Is It Common for Belt Lipectomy with Fleur De Lys Abdominoplasty?

To truly answer this I would need to examine you.  The first consideration for you is whether you trust your surgeon.  If you do then they may be offering you good advice.  Many very experienced surgeons use this technique.

I would rarely suggest the Fleur-de-lis to my patients.  The time I would consider it is if vertical scar (laparotomy incision) is already present from other surgeries.  If that is not the case I would typically advise patients to have a circumferential body lift instead of the Fleur-de-lis.  My strong personal preference is slightly less tight contouring but a scar hidden in your bikini.  That being said if you may have too much excess skin your surgeon may be correct.  At the end of the day it is a personal choice that you must make:  tighter contour and visible scar or slightly looser but hidden scars.

Also, with significant weight loss people often have loose skin in the buttock, lateral thigh, and back.  This is corrected with the circumferential lift.Dr Rodger ShorttPlastic Surgeon Oakville

    I would get several opinions on the need for the vertical scar.  I think that I would ask the surgeon about the experience with performing all of those procedures together.  Kenneth Hughes, MD Los Angeles, CA

It sure is confusing, trying to figure out what's going to give the best result, what is safe, and which surgeon to use.  Is a fleur-de-lis tummy tuck common when doing a belt lipectomy?  Not really, but that doesn't mean that it's uncommon either.   Sometimes adding the vertical incision (and resulting scar) adds quite a bit to the result on the abdomen.  Try this:  with your left hand, pinch as much of the loose skin as you can between your belly button and your pubic area together.  While doing that, with your right hand pinch, in a side-to-side manner, as much skin together as you can just above your belly button.  If you're able to pinch quite a bit of skin together with your right hand while doing this maneuver, a fleur-de-lis might improve your result.  A fleur-de-lis does add some time to the surgery and probably increases the risk of problems healing the incision, but the benefit might be impressive.  That's why visiting with reputable surgeons is important.  You will certainly receive different opinions as to what is likely to create the best result.  Make sure to ask lots of questions during your visits.  Ultimately it's your choice.  The benefits versus the risks.  The fleur-de-lis can create some substantial improvements in the results, but they're a little more involved.  Common with a belt lipectomy?  Not exactly, but it may enhance the result tremendously in an appropriate patient.

The horizantal scar in the abdominoplasty is indicated whaen there is lots of excess skin horizantally. the verical scar removes excess skin in the vertical direction and gives more definition to the waist in those with excess skin verical.

Extending the tummy tuck to the back tighten the back and the buttoc is lifted.

Cobining these procedures is too much surgery and the risks of blood clots and healing problems can be increased. Recovery is more difficult and also you want the surgeon to take time to do the best that can be achievedand not hurry through the surgery.

I would not personally recommend that combination for one setting. Among other reasons, the fleur-de-lis will tighten the back to a large extent, and you may not require more back tightening. 

Without photos, I can't comment on the choice of procedures, but with the amount of weight loss you have had, it would not be a surprise if that were an excellent option. 

All the best.