Hi BettyPie om Indianapolis, Thank you for your question regarding whether a LBL and a FDL can be performed together. Thank you for your history and your pictures. Congratulations on your 162-pound weight loss! Great job. Let us clarify that LBL stands for lower body lift and FDL stands for fleur-de-lis abdominoplasty. Now let’s look at what the lower body lift (LBL) entails. The lower body lift entails a tummy tuck or abdominoplasty, abdominis rectus muscle plication, pubic or mons lift and reduction, hip lift and reduction, and buttock lift and reduction. A lower body lift results in an incision that goes 360° circumferentially around your body. Indeed, some plastic surgeons term the 360-degree circumferential lower body lift a belt lipectomy. This is because the incision goes around you like a belt. Now, let’s look at what the fleur-de-lis (FDL) includes. The fleur-de-lis abdominoplasty includes a horizontal abdominoplasty, a vertical abdominoplasty, abdominis rectus plication, and a pubic or mons lift and reduction. The fleur-de-lis abdominal plasty does not include a hip lift and reduction, nor a buttock lift and reduction. Therefore, when you combine the lower body lift and a fleur-de-lis, there is a lot of overlay. Including a fleur-de-lis to a lower body lift just adds the vertical component. The vertical incision extends from the top of the pubic region to the bottom of the sternum. The lower body lift and the fleur-de-lis are often performed together. This leads to a dramatic reconstruction of the anterior abdominal wall, especially after massive weight loss. In regards to the excess skin on your back, I would suggest a horizontal torsoplasty. I would suggest this be performed at a separate surgery after the lower body lift and fleur-de-lis abdominoplasty. A horizontal torsoplasty is also called a bra strap lift and is made with an incision that goes horizontally across your back. Typically, the incision is hidden under a bra. I hope that I helped to answer your question about whether a lower body lift (LBL) and a fleur-de-lis (FDL) can be performed together. Good luck. Sincerely, J. Timothy Katzen, MD, FASMBS, FICS, Plastic and Aesthetic Surgeon