Should I get a back lift or belt lipectomy? (Photo)

Hi Salz777, thank you for your question regarding getting a back lift or a "belt lipectomy".  First of all, lets talk about each procedure and its goals.  A "back lift" is also called a horizontal torsoplasty, upper body lift, bra strap lift, or bra straplasty.  During a back lift, an incision is made across the back in the bra strap line.  Dissection is made from the upper part of the back towards the buttock.  The back is then pulled towards the bra strap line.  A butterfly shaped of excess back skin and fat is removed.  Excess rolls of upper skin are removed.  Usually, the incision is hidden in the bra strap line.  The back lift is performed under general anesthesia and takes about 3 three to four hours to complete.  The back lift can be performed as an inpatient or outpatient basis.  A belt lipectomy is also called a lower body lift, 360 circumferential lower body lift, belt lipectomy, or belt dermo lipectomy.  Personally, I do not like the term "belt lipectomy" because it only describes removal of fat from the belt region.  During a 360 circumferential lower body lift, a incision is made all the way around your body.  Excess abdominal, hip, and buttock skin and fat are removed.  During the 360 circumferential lower body lift, on the front, dissection is made upwards to the rib cage and the abdomen is pulled down.  During the 360 circumferential lower body lift, on the back, dissection is made downwards to the bottom of the buttock and the buttock is pulled up. A 360 circumferential lower body lift takes about 6 to 8 hours to complete under general anesthesia.  A 360 circumferential lower body lift can be performed as an inpatient or outpatient basis.  
In regards to your back, a 360 circumferential lower body lift will not remove these bra strap or rolls of back fat.  Only a back lift, horizontal torsoplasty, upper body lift, bra strap lift, or bra straplasty will eliminate the rolls of bra strap fat.  Thank you for your questions regarding how to manage your back skin rolls and bra strap rolls.  I hope that I have answered your questions on how to manage your back.  
Before you make any decisions regarding a 360 circumferential lower body lift, back lift, horizontal torsoplasty, or brastraplasty, I would suggest you seek consultation with an expert in the field of reconstructive plastic surgery after massive weight loss. Please seek an experienced, board-certified, plastic surgeon.  Travel out of state if you must to find such an expert. If you have any more questions regarding a 360 circumferential lower body lift, horizontal torsoplasty, bra straplasty, back lift, or plastic surgery in general, please contact my office.  Sincerely, Dr. Katzen. ("Verified" by RealSelf, certified by the American Board of Plastic Surgery and member of the American Society Plastic Surgeons, International Society of Aesthetic Plastic Surgery, American Academy of Cosmetic Surgery, and Fellow of American College of Surgeons and American Board for Metabolic and Bariatric Surgery, Awardee: RealSelf 100.)

Hello, and thank you for your question and photos.
I would suggest a belt lipectomy / lower body lift to address your abdominal skin excess, and a back bra lift for the upper back concern. I would usually recommend that these be done separately.
A consultation with an appropriately qualified plastic surgeon will help determine the best path forward.
All the best,
Matthew

Thank you for your question.   Base in your pictures the most benefit  to your body will be obtain with a 360 LBL with a flour du Liz