Hello, and thank you for your question regarding being 5'7" and weighing 190 pounds, considering a tummy tuck, and specifically wondering if you need to lose more weight first, and whether you can expect a flat stomach after a tummy tuck. Thank you for your history and your pictures. At 5'7" and 190 pounds, your BMI is 29. Even though your BMI is less than 30, most plastic surgeons would agree that it would be best if you lost more weight. By losing weight, you will lose both subcutaneous (under the skin) and visceral (under the muscle) fat. The more fat you can lose, the better your tummy tuck results. Most plastic surgeons suggest you eat a high-protein diet with minimal carbs and low sugar. It is recommended to exercise for at least an hour a day. If these are too difficult to do, consider taking a GLP-1 medication to help with further weight loss. In your case, most plastic surgeons suggest at least a 10- to 15-pound further weight loss. This will help to reduce your visceral fat significantly and will keep your tummy from bulging. Currently, your abdomen bulges on profile due to too much visceral fat. During a tummy tuck or abdominoplasty, three anatomic areas are repaired. The rectus abdominis muscle is repaired, excess abdominal skin is removed, and excess abdominal fat is removed. If, however, the rectus abdominis muscle is being distended by visceral fat, the muscle can only be repaired to a certain extent. Even though the skin and fat are pulled tightly over the rectus muscle, the abdomen may still be distended due to the presence of visceral fat pushing the rectus abdominis muscle outward. Therefore, in your case, it would be best to lose as much visceral fat as possible, undergo rectus abdominis plication to achieve a flat tummy on profile, and then the skin and fat can be redraped. This would yield the best results. Therefore, it would be best to lose more weight before your tummy tuck and lipo flank and back surgery. Good luck. I hope I’ve answered your question regarding whether you need to lose more weight first and whether you can expect a flat stomach after a tummy tuck, considering you are 5'7" and weigh 190 pounds. Good luck. Most plastic surgeons offer complimentary virtual or in-person consultations. Therefore, explore what other plastic surgeons have to say. If you have any further questions about a tummy tuck, please consult an experienced plastic surgeon. Please consult an experienced, board-certified plastic surgeon with a proven track record of performing tummy tucks. Ensure they have performed numerous tummy tuck surgeries and have before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. If you cannot find an experienced plastic surgeon in your area, consider traveling to another state. Sincerely, Dr. Katzen. (Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)