Choosing a procedure should be based on first and foremost having a clear understanding of what the problem is. After that you need to understand what each treatment options can and cannot accomplish. In other words make an accurate diagnosis then to prescribe the correct treatment. You’re not alone and not wanting to have a tummy tuck. Nobody wants to have one. It is however the correct procedure to treat pregnancy related changes so women who want to get a tight flat abdomen from pregnancy related changes often correctly choose a tummy tuck because it accomplishes their goal. There are four variables that determine what someone’s abdomen looks like. In other words if you don’t like the way your belly looks it is always because of one or more of for different reasons. each of these variables is a separate layer of tissue and each one has its own way of being treated. The four variables are skin laxity typically due to previous pregnancies, weight fluctuations or sometimes loss of skin elasticity due to age. The second variable is excess subcutaneous fat. The third variable is muscle separation from previous pregnancies called diastasis rectii. The fourth variable his exes visceral or intra-abdominal fat .An accurate assessment will differentiate each of these variables making an assessment with a primary, secondary, tertiary diagnoses etc. Before we begin that process I’d like to point out that having children or being pregnant does not change fat distribution. This is why Liposuction is generally not the treatment of choice for pregnancy related body changes. You might think you can overcome skin laxity and muscle separation by having liposuction but since fat isn’t the problem and you’re not treating the problem Liposuction isn’t going to deliver a quality outcome. To differentiate skin laxity simply put your skin under tension by pulling or lifting on edge. have someone else take pictures are used to timer of your camera to get an idea of how much skin laxity is contributing to body contour. To assess the thickness of your subcutaneous fat layer but your skin under gentle tension and with the Tip of one finger gently press against your skin until you feel the underlying muscle wall. It does not require much pressure at all. Try doing it over your ribs or over your hip bone to get an idea of how hard you need to press before you feel the underlying tissue layer. you don’t have much body fat so I’m guessing your subcutaneous fat layer around your mid abdomen is less than half an inch. Do not try to assess the thickness of your subcutaneous fat layer by pinching your skin or by recruiting large areas of skin laxity. punching up loose skin will make it seem like you have far more fat than you actually do. Loose skin looks and feels like fat to most people. A straight muscle wall should create a B line between your sternum and your pubic bone. use your fingers the same way you felt for the thickness of your subcutaneous fat layer and feel where the muscle wall is along the abdominal midline. put one finger on your pubic bone and another finger on your lower sternum and see if your muscle while follows a straight line. if it doesn’t then you have a bulging abdominal wall and this is either due to muscle separation, visceral fat or both. In your case I don’t believe visceral fat is an issue but all women Will develop some degree of muscle separation from having a term pregnancy. Even slight muscle separation will cause a slight bulge of the abdominal wall. To differentiate visceral fat from muscle separation try seeing what your abdomen looks like when you lay on your back. If it goes completely flat then visceral fat is not contributing. If it’s still bulges with someone laying on their back and visceral fat may be contributing. Based on your pictures I would say that the reason your abdomen doesn’t look the way you want to what doesn’t have an ideal pre-pregnancy appearance is in order related to first muscle separation, second skin laxity, third subcutaneous fat and lastly potential visceral fat. You can expect Liposuction to remove 50 to 75% I have your subcutaneous fat layer. That means if your fat layer is 1/2 inch you can expect it to come in by 3/8 of an inch. and it’s not enough to get you a flat abdomen. In fact Liposuction will not have much of an impact on the front of your abdomen because you don’t have that much fat to remove and fat isn’t the problem. Liposuction it’s a really good procedure for love handles, waist, back and under arm area and it could include the front of your abdomen just don’t expect it to have that much impact where your body bothers you the most. If you choose a procedure that doesn’t treat the primary problem then you should expect only slight subtle improvements. Plastic surgeons don’t recommend take me tax because we enjoy giving people really big scars, weird looking belly buttons or enjoy watching people recover for weeks. We recommend the procedure because we know it is the correct procedure and the only one that correctly addresses significant to pregnancy related changes. Overall your abdomen looks very good and you should count your blessings and give yourself kudos for having maintained reasonable weight, having lost weight and stayed fit during the process. It is however important to understand that that really isn’t the problem and a fat based solution isn’t going to give you an impressive results. Liposuction it’s a procedure that’s more difficult to do well than most people believe. Unfortunately a substantial number of well intended properly trained board-certified plastic surgeons