Hello Loving334869, thank you for your question regarding whether to opt for an FDL or reverse tummy tuck. First of all, congratulations on your incredible weight loss! Losing 250+ pounds is a remarkable achievement, and you should be very proud of your journey. Based on the amount of excess skin you have, I would recommend a Fleur de Lis (FDL) tummy tuck or even a circumferential body lift if your buttocks and hips bother you. Fleur de Lis (FDL) Tummy Tuck The FDL tummy tuck involves both a vertical and horizontal incision, which allows for the removal of excess skin and fat from the upper and lower abdomen. This procedure is particularly effective for patients who have experienced massive weight loss, as it provides significant skin tightening and contouring, especially in the midsection. Circumferential Body Lift A circumferential body lift, also known as a 360 body lift, addresses excess skin and fat around the entire torso. This procedure not only tightens the abdomen but also lifts the buttocks and outer thighs. It's an excellent option if you have concerns about your buttocks and hips in addition to your abdomen. Reverse Tummy Tuck A reverse tummy tuck primarily addresses excess skin in the upper abdomen and is less comprehensive compared to the FDL or circumferential body lift. Given your significant weight loss, a reverse tummy tuck may not provide the extensive skin removal and contouring you need. In summary, considering the amount of excess skin you have, I believe you would benefit most from an FDL tummy tuck or a circumferential body lift. These procedures will help you achieve a more contoured and aesthetically pleasing result. Good luck, and I hope this helps you make an informed decision about your surgery. Sincerely, J. Timothy Katzen, MD, FASMBS, FICS Plastic Surgeon