Do I need a tummy tuck? Or what can be done about stomach loose skin? (Photo)

Your photos suggest you would achieve the best outcome with a tummy tuck. It is possible that you could achieve an acceptable improvement with liposuction and one of the skin tightening devices. To confirm this would require a physical examination of your tissues. Seek a consultation with a board-certified plastic surgeon for a definitive answer to your question.

Hello and thank you for your question. First off, congratulations on losing all that weight, that's definitely a big accomplishment! From the pictures you have provided, it is honestly difficult to make out the details of your abdomen well enough to advise you one way or the other. All I can tell is you have some excess subcutaneous fat and skin diffusely throughout your abdomen and flanks.
In general, after patients lose a significant amount of weight (as in your case), their skin is not able to fully stretch and recoil properly, and therefore usually does not fully contract with just liposuction alone (without resecting any of the excess skin)- that tends to produce a very deflated appearance and ultimately requires another procedure to resect the excess skin and tighten the overall contour. This is why those patients usually benefit from an abdominoplasty (tummy tuck) and usually also liposuction of the flanks to best help improve their abdominal/trunk contour.
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. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon