What surgery would smooth my back and remove my loose skin? (photo)

To smooth your back and remove loose skin, several surgical procedures could be considered, depending on the location and extent of the loose skin. Here are the most likely options:

1. Back Lift (Torsoplasty):

This surgery specifically targets the back area to remove excess skin and fat, leading to a smoother and more contoured appearance.  
There are different types of back lifts depending on whether the excess skin is primarily in the upper back (often called a "bra-line back lift"), lower back, or extends around the sides (sometimes part of an "extended body lift" or "circumferential body lift").  
Upper Back Lift: Addresses folds and fatty collections of skin in the mid to upper back, potentially extending to the sides or upper abdomen. The incision is often placed along the bra line to be inconspicuous.  
Lower Back Lift: Often combined with a tummy tuck, thigh lift, and/or liposuction to remove excess skin in the lower back and lift the outer thighs and buttocks, reducing the torso. The incision is typically low along the waistline.  
Extended or Circumferential Back Lift: This is a more comprehensive procedure that addresses loose skin around the entire torso, often as part of a post-massive weight loss surgery.  
2. Body Lift (Lower or Upper):

A body lift is a more extensive procedure designed to address loose skin in multiple areas.  
A lower body lift typically addresses the abdomen, hips, thighs, and buttocks, and can indirectly improve the contour of the lower back.  
An upper body lift can address the breasts, upper back, and arms.  
3. Tummy Tuck (Abdominoplasty):

While primarily focused on the abdomen, a tummy tuck can sometimes indirectly improve the appearance of the lower back by tightening the skin and underlying tissues of the torso.
An extended tummy tuck or a circumferential abdominoplasty (which goes around the sides to the back) would have a more significant impact on the back area.  
4. Liposuction:

If the issue is primarily excess fat with good skin elasticity, liposuction alone might be an option to contour the back. However, it doesn't remove loose skin. Liposuction is often combined with skin removal procedures to achieve the best results.  
5. Brachioplasty (Arm Lift):

In some cases, loose skin on the upper back near the armpits can be addressed as part of an extended brachioplasty, which removes excess skin and fat from the upper arms and can extend to the side of the chest and upper back.
How to Determine the Best Surgery for You:

The best way to determine which surgery is appropriate for your specific needs is to consult with a board-certified plastic surgeon. During your consultation, the surgeon will:

Evaluate the location and amount of your loose skin.
Assess your skin elasticity and overall health.
Discuss your goals and expectations.
Explain the different surgical options available.
Discuss the risks, benefits, and potential outcomes of each procedure.
Help you determine the most suitable procedure(s) to achieve your desired results.
It's crucial to have realistic expectations and understand that these surgeries will result in scars. The surgeon will aim to place incisions in inconspicuous areas as much as possible.

Thank you for your photographs. A circumferential tummy tuck, also known as a belt lipectomy, would remove the excess tissue from your trunk and is a very powerful operation for rejuvenating the entire trunk. It always gives the best results if patients are as close to their ideal body weight as possible at the time of their surgery. Even though the incision for the belt lipectomy does not include the creases on the back, in my experience, these creases get markedly better from just the belt lipectomy itself. It is possible to add a small amount of liposuction after you have healed up from the initial belt lipectomy in order to maximize your improved back contour. Check with your Plastic surgeon about your best options.