I believe you need a tummy tuck because you have too much skin and I think you have muscle separation as well that can be repaired with the hernia at the same time. (Vishnu Rumalla, MD, Dallas Plastic Surgeon)
Tummy tuck versus lipo
Based on the photographs that you provided, it appears that a tummy tuck would be (by far) your best option. I see many women who are confused about their options and don’t know if they will need a tummy tuck (abdominoplasty) or liposuction.
Obviously, most want to avoid the scar associated with a tummy tuck, but the final outcome is dependent on far more than the scar. In general, excess skin and fat together are best addressed with a tummy tuck, while excess fat only is best treated with liposuction.
In your case, you have had 3 children, have stretch marks (which suggests poor skin elasticity), excess skin and fat, loose skin, a previous C-sec scar, and an umbilical hernia. This is the situation in which a tummy tuck should be suggested.
The tummy tuck can remove the excess skin and fat, remove many of the stretch marks, tighten the abdominal muscles, and repair the hernia. Lipo to your flanks can be carried out in addition to your abdominoplasty, but I would not recommend liposuction alone based on the available information. Please realize that for me to give a definitive answer an examination would be required. (Eric T. Emerson, MD, FACS, Charlotte Plastic Surgeon)
Tummy Tuck, Lipo or Both?
When there is very loose skin in the abdomen, a tummy tuck is the better choice. Adding liposuction may be helpful to contour the trunk. (Karol A. Gutowski, MD, FACS, Chicago Plastic Surgeon)
Lipo does not tighten skin
This is a very common question. Today alone I have seen several ladies in consultation that come in asking should they get a tummy tuck or just liposuction.
Clearly nobody wants a large incision and scar if they do not need one however they also do not want the loose skin that can come from liposuction in a patient with preexisting stretch marks and loose skin. Pregnancies produce stretch marks. It is a sad fact but we do not have the technology to treat this skin with lasers or other magical devices quite yet.
I see patients who have gone and gotten laser, radiofrequency treatments, tried creams and potions, and even gone to some doctors who offer smartlipo(tm) as an option. The link below is a testimonial from a lady in your situation who went and got liposuction only to ultimately need a tummy tuck.
While I cannot give you medical advise on the internet just based on photos without a true exam I would be very cautious about considering this. (Evan Sorokin, MD, Cherry Hill Plastic Surgeon)
In my opinion, you will achieve a better result with an abdominoplasty that will remove the loose skin, some of the stretch marks, and allow repair of the hernia. In addition to liposuction giving you a poorer result, it can be dangerous to perform in patients with a known abdominal hernia due to the risk of intraabdominal organ injury. (Donald Griffin, MD, Nashville Plastic Surgeon)
It used to be that a tuck was the only option for a woman with a bulging tummy. Then lipo came along, and we could do a smaller procedure with virtually no scarring. However, people who have especially slack skin in their midsection need more than what lipo can offer.
Typical candidates for this surgery are women with drooping abdomens after pregnancy, women and men who’ve lost a great deal of weight, menopausal women, or older people with loose skin due to age. In the tummy tuck, the skin from the rib cage down to the pelvic area is tightened, and the navel is moved up and secured in a new position. (Michelle Copeland, MD, DMD, New York Plastic Surgeon)
Liposuction just will not give enough contraction of the abdominal skin and you may find that lipo alone may produce more skin laxity. The tummy tuck seems the best fit, especially if you expect the skin you are holding in your middle to be improved by your procedure. (Peter E. Johnson, MD, Chicago Plastic Surgeon)
it appears that a tummy tuck will give you the best result. The umbilical hernia may be repaired at the same time. As you have discovered, plastic surgery is not an exact science and the more opinions you seek, you may continue to receive different advice.
Based on your information and photographs, I would suggest: losing weight prior to surgery as this will benefit your final result, it appears that your excess weight is concentrated in the abdominal region and possibly inside the abdomen (under the muscles of the abdominal wall, although this can really only be determined by the physical examination), also losing weight preoperatively will decrease the recurrence rate of the umbilical hernia.
