If I can tighten my tummy, and only able to "pinch a few inches" why do I still look this way? (Photo)

It looks like your muscle have split (diastasis recti) This causes the bowing of your lower abdomen. Tightening the skin and muscles can help to flatten you tummy. It sounds like your surgeon is on the right track. Good luck,DrT

Thank you for your question and photograph.  You need to understand that when your belly protrudes like that and you only have a small amount of loose skin there are other things causing your tummy to protrude forward.  The most likely cause is that there is normal fat wrapped around your intestine called mesenteric fat which can only be reduced by weight loss.If you have a tummy tuck now there is a very good chance that your tummy will still protrude therefore U will be well served to lose significant weight before having a tummy tuck.In addition if your tummy muscles are split due to pregnancy this can also contribute to the abdomen protruding.  The split muscles can be repaired during your tummy tuck which will significantly help this.  However the most important thing for you now is to lose weight with diet neck shows size until the protrusion is much less before considering tummy tuck.

I agree with your surgeon recommendation of tummy tuck and lipo to flanks will give you great result and flattening of the bulging abdomen area.