I have a fleur-de-lis & medial thigh lift scheduled for Sep. I’m 28,185lbs & 5’9. Loss of 140lbs(325-heavest). I've maintained for 2years. I don’t mind a vertical scar… as long as it is worth the trade off. Also, I’ve been a smoker for years, but stopped July 23,2012 (7 weeks before appt.) in prep for this surgery. Also,with the thigh lift I only plan to have the scars extend 1/3 down my leg and have not seen many pics. of this. Links? Input, advice, suggestions?
Feur-de-lis TT or Almost the Same Results with a Regular Horizontal, Hip-to-hip Incision? (photo)
Doctor Answers 16
Fleur-de-lis abdominoplasty (tummy tuck) with thigh lift
It does not appear from your photos that you have enough horizontal laxity to warant the additional vertical scar of a fleur-de-lis procedure. Also I am hesitant to suggest that a thigh lift in conjunction with a tummy tuck is a good idea. My concerns are two-fold:
1) blood clots (deep vein thrombosis; DVT) can develope after any surgery and can travel to the lungs causing the serious complication of a pulmonary embolism. DVT's are most likely to occur with lower abdominal/pelvic surgery, especially when there is decreased mobility. If you have a full-blown tummy tuck AND a thigh lift you will have enough pain/discomfort that you may not be as mobile as you should be, increasing your risk of DVT.
2) it is always a good idea to try to combine procedures, but only when healing from each procedure does not increase risks. The basins for lymphatic drainage from the tummy and the thighs overlap in the groin area. My worry is that you will overwhelm your lympatic system and have too much swelling to allow for uncomplicated wound healing.
You are better off separating these procedures.
The addition of a vertical scar would be aimed at maximizing the tightening of the abdomen that requires it in multiple directions, horizontal as well as vertical. It appears that the standard lower abdominal incision may work sufficiently for you but be sure to question your surgeon on this specific point prior to your procedure. I hope this information is helpful.
Avoid Feur-de-lis tummy tuck
From your photographs, I recommend a transverse incision only, you do not need the vertical component. I recommend undergoing an abdominoplasty with mesh reinforcement. There are recent articles publishes in Plastic and Reconstructive Journal about this technique which results in weight loss and helps patients maintain the reduced weight. I would not do the thigh lift at the same time due to the prolonged duration of surgery.
Gary Horndeski, M.D.
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Fleur de Lys v/s standard abdominoplasty
With just pictures and not feeling the skin laxity it is difficult to make a final jugement. From the pictures alone a standard incision that would go from one hip to the other should do, but be prepared for a dog ear revision. It is not a complication but the surgeon with so much tissue and laxity is unable to have perfect measurements.
As far as the thigh lift If the whole thing can be done under 5 hours then OK with protection from DVT. If an overnight admission is required then the risk outweighs the benefits there will be no meaningfull cost saving at the price of a higher health risk and a more tired surgeon.
From your pictures that you have posted for us it does not look that you actually need a vertical scar to get great results. A typical Tummy tuck would give you good results as well and your able to hide the scar nicely since you are only 28 years old. i would make sure and talk to your PS and make sure you get all your questions answered.
Tummy tuck on a smoking patient not a good idea
I'm afraid that I am going to spoil your plans. MY NUMBER ONE CONCERN IS YOUR SAFETY. You have planned a very long and extensive operation and you admit to a long smoking history. Your risk of potential post-operative complications is very high including DVT (Deep Vein Thrombosis) and skin slough or death.
Smoking interferes with the blood supply to the abdominal flap and permanently damages small to medium blood vessels that keep the skin alive. Even if you stop smoking before surgery, the long term effects are still there. Then, if you have a "T" incision closure (Fleur-de-lis) the skin at the junction of the "T" closure is especially vulnerable to skin death. Your risk of skin death is exceptionally high!
The development of DVT is directly related to quantifiable risks that we can identify before the surgery. Some of those risks are age, smoking history, use of estrogen, length of surgery and mobility after the procedure. With your planned procedures, you are at a high risk of developing DVT and subsequently Pulmonary Embolism (PE). The most common cause of death after this procedure is from a PE (i.e. Dante West). I would recommend if you have this procedure performed that you maintain an anticoagulant chemoprophylaxis program after the surgery (i.e. coumadin, heparin, lovenox, xarelto) for 10-14 days.
I personally would NOT perform this procedure on you, I would decline because of the potential risks to your health.
Tummy Tuck and Thigh Lift--Limit Surgery & Increase Safety
When undergoing body contour surgery, assuring safety to prevent severe complications, such as blood clots in the legs or pelvis, is most important. That's why I would not choose to perform both a tummy tuck and thigh lift at the same time. Regarding the tummy tuck, a midline vertical incision is added only when the amount of looseness of the abdominal skin in a horizontal direction requires removal of skin to tighten skin side to side. More commonly, the tightening is done in a top to bottom direction just through a long horizontal incision above the public area. Even through this horizontal incision, the surgeon can tighten somewhat horizontally, so I would only choose the additional vertical incision if you and your surgeon feel it is warranted based on the degree of looseness. Both the tummy tuck and the thigh lift can create nice contours with acceptable scarring.
Benefits of Vertical Abdominoplasty Scar?
I see little benefit based on your photos of adding the vertical scar to your abdominoplasty. While some additional tightening is obtained with the vertical excision, I think the trade-off of the scar may not be worth it. Patients who benefit by the fleur-de-lis approach in my experience have a lot more extra skin and abdominal rolls than you do. As for the thigh lift, your pictures alone are not enough to comment on the value of the addition of the vertical inner thigh scar as opposed to just a horizontal scar only. The issue is the same as that in the abdomen...does the extra scar make a significant tightening and contouring difference?
Do I need a vertical tummy tuck scar?
One of the nice things about Tummy Tucks is that the scar is low and horizontal and relatively easy to hide with clothing. Once you add the vertical component, you can never hide that scar. So, I would not undergo a fleur-de-lis unless absolutely necessary. There are also increased problems with wound healing due to blood flow issues and in a smoker those problems are compounded.
In San Antonio, most of the patients we see do just fine with the traditional horizontal incision. In patients who have lost over 100 pounds I usually will perform a belt lipectomy or circumferential body lift to get the nicest results.
If you have any doubt, I would encourage you to see another Board Certified Plastic Surgeon for a second opinion.