When the abdomen has sagging skin due to weight gain and subsequent loss, or because of a large deposit of fat leading to associated sagging of the skin, it is essential to perform a procedure that involves removing the excess skin to achieve a flat abdomen. Liposuction will not provide this result, as it can worsen the flaccidity, especially if the patient has stretch marks indicating that the skin has lost its ability to retract.

If the sagging skin is both above and below the belly button, a full abdominoplasty is necessary. This procedure involves creating a scar around the belly button and another at the level of the groin crease and above the pubic area (which will be covered by underwear). However, if the sagging is only below the belly button, a mini-abdominoplasty can be performed, resulting in a scar above the pubic area similar to that of a cesarean section. The length of the scar will depend on the amount of skin to be removed due to the degree of skin sagging. This procedure offers the advantage of potentially removing most, if not all, of the stretch marks present on the patient's skin by surgically removing the loose skin.

Apart from removing excess skin, the surgeon will also tighten the abdominal muscles that have separated due to pregnancy or poor muscle tone (diastasis). This procedure may be combined with liposculpture to shape other body areas, such as the waist and back, and create a harmonious body contour.