Loose tummy skin
I think you might be able to get away with a mini-abdominoplasty if your main concern is the skin excess in the lower abdomen.
If you really want to get it flat, that would be a full tummy tuck (and you would have to quit smoking for 6 weeks before) (Frederick G. Weniger, MD, FACS, Hilton Head Island Plastic Surgeon)
I think you would be a good candidate for a tummy tuck. This would accomplish two goals.
First, it would remove excess skin and give you a tighter, flatter stomach.
The longer the incision, the more skin can be removed. Generally, with a full tummy tuck stretch mark, any skin from the belly button to the pubic area (including any stretch marks in this area) is removed. Second, a full tummy tuck would allow your stomach muscles to be tightened. Your pictures demonstrate a protruding abdomen which would result from weakness between your stomach muscles. The can be tightened during a tummy tuck stretch mark which would also contribute to a flatter stomach. The trade-off would be a scar across the lower portion of your abdomen.
You need to determine if you would rather have loose skin and a protruding abdomen or a scar. If you are considering this surgery, I would also STRONGLY suggest that you quit smoking ASAP. Smokers not only tend to have more discomfort following surgery but they also have a higher risk of complications. (Edwin C. Pound, III, MD, Atlanta Plastic Surgeon)
Doing so will accomplish the following:remove some of the skin that has stretch marks, thereby having the remaining stretch marks lower down on your abdomentighten the abdominal wallrejuvenate the belly buttonThe before and after photo link below shows what a full tummy tuck can accomplish in a similar built individual. (Remus Repta, MD, Scottsdale Plastic Surgeon)
A tummy tuck will help obtain a flatter belly with tighter skin. However, it will not eliminate most of the stretch marks, especially those on thehips. Althought some surgeons will perform surgery on patients who smoke, most surgeons will make patients stop smoking and using all forms of nicotine for at least two weeks prior and 4-6 weeks after surgery because of the significantly increased risk of complications. (Nicholas Tarola, MD, Nashville Plastic Surgeon)
Do you need a tummy tuck stretch mark?
It is difficult to make an evaluation from your photographs. It certainly does look like you have significant laxity of your muscles. (Ira H. Rex lll, MD, Fall River Plastic Surgeon)
Tummy tuck in smokers
Sorry to hear about your stretch marks. You are an excellent candidate for a tummy tuck (and possibly a mini-tuck) and should get a great result. Though the surgery would give you a flat belly, it would not really change the appearance of the stretch marks to any significant degree. There are some non-invasive technologies that could help. Though I have always recommended that people stop smoking before procedures such as tummy tucks, it would not prohibit you from having surgery as long as you accept the fact that your risk of complications is higher. (Victor Ferrari, MD, FACS, Charlotte Plastic Surgeon)
Best option for abdomen
First off, there is no cure for stretch marks. You may be able to make some mild improvement in them with chemical peels, laser treatments or micro-needling treatments. If you are willing and able to quit smoking for at least three weeks before and after surgery, you may be a candidate for an abdominoplasty (tummy tuck stretch mark) which allow you to get rid of, by cutting them out, some of your stretch marks as well as tighten up you abdominal wall muscles to give you a flat stomach, if this is your goal, rather the pouchy appearance seen in you photos. You should consult with an American Board of Plastic Surgery certified plastic surgeon to discuss your concerns, goals and options. (Todd C. Case, MD, Tucson Plastic Surgeon)