Do I need a fleur de lis tummy tuck? (Photo)

After 20 years of working with weight loss patients and co-authoring a book for patients on the subject, I have seen the FDL tummy tuck or body lift make a comeback.  The question is how well your upper abdominal laxity is going fit over your hips once the excess is gone. In some patients, this fixes the excess skin in the middle. Others have residual laxity.  Leaning forward will show how much of that excess is there.  If you want to show off your waist as much as possible and can accept the extended scar, an FDL might be your best option. You didn't mention this, but given your small frame and massive weight loss my guess is  lower body lift, not just a TT may be needed.  

Hello and thank you for your question. Congratulations on your weight loss! From your photos, it appears that you would benefit from an extended tummy tuck and be able to avoid the visible vertical scar of a FDL approach. Additional skin tightening can be achieved when the tummy tuck is combined with VASER (ultrasound) liposuction and radiofrequency skin tightening (J-plasma/Renuvion or Bodytite). I would advise you to see a board-certified plastic surgeon in consultation to determine the amount and location of your skin excess and discuss surgical options that best suit your needs and desires.
Best regards,
Dr. Zamani

Most tummy tuck candidates have vertical excess (i.e. an abdominal roll). Some (often after massive weight loss), have transverse excess (i.e. upper abdominal midline excess). 
In much the same way a horizontal incision/excision can address the traditional lower abdominal roll, a vertical incision (or inverted T/Fleur de Lis) can address the transverse excess. There is a greater scar burden and candidates must decide for themselves if this improvement is worth it.
Anecdotally, most patients will do well with a standard transverse incision tummy tuck. The addition of a vertical scar is much less common and is most typically encountered in the massive weight loss population.
Based on your photos, you might benefit from a Fleur de lis/T abdominoplasty. However, there is no replacement for an in-person exam. The decision is simply a question of skin excess in the vertical and horizontal dimension.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
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Thank you for your question and congratulations on the weight loss! That's an amazing amount of weight to lose.  Looking at your photos I would suggest a regular tummy tuck possibly an extended tummy tuck.  This will allow your surgeon to remove all the extra skin and tighten up the abdominal wall muscles that have loosened up during the weight loss.  I would suggest seeing a Board Certified Plastic Surgeon in person to evaluate you and discuss your options with you.  Best of luck to you and again congratulations on the weight loss.

I would consider doing a tummy tuck with the option of making an intra-operative decision on how much skin laxity you had in the vertical domain after setting your skin tension with the horizontal wound closure. I've done that a few times and I've been pleased with the result.

You will have to decide whether the vertical scar is worth the improvement in smoothness and contour. The FDL scar would not be hidden by bikinis or workout pants worn beneath the BB.