Best option? TT, floating abdominoplasty or reverse TT? (Photo)

Hello and thank you for your question. From the pictures you have provided, you have a minimal to moderate amount of excess subcutaneous fat and skin present diffusely throughout your lower abdomen and periumbilical region (around the belly button). There is minimal flank adiposity (excess skin/fat), and no significant upper abdomen adiposity. Based on all this, you would benefit from a traditional abdominoplasty (tummy tuck) to help improve your abdominal/trunk contour. There is always a possibility you might have a residual vertical scar (from the cutout of your current belly button) if it is determined in the surgery that there is not enough tissue to resect. This may or may not be connected to the main horizontal tummy tuck scar. Of course, we surgeons always try to remove enough skin in the operating room to prevent this vertical scar, if it is safe to do so. Some surgeons pull things tighter than others, but the downside of pulling things too tight and resecting too much skin during this procedure is there can be too much tension on the horizontal wound- meaning they might not be able to get things closed in the operating room, or if they do, the wound will be under too much tension which can significantly increase the risk of wound healing complications (wound breakdown, dehiscence, infection, widened or unattractive scars). Weighing these potential risks against the risk of a small vertical scar which almost always heals uneventfully and is minimally noticeable, I'm sure you'd agree that the small vertical scar is worth it. Regarding the transverse lower abdominal scar, it should be well hidden within your bikini or underwear, and if you adhere to proper scar care and sun avoidance after surgery, it (and any potential vertical scar) should eventually heal to be minimally noticeable.
Because your issue is predominantly skin and fat excess to the lower/mid abdomen, none of the other options you listed would adequately address this and provide you with a good aesthetic result.
Regarding a reverse abdominoplasty (reverse tummy tuck)- this procedure places the incision across your upper abdomen along both inframammary folds and connecting the two. It is beneficial for patients who have little to no lower abdomen and periumbilical adiposity, and whose main issue is focal excess skin and especially subcutaneous fat in the upper abdomen, just below their ribs. It is great if combined with a breast procedure, to help minimize the scars. But unfortunately, your abdominal concerns are located too low for this to even be a reasonable option for you.
Regarding a "floating-abdominoplasty"- it is essentially the same procedure as a standard/traditional tummy tuck. In this procedure, the stalk of the umbilicus (belly button) is cut and the whole slab of abdominal skin, fat, and belly button is pulled down as a single unit with excess skin and fat resected at the bottom and sutured closed. This differs from a standard tummy tuck only in that the belly button is "floated" down with the rest of the tissue, whereas in a standard tummy tuck, it is translocated- a hole is cut in the abdominal skin at the ideal location and the belly button is brought out and sutured into this new location. A "floating tummy tuck" is generally only an option in patients that have a notably long torso and a belly button which is positioned higher than normal, since the procedure brings down the belly button- otherwise in a patient with a normally located belly button or normal torso, these operations make the belly button look too low which looks VERY weird. Given your goals and current appearance, I feel this would not give you as pleasing of a result as a traditional tummy tuck.
Liposuction is a great adjunct which could provide some additional benefit, particularly to the contour of your flanks, and can be done at the same time as your tummy tuck procedure for the best possible single operation results.
With all that said, it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from any photos and descriptions provided. It sounds like you have already seen multiple plastic surgeons for evaluation, so ultimately you should choose a surgeon who you trust, feel comfortable with, and who you feel can deliver the best results that align with your individual goals. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Dear dreambigorwhybother,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery