Hello Ruth86, and thank you for your history and your pictures. Your best results would be achieved with a horizontal abdominoplasty (tummy tuck). During a tummy tuck, the rectus abdominis muscle is sutured together or plicated to flatten your abdominal profile. This is especially beneficial if your abdominal wall has weakened or stretched due to fluctuations in weight. Additionally, during a tummy tuck, the pubic region is lifted and reduced, and excess skin and fat are permanently removed. The belly button is also repositioned into a more natural and aesthetically pleasing location. Most plastic surgeons would recommend a tummy tuck over liposuction for you. With liposuction alone, you run the risk of skin rippling or irregularities post-operatively, as it does not address excess or loose skin. Liposuction can also lead to asymmetry if the skin and muscle underneath are not adequately addressed. A tummy tuck, on the other hand, provides a much more comprehensive solution by removing excess skin and fat while tightening the abdominal muscles to achieve a flatter and firmer abdomen. When tightening the rectus abdominis muscle, the muscle is brought together along the midline, inverted, and flattened. The rectus muscle is tightened from the sternum to the pubic region, resulting in a significantly flatter abdomen. This type of muscle repair is a key difference between a tummy tuck and liposuction, as liposuction does not address muscle laxity or loose skin. Based on your photos and history, a tummy tuck would yield far superior results compared to liposuction. A tummy tuck would not only flatten your abdomen but also provide a shapely, sculpted contour. When seeking surgery, it is essential to consult with an experienced, board-certified plastic surgeon who has performed hundreds of tummy tucks and can show you "before and after" pictures to give you confidence in their expertise. Good luck, and I hope I’ve helped answer your question regarding your options! Sincerely, Dr. Katzen