Concerns with my upper ab region. What are my options?

Dear karso,Thank you for your question. You look to be a good candidate for a tummy tuck. Your surgeon is correct, overaggressive liposuction of  the upper abdomen can cause necrosis of the skin. That being said, limited and judicious liposuction can be done safely during a tummy tuck. Flank liposuction is also safe, which based on your photos you would benefit from.Good luck,Nirmal R. Nathan, M.D.

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgeons
RealSelf Top Doctor and RealSelf Hall of Fame

A TT addresses both the loose skin and the lax abdominal wall as to give a nice, flat youthful contour to the abdomen.  The TT also creates a more youthful belly button and removes the c-section scar. All stretch marks will not be removed.
TT without muscle repair may make the recovery easier, but, if you have laxity in that area from any pregnancies, the result will be better with plication. In general, the muscles should be brought to anatomic norms. The smaller the separation, the less tightening required and probably the less discomfort. Swelling will occur irrespective of muscle repair, and almost every patient requiring a TT will benefit from the muscle repair.
Consult via Skype or in-office with a board certified plastic surgeon to determine the best treatment plan for you.
Best of Luck!