We live in a society that has rather large midriffs. There are two basic reasons for this: fat and a relaxed abdominal wall. The fat is located not only on the outside of the belly wall which can be treated with liposuction, but it is also found on the inside of the tummy wall where the intestines are located. This depository of fat can only be reduced by exercise and diet. The other scenario for a protruding abdomen is the relaxation of the muscular wall. In women, this often exists from the belly button downward and is usually attributable to pregnancies. In men, it is found from the belly button upwards and exists when the six-pack muscles separate either from over exertion and/or a rather large collection of inward fat. This deformity is often worse after a large meal when the belly is even more protrusive because the muscular wall is not strong enough to hold the stomach in after having been filled. The surgical redress for these issues are either liposuction, abdominoplasty (tummy tuck) and /or both. In my practice, I prefer to liposuction the fat from around the abdomen and flanks followed several months later with an abdominoplasty where the stretched tissues are put back together. Regardless, the goal for either gender is a smaller waist and a flatter tummy. When indicated, staging the procedures by removing the fat first with liposuction and tightening the abdominal wall and skin later gives the very best results.