I would also recommend having the umbilical hernia repaired at the same surgical setting as the abdominoplasty. It does look like an abdominoplasty, combined with liposuction and hernia repair will be the best overall option for you. (Sean A. Simon, MD, Miami Plastic Surgeon)
Based on your pictures and young age, i think liposuction would be the better choice for you. You should ask your surgeon why a tummy tuck would be better. (Karol A. Gutowski, MD, FACS, Chicago Plastic Surgeon)
I believe you are an excellent candidate for liposuction because you do not appear to have a large skin excess and your rectus muscles are not separated because you have not had children.
Should I Have Liposuction or a Tummy Tuck?
From your pictures it seems that you have good skin quality without excess skin, some excess subcutaneous fat, and probably no muscle weakness (since you have not had pregnancies). You are an excellent candidate for liposuction.
If there was muscle weakness, stretch marks, or excess skin, then a tummy tuck is a better option. I would recommend SmartLipo in order to decrease bruising, enhance fat removal, and improve the skin contracture after the procedure. (Frank Agullo, MD, El Paso Plastic Surgeon)
There’ s nothing like an examination to confirm, but from your photos you should do great with lipo. Go get another consult. (Ronald Schuster, MD, Baltimore Plastic Surgeon)
Unfortunately, your pictures are dark and not adequate for precise evaluation. Based on your description however, I think a tummy talk would be overkill and premature. You may or may not be a good candidate for liposuction depending on your physical examination ( for example the quality of skin elasticity present). You may want to visit with a few more well experienced board-certified plastic surgeons if you are still considering surgical intervention. I hope this helps. (Tom J. Pousti, MD, FACS, San Diego Plastic Surgeon)
As you see all expert posters would use a type of lipo. I agree, I would use the Smart lipo TRIPLEX + lipo. (Darryl J. Blinski, MD, Miami Plastic Surgeon)
It is hard to be definitive without examining you but you appear to have good quaility skin without significant skin laxity, and you have not had children. Therefore I think liposuction alone would provide very satisfactory results in your situation. Remember that with a Tummy Tuck there is a tradeoff of a long scar which is acceptable if you have rolls of loose skin and a stretched out muscle wall, but that is not where you are at.
If you wanted to have a smaller waist, then you should consider some liposuction in the flank area as well. I have found that a combination of VASER (ultrasonic) liposuction in the flank area and a combination of VASER liposuction of the deep layer in the abdomen and LASER (SmartLipo) liposuction superficially, to maximize skin retraction, provides very nice results for someone with your body shape. (Braden Stridde, MD, Federal Way Plastic Surgeon)
Liposuction is best used in the treatment of excess fat whereas a tummy tuck addresses lax skin. These are different issues but can, at times be used, concurrently. Though your photos are dark and not of very good resolution, and combined with a history of no pregnancies and I’m guessing no massive weight gain and loss, then it appears your issue is more related to fat deposition rather than lax skin. Therefore, liposuction is probably the better choice. You should seek two or more additional opinions with reputable board certified plastic surgeons and then make your decision. (Steven Turkeltaub, MD, Scottsdale Plastic Surgeon)
The only one who can make a definitive recommendation is a plastic surgeon examining you personally, but in general tummy tucks are done after pregnancy. Liposuction removes fat but does not tighten skin very much (even with laser), so if your skin tone is good and the fat is localized to the abdominal area, lipo might be a good choice. Pregnancy often results in skin laxity with stretch marks and muscle separation, so the tummy tuck can address those issues better. (Richard Baxter, MD, Seattle Plastic Surgeon)
Tummy tuck or liposuction
Based on your age and your photos, I would think that liposuction alone should give you an excellent result. Your skin tone looks good and you do not have loose skin. The recovery is much easier and the only scars you will have will be a few 1/4 inch long marks that should not be very noticeable at all. (Jeffrey E. Kyllo, MD, Seattle Plastic Surgeon)