Excess Skin Removal After Massive Weight Loss; LBL or Fleur-de Lis Abdominoplasty? (photo)

You definitely need to have a combination of procedures performed, but safety and operative time must be considered first. I would recommend the extended abdominoplasty with vertical incision (Fleur-de Lis) and liposuction to the flanks.  You will need to recover from this for 6 months then return to the operating room for the posterior body lift and butt lift. Some patient also add the Brachioplasty (arm lift) at that time as well.

 You deserve plenty of praise for your hard work and major weight loss. This is quite an accomplishment and you will be so much healthier now.  Eat well and get plenty of healthy protein and vitamins in your diet before surgery.  Good luck.

Congratulations on the weight loss.

Without having seen you or knowing too much about your personal health, I would be inclined not to do a full lower body lift and vertical excision at one setting, due you concerns for safety.

The options then would be a first stage fleur-de-lis TT, followed by posterior LBL, or, a full LBL, followed by the vertical resection.

I would favor the later choice, since I am quite certain that if you did the fleur-de-lis first you would absolutely feel the need for the posterior LBL after. But if you did the full LBL you might find that there was enough correction that the vertical TT doesn't add enough to do another procedure. 

Someone who has actually examined you has a better framework from which to make recommendations.

Thanks for the question, and for the photos. Best wishes.