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

As opposed to everyone else, my answer is YES. Your question was 'to get the best flat stomach possible', and the answer to that is, by removing loose skin in both a horizontal and a vertical direction, you will have tighter flatter abdominal skin. Plastic surgeons love to tell patients what to think, and they especially love to tell patients 'you won't like the vertical scar'. I've done heaps of FDL's. Almost every patient *tells me* afterwards that they don't care about the vertical scar.
If your surgeon says you don't need an FDL, you just need to ask them how many have they done in the last 12 months. To get a fair dinkum opinion, you need to see a surgeon who actually regularly does both FDL and standard/extended etc.
Regards, Mark.

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.

Congratulations on losing the weight. That is amazing. After looking at your photos, I don't think it is an absolute that you get a fleur de lis tummy tuck. Most of the time to avoid the scaring centrally and extended tummy tuck can be done to remove the excess skin you have along with tightening the abdominal muscles. You have some skin along the waistline and extending the scar in the bikini line should remove most if not all of that as well. 

FDL adds a vertical scar for a large T and can jeopardize the lower skin healing.I usually perform traditional tummy tuck and allow settling of the skin and tissues for optimal healing. Then the results can be assessed if a second stage FDL is required or not.After massive weight loss, more than one body contouring procedure is common for best results.An exam and consultation with a plastic surgeon is recommended to confirm this as well as discuss your options and expectations. 

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.  

Definitely meet with a board certified (ASPS Member) plastic surgeon to be evaluated!You'll have a really nice transformation of your abdominal contour with an extended tummy tuck!It's unlikely that you'll benefit from a "fleur de lis" addition. But, an actual in person exam would be best to definitively answer that question. Best of luck to you!