Thank you for your question regarding what to do with your body after significant weight loss. Based on your pictures and your history, I would suggest at minimum an extended tummy tuck or even better, a 360 circumferential lower body lift. During an extended tummy tuck, an incision is made from one hip to the other hip. During an extended tummy tuck, the incision would start where the skin fold ends on your hips and goes to the other hip. During this procedure, the muscle is tightened, the pubic region is lifted and reduced, and the excess skin and fat of the abdominal wall is permanently removed. If your buttocks also bother you, I would suggest converting that extended tummy tuck into a 360 circumferential lower body lift. That would entail an incision that goes completely around your body and would not only flatten the abdomen, reduce and raise the hips, but it would also raise the buttocks and eliminate the wrinkles on the buttocks. Also, on the profile shot, I see roles of back fat. These are usually not able to be eliminated with a tummy tuck and would either require concentrated liposuction of that area or a torsoplasty. During a torsoplastly, an incision is made from the armpit down the side to eliminate those roles of fat in the love handle region. During a horizontal torsoplasty, an incision is made across the back and a butterfly shaped area skin and fat is removed and the back fat is permanently eliminated. I would separate the 360 body lift and the torsoplasty into two separate procedures because of blood supply issues. I hope this helps answer your question about what to do with your abdomen, hips, buttocks, and back. If you have any more questions regarding a tummy tuck, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy please contact my office. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research. Make sure they have performed at least 100 tummy tuck or circumferential lower body lift surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, tummy tuck or lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)