, and this makes assessments more difficult. Your previous provider did not do the best job at Liposuction. Leaving you with an uneven fat distribution. In regards to skin laxity there is no procedure that works other than direct skin excision which for the front of the abdomen is going to be a tummy tuck. Based on your pictures your abdominal wall bulges, which indicates you either have muscle seperation or excess visceral fat or both. If you have children, i.e. previous pregnancies, then most likely you have muscle separation. You don’t need to be able to put your fingers between your rectus muscles to have muscle separation. The diagnosis of muscle separation is determined by if you’re abdominal wall creates a straight line between your sternum and your pubic bone or not. There are generally only two variables that cause the abdominal wall to bulge. One is muscle separation and the other is excess visceral fat. Differentiating excess visceral fat from muscle separation isn’t rocket science and most plastic surgeons should be able to help you with this. Individuals who have muscle separation should definitely have muscle tightening as part of any tummy tuck procedure. One way to differentiate visceral fat from muscle separation is to see what your abdominal wall looks like when you lay on your back. If it gets completely flat or drops slightly below a fictitious line between your sternum and your pubic bone then visceral fat is probably not contributing. If it still has a slight bulge while you lay on your back then visceral fat is a significant component. There are four variables that determine what the abdomen looks like. If somebody doesn’t like the way, their belly looks, it is always because of one or more of these four variables. Each variable has its own way of being treated so understanding the problem is the key to choosing the correct procedure. The four variables are abdominal skin laxity, excess subcutaneous fat, muscle separation and excess visceral fat. Renuvion will not create skin tightening. (First hand experience) Your previous provider left you with an abnormal fat distribution by failing to include your back and under arm areas when they did liposuction. That is probably the main reason for why your body looks the way it does from the backside. Skin laxity on the back is difficult to treat, and there is no great treatment for it without skin excision. To get an accurate assessment, will absolutely require an in person consultation and having access to proper before and after pictures. Having had previous surgery, your situation is now more complex than those who not had previous procedures. Do not attempt of making your own assessment, or determine what are appropriate procedures without proper training. There’s a good saying in medicine, saying “the Doctor Who treats himself has a fool for a patient”. Trying to make your own medical decisions without even having medical training, simply doubles the emphasis of that saying. Find the most qualified providers in your community by having multiple in person, consultations and listen to what they have to recommend. Nobody has to have cosmetic surgery, so in the end, the decision will be yours, but should be based on having a clear understanding of what the underlying problems are and what each procedure option can and cannot accomplish. In regards to your abdomen treatment options should be based and understanding which tissue is contributing and that should not be too difficult if you find a sufficiently talented and experience provider. Individuals who are even moderately overweight, should consider weight loss as the first, safest, and most effective way of improving their bodies. You do not appear to be a good candidate for a mini tummy tuck, and if you’re going to have a tummy tuck, it needs to include muscle tightening. The question is really whether you also have visceral fat in which case weight loss is mandatory in order to get a quality outcome. Nobody has to have cosmetic surgery. Nobody has to have a tummy tuck. These are elective cosmetic surgical procedures. The two single variables that determine quality cosmetic surgery outcomes are almost always based on patient candidacy and the skill of the surgeon. When things don’t go well it is almost always because of one or both of those two single variables. Understanding your own candidacy for various surgical procedures, and choosing the best provider by having a multiple in person consultations are fundamental foundations of ensuring quality outcomes. Best, Mats Hagstrom, MD