My insurance uses Interqual guidelines for a pannilectomy and this is the only criteria I am not sure I meet. It requires either 100+ lbs lost or a grade 2 pannus. I tried to look at reference photos but it seems they all show a belly hanging over the pubic area where as my whole entire area hangs due to what I believe a more severe dissectus recti. I have lost a out 75 lbs after the sleeve in '21
That would be considered a cosmetic abdominoplasty
Panniculectomy is the removal of the hanging skin ONLY. Does not include muscle repair, or relocation of the umbilicus.
You seem to need an abdominoplasty based on your question and pictures posted. Best to have a consult with a Board Certified Plastic Surgeon. Discuss your expectations and the surgeon can tell you what to expect based on your anatomy.
Congratulations on your weight loss. For the best result possible you would need the panniculectomy with repair of the diastasis and liposuction of the abdomen, flanks and back. You could have the operation now but your best result would be with quite a bit more weight loss first and the more you weigh, the lesser the results. Many surgeons will not perform this operation at your current weight. I think it is ok as long as you are aware of the limitations this could cause. Looking at your pictures, I think this would be a cosmetic operation that insurance is not going to cover. A panniculectomy alone has many shortcomings and many surgeons are just not going to do it.
From your given photos,I recommend you to do abdominal liposuction with Abdominoplasty with abdominal muscle repair and relocated new umbilicus.