What would be the recommended procedure to fix my midsection? (Photos)

Based on the photos you provided and the history of two C-sections, including one with twins, a full (or extended) tummy tuck (abdominoplasty) is the most suitable procedure to address your concerns. This procedure will help tighten your abdominal muscles, repair any separation (diastasis recti), and remove excess skin that is difficult to tone through exercise. Additionally, liposuction could be performed for contouring the flanks and helping to further shape and define your waistline. For those with multiple pregnancies, including twin pregnancies, this combination often provides the most dramatic improvement.
To explore the best option tailored to your needs, it's crucial to consult with an experienced plastic surgeon who can evaluate your body and provide personalized recommendations.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Hello and thank you for your question. For starters, it's great that you are doing what you can to maintain a healthy and active lifestyle- this helps physically condition your body for surgery and makes the recovery process easier. From the pictures you have provided, you have a significant amount of striae (stretchmarks) present throughout your lower to mid abdomen and extending to your sides into your flanks. You also have a severe amount of excess skin and subcutaneous fat in these regions. There is a significant amount of both horizontal and vertical excess tissue present. Based on all this, you would benefit from a fleur-de-lis abdominoplasty (tummy tuck) and staged 360 liposuction to improve your abdominal/trunk contour.
The fleur-de-lis abdominoplasty differs from the traditional abdominoplasty in that you will end up with both the standard horizontal lower abdominal scar, as well as a vertical scar extending from the horizontal scar up the middle of your abdomen to the bottom of your ribcage. In your case, there is a significant horizontal excess of skin and fat, which would not be adequately addressed with just a traditional abdominoplasty- therefore in order to resect this additional tissue and greatly improve the resulting trunk contour would require the additional vertical scar in additional to the standard horizontal scar. The horizontal scar should be well hidden within your bikini or underwear, and if you adhere to proper scar care and sun avoidance after surgery, both the horizontal and the vertical scars should eventually heal to be minimally noticeable.
Liposuction is a great adjunct which would definitely provide some additional benefit, particularly to the contour and symmetry of your flanks and back. In your case though, since there would be such a large amount of tissue resected (cut out) with the fleur-de-lis procedure, I would recommend delaying the liposuction to be performed at a later time (at least 6 months later). Separating liposuction into a separate procedure is important- this would minimize the risk of wound healing issues during the fleur-de-lis abdominoplasty procedure because the extensive dissection involved compromises the blood supply to the tissues, and liposuction there further disrupts it resulting in increased risk of complications. Delaying the liposuction would also allow for a better overall aesthetic result- any asymmetries from the initial surgery could be better corrected during the later liposuction procedure, and the liposuction can be more aggressive, especially to the anterior trunk (abdomen) as everything should be healed by this point so liposuction would not cause issues.
With all that said, it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from any photos and descriptions provided. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Hi there! Thanks for your question. I would reccomend an abdominoplasty with flank liposuction, aka a tummy tuck! You are an excellent canidate for this due to your excess skin. I would reccomend a consultation with a board certified plastic surgeon. You may also have diastasis seperation that needs repaired due to your pregnancies.