You are in great shape. You have no excess skin or fat but have a lot of laxity to your rectus muscles. You also have a bellybutton hernia. I would recommend fixing this through a very low incision hidden in your bikini line. The hernia could be fixed at the same time and could even be covered by insurance.
Plication of the abdominal wall musculature can improve the appearance of the abdomen.
Kenneth Hughes, MD
Los Angeles, CA
Thank you for your question and photos.You do have a wide separation of your rectus muscles and the lateral border of the muscle is too lateral due to this as well. That is why you do not have much if any waistline. Yes, it is possible that you have a hernia, but it is difficult to tell without an in person examination. To make the abdomen flat, you will need an abdominoplasty with an umbilical float (you do not have enough skin for an umbilical transposition). I would also suggest liposuction of the hips/waist to improve the back curvature and waistline. The abdominoplasty in your case can be done via a short supra pubic incision only and a small incision in the belly button. The whole muscle needs to be tightened from the breast bone to the pubic bone. See a board certified plastic surgeon for an in person evaluation, examination. Good luck.
You have little fat in the abdoment due to your exercise program but there is considerable laxity to the skin and a significant diastasis of the muscles. An abdominoplasty can fix that to some degree and make your abdomen flattER, but not flat. Look at your side photos and what a curve you have to your lower back. A "flat" abdomen will mirror that curve.