What is the best procedure to get rid of the fat I have so I can finally have a flat stomach again?
No amount of exercising will ever tighten up excess skin especially skin with stretch marks. I believe that liposuction alone will cause the exact problems that you are worried about, namely more loose saggy skin. In your photos, it looks like your biggest problem is really the skin laxity. You are a perfect candidate for a full tummy tuck procedure. (Donald Griffin, MD, Nashville Plastic Surgeon)
Liposuction is an option but may not be happy if you get loose skin (but can do a tummy tuck later). For a better result, a lipoabdominoplasty can be considered. (Karol A. Gutowski, MD, FACS, Chicago Plastic Surgeon)
Liposuction or full tummy tuck procedure?
Unfortunately, work in the gym and even further weight loss will not improve the quality of your post-baby abdominal skin. The best answer to obtain a flat tummy is to have full tummy tuck procedure. With this surgery, the extra skin and stretch marks of the lower abdomen are removed and the muscles are tightened to restore your shapely figure.
You will be pleased to know that abdominoplasty surgery has been revolutionized within the past few years by using the Progressive Tension Suture technique (no drain tubes) and EXPAREL. EXPAREL is an injectable numbing medicine we inject into the muscles and incisions at the time of surgery.
Our patients who have had EXPAREL on average require 50-60% fewer narcotic pain relievers and are up and about much more quickly. Please obtain consultation with an experienced board certified plastic surgeon (or two) to leatn your options. (Kevin L. Smith, MD, FACS, Charlotte Plastic Surgeon)
Best procedure to have a flat stomach again?
From pictures and description, it looks like you would be a great candidate for a mini tummy tuck. Whether or not the muscle is tightened with the procedure, it appears that you would benefit from removing some of the loose skin from the lower abdomen.
Exercise, while important for maintaining your results long term and overall good health, will not shrink excess skin and it won’t tighten muscles that have been overstretched by childbearing. Only a full tummy tuck procedure can do that. Your best bet is to consult with an experienced Plastic Surgeon who can deliver the results you desire. (Ruth Celestin, MD, Atlanta Plastic Surgeon)
Based on your photos, my recommendation would be a standard tummy tuck with liposuction of the waist/hip area. The recovery is certainly longer than liposuction, but I think a tummy tuck would deliver a better result overall. (Scott C. Sattler, MD, FACS, Seattle Plastic Surgeon)
Full tummy tuck procedure
There are a variety of procedures including liposuction alone or tummy tuck variations that can produce a good cosmetic result in the appropriate patient: a mini tummy tuck, a modified with an umbilical float, or a variety of a full abdominoplasty procedure.
All of the tummy tucks may, or may not, include tightening of the muscle and liposuction of selective areas. Generally if there is significant loose skin, a tummy tuck will result in a greater correction and better outcome. Liposuction, no matter which type, will not correct significant skin laxity, nor will it improve the weakness of the abdominal muscles which usually stretch out and lose tone from pregnancy.
Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on limited two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest.
I would suggest another opinion from a plastic surgeon who is certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.Robert Singer, MD FACSLa Jolla, California (Robert Singer, MD, La Jolla Plastic Surgeon)
Based on your pictures only, my first thought would be that a tummy tuck would give you the best result. It would remove the excess skin, remove the stretch marks below your belly button, and allow the surgeon to tighten any looseness between your stomach muscles. The trade-off would be a scar across the lower portion of your abdomen. My second option would be liposuction using SlimLipo or SmartLipo.
The liposuction would remove the excess fat while the laser (SlimLipo or SmartLipo) would help tighten up your skin. This is important because the stretch marks compromise your normal skin elasticity.
If you didn’t have the stretch marks then I might think that you could get away without using the laser. Skin won’t tighten up with exercise. There is no muscle in skin to tighten. The other downside to this second option is that you could not tighten up the connection between your stomach muscles. (Edwin C. Pound, III, MD, Atlanta Plastic Surgeon)