Muscle repair is what makes it last
Pregnancy and weight change separate the vertical abdominal muscles (diastasis recti), which lets the abdomen bulge forward even in fit patients. Suturing that separation back to the midline is what produces a genuinely flat profile and often improves core support and posture.
Excess skin below the navel is then removed and the remaining skin redraped, usually with liposuction of the flanks to keep the waistline continuous.
