This patient was very bothered by her protruding abdomen after a c-section for large twin baby girls. She had significant weigh gain during the pregnancy and after working out diligently with a personal trainer for 2 years. She achieved some reduction, but ended up with very loose skin. Her goal was to have a more shapely figure and a very flat abdomen. Dr. Feng performed tumescent liposuction of the hips and back to improve the contour of the trunk. She then performed intercostal blocks prior to starting the abdominoplasty and repairing the large tear in the diastasis recti. She anchored the subcutaneous tissue down to the muscle layer using progressive tension sutures to achieve a better definition of the abdomen and to avoid the use of drains. The after photos are 14 months post-op.