You have a skin overhang along with moderate diastasis. You will be best served with a tummy tuck along with the repair of your muscles and liposuction to your waist area.
Since your umbilicus is slightly higher in position compared to the average patient, there is a small chance that you may have to accept a small vertical scar as a trade off.
Usually, these heal well and a fade away with time looking like a faint stretch mark. (Maan Kattash, MD, FRCS, Los Angeles Plastic Surgeon)
I do see an occassional patient whose abdomen is board flat and there is no palpable diastasis and those patients do not benefit from muscle tightening.
It woud take an exam to determine your status in that regard. Even using a very low scar, I don’t find the need for a vertical scar except in about 5% of patients or less and that has been the case for many years since using the progressive advancement closure technique.
If you are not comfortable with the surgeon’s recommendations, don’t hesitate to get another 2-3 opinions. (Ronald V. DeMars, MD, Portland Plastic Surgeon)
After pregnancy seldom does a patient not benefit from abdominal wall tightening with and abdominoplasty. This makes convalescence a bit harder but it translates into a much better aesthetic result. (Vincent N. Zubowicz, MD, Atlanta Plastic Surgeon)
The one thing that cannot be determined from them is whether or not you need you muscles tightened. If you muscles are together, there is no point in doing the extra surgery. However, if you have had a pregnancy it is likely that your abdominal wall has been stretched.
The way to tell is to lay down and lift you head up like you are doing a crunch. Feel you stomach in the middle close to your belly button or umbilicus. If you feel a soft spot along the midline or you see a bulge in this area then your muscles are separated and a repair would help.
Most plastic surgeon will try to get their incisions as low as possible and use sutures that minimize scarring. There are a number if things that can be done if you get a bad scar but unfortunately, how you scar, is more about you genetics and skin tone than anything else. It does not appear that you would need to have a vertical component to your incision. Finally, recovery after an abdominoplasty does not have to be the ordeal that it used to be. With rapid recovery techniques, no drain tummy tucks and the use of Experal (the long lasting local anesthetic) an abdominoplasty recovery can be as soon as 24 hours. Yes, that even appies to patients who have their muscle repaired. You are not healed but most patients who have these protocols will be back to doing things like driving, shopping and even going out to dinner at 24 hours. (Brian Windle, MD, Kirkland Plastic Surgeon)
With pregnancies the rectus muscles get stretched, pushed forward on a curve and distracted to the sides. After the pregnancy the abdominal wall tries to reshape itself however a few things happen.
1) The belly wall skin gets stretched and damaged
2) The collagen and elastic fibers are torn and become weak (stretch marks)
3) Belly button is typically distorted
4) Rectus muscles stay separated (rectus diastasis)
5) Oblique muscles can be stretched and weakened.
6) Subcutaneous fat looses its quality and with poor skin the abdomen gets a “bread dough feel”
7) Hernias can show, not oftenAs a result of all or some of the above, to do an abdominoplasty with managing the muscles, hernias etc. is like getting a horse to the watering trough and getting a full drink.
These are general comments and need to be addressed with your operating Plastic Surgeon as he / she can see and feel your belly in three-dimensions. (Stephen M. Davis, MD, FACS, Nashville Plastic Surgeon)
If you want the very best results, then you will need muscle tightening. I always do a lot of VASER liposuction of the whole back, waist, hips and sometimes thighs and arms with my tummy tucks. I believe in improving and rejuvenating the person’s midsection all the way around for the best results. Will you have a small vertical scar in the lower abdomen?
I do not know, but that can be decided during a physical examination. You get a clean minimal scar based on the surgeon’s closure technique, your ability to heal and not being a smoker. If you are not sure about your advise, seek another opinion from board certified plastic surgeon. (George Marosan, MD, Bellevue Plastic Surgeon)
Very rarely (less than 1% IMO) of tummy tucks need no muscle tightening especially if you have been pregnant. The muscle component does add discomfort and a little extra recovery but restores the muscles to their tight prepregnancy tone. From there, you can even make them better with exercise. (Richard P. Rand, MD, FACS, Seattle Plastic Surgeon)
I find that most patients benefit from muscle tightening at the time of the abdominoplasty. It is also a very easy procedure to perform with the exposure of a full tummy tuck. which you appear to need by your pics. Make certain that your doctor is a plastic surgeon. At least in my Nashville, that technique that you describe has become popular among non-plastic surgeons performing these cases under local with extremely disappointing results. Take care and good luck. (Shayne Webb, MD, Nashville Plastic Surgeon)