are not able to consistently deliver quality liposuction results on a regular basis. Most plastic surgeons think they’re far better at Liposuction than they actually are. There are definitely plastic surgeons who are really good at liposuction but there are also and unfortunately substantial number of providers who do not take the procedure seriously and I’m not gone through the learning curve to deliver consistent quality results. If you opt for Liposuction then I would encourage you to be highly selective and she was only providers that I’ve been properly vetted and proven to you that they can deliver a consistent quality results on a regular basis. The same is true for any cosmetic procedure but Liposuction has such a variation in outcomes purely based on who does the procedure I feel I need to make an extra point for this procedure regarding the importance of provider selection. Start the process by finding a local board-certified plastic surgeons will have large numbers of quality liposuction before and after pictures on their website. don’t bother looking at pictures of patients but also had other procedures like a tummy tuck. once you found enough names of providers that seem to have the ability to do quality Liposuction start scheduling in person consultations. I recommend patients avoid virtual consultation so whenever possible and I highly recommend patients avoid traveling long distances for elective surgical procedures. Bring pictures of your body with you in printed format and use those as a reference during the consultation. During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures for abdominal liposuction. I asked them to show you only pictures of previous patients who have very similar body characteristics to your own. It should be women of the same age with relatively thin layers of fat, mild to moderate skin laxity and mild muscle separation. Seeing pictures of chubby 20 year olds have never had children is not a good comparison. Being shown a handful of preselected images most likely representing the best results of anyone providers career is insufficient to get a clear understanding of what average results look like or how many of these procedures anyone in providers actually performed. Providers may be apprehensive to open up their portfolio and show you anything other than their pre-selected pictures but I encourage you to push and insist on seeing as many pictures as possible. Specifically ask the provider to show you examples of excellent outcomes, average outcomes and outcomes that didn’t turn out as well as stay at home for. if they start showing you pictures of people who are different body characteristics in the before pictures and put those to the side and say you’re not interested in seeing results on people who are different than you. For reference and experience plastic surgeon should have no difficulty showing you at least 50 sets of before and after pictures of commonly perform procedures like abdominal liposuction. When reviewing the before and after pictures ask the providers to point out exactly what areas were treated and what areas were not treated. Look very carefully at all treated areas to make sure there are no skin contour irregularities seen anywhere.You should also look carefully at transition zone between treated and untreated areas to make sure they look completely natural. other than possibly seeing well healing tiny incision marks there should be no evidence that someone has had liposuction. Personally I view the torso as a single anatomic unit and generally recommend treating the entire torso when doing abdominal liposuction. By doing that patient so (even natural within fat distribution that’s consistent on their entire torso without transition zone between treated and on treated areas. Personally I view the torso as a single anatomic unit and generally recommend treating the entire torso when doing abdominal liposuction. By doing that patient so (even natural within fat distribution that’s consistent on their entire torso without transition zone between treated and on treated areas. To judge tummy tucks look specifically for plastic surgeons to get the most natural looking belly button with a very low set scar that follows anatomic contours naturally and heavenly on both sides. Guitar so it should look balanced attractive and proportion it from all angles including from behind. To judge tummy tucks look specifically for plastic surgeons to get the most natural looking belly button with a very low set scar that follows anatomic contours naturally and heavenly on both sides. Guitar so it should look balanced attractive and proportion it from all angles including from behind. The biggest mistake most people make is not scheduling enough consultations and not properly fatting providers. This increases the chance of having the wrong procedure or not finding a provider sufficient skillet experience. This increases the chance of having the wrong procedure or not finding a provider sufficient skillet experience. patients need to take responsibility and realize that if you don’t select your provider accurately the results may suffer. The results from these procedures are permanent and irreversible. Finally women considering a tummy tuck should probably be quite comfortable with their decision to not have future pregnancies if they’re going to have that operation. When in doubt slow down and schedule more consultations. Do not rush the decision or the process itself. You will be reminded every day for the rest of your life and the time to be selective is now. Best, Mats Hagstrom MD