Should I get a 360 Tummy tuck or Fleur de Lis? (photos)

The indications for a Fleur De Lis or vertical abdominoplasty includes significant central abdominal skin excess not alleviated with downward traction (horizontal skin excess). A pre-existing vertical scar is also an indication. An FDL should be used very selectively and you have none of these indications.An FDL would add a central abdominal scar which is definitely noticeable. A 360 abdominoplasty could remove the abdominal excess tissue through a lower abdominal scar as well as lift the outer thighs and buttocks. A consultation would help to meet your goals with a specific type of abdominoplasty

Thank you for your question and congratulations on the weight loss.  Looking at your photos I would recommend a tummy tuck to be done with a little bit of liposuction on the flank and bra roll area.  This will allow your surgeon to start to contour the flank area and remove all the extra skin on the abdomen area.  You may need some additional liposuction down the line to contour it a little bit more.  A brachioplasty is a great option to remove the extra skin on the arms.  In regards to your breast without seeing what they look like is hard to determine if you just need a breast lift or an implant and lift.  You don't necessarily need to add an implant for size but for upper pole/ firmness and shape.  I would speak with your surgeon of choice and discuss your options.  Best of luck to you and again congratulations on the weight loss.    

Hello! Thank you for your question and pictures. I wouldn't recommend a Fleur de Lis on your case because of the long visible scar. I believe you would have great results if you get Liposuction, BBL and Tummy Tuck. You are in a healthy weight and seem to be a great candidate for a traditional Tummy Tuck. 

Most tummy tuck candidates have vertical excess (i.e. an abdominal roll). Some (often after massive weight loss), have transverse excess (i.e. upper abdominal midline excess). 
In much the same way a horizontal incision/excision can address the traditional lower abdominal roll, a vertical incision (or inverted T/Fleur de Lis) can address the transverse excess. There is a greater scar burden and candidates must decide for themselves if this improvement is worth it.
Anecdotally, most patients will do well with a standard transverse incision tummy tuck. The addition of a vertical scar is much less common and is most typically encountered in the massive weight loss population.
Based on your photos, you might benefit from a Fleur de lis/T abdominoplasty. However, there is no replacement for an in-person exam. The decision is simply a question of skin excess in the vertical and horizontal dimension.That being said, you may still need a posterior body lift. However, in my practice, these 2 procedures are staged both for healing and recovery concerns.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Verified Member
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You do not need 360 or fleur de lis.  If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement.  The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.  In terms of your breasts, I recommend a lift using The Bellesoma Method.  This will  reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.  I recommend you do the breast lift first otherwise the tummy tuck can pull the breasts lower making it more difficult to lift the breasts as high as possible.Best Wishes,Gary Horndeski, M.D.

Thank you for your inquiry and photos, congratulations on your weight loss! It is a bit hard to determine with photos if you are candidate for FDL, an in person consultation would be best, usually FDL is recommended for massive weight loss patients who have had bariatric surgery preformed, this also depends on your back skin, if there is excessive skin on back the FDL helps pull the back skin since lipo does not always work if its skin. I suggest seeking board certified plastic surgeons with experience to discuss details. Best of luck! 

Thank you for sharing your question and photographs.  It appears that you are an excellent full brachioplasty and breast lift candidate.  As for your torso, the best recommendation can only be made based on your expectations.  It appears that an extended TT should afford you an excellent improvement in contour, but if your buttocks need to have a lift, then a belt lipectomy may be a better option.  Hope this helps.

You will have to decide whether the vertical scar is worth the
improvement in smoothness and contour.  The fleur de lis TT is
for patients with extremely redundant abdominal skin after massive
weight loss or bariatric surgery. Often, candidates for the fleur de lis
have an abdominal region that is wider than the hips. In a fleur de
lis, excess skin and fatty tissue are removed and abdominal muscles can
be repaired through a standard TT incision as well as a vertical
incision in the center of the abdomen.  Stage the three procedures:  TT first; breast lift; then brachioplasty. Photos do not indicate that you need a FDL but I would need to verify in person.

Thank you for your question and photos. Based on these photos, I would advise against a fleur de lis tummy tuck. It is impossible to evaluate your buttock area, since it is covered up and without a physical examination it is not possible to tell how much sagging and looseness you have. That would determine if a buttock lift is needed or just fat augmentation for shaping and enhancement with your tummy tuck. You still have significant fat on your abdomen and rib cage which needs to be liposuctioned at the same time.See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Hello and thank you for your question.   First off, congratulations on the weight loss.  Although you would be best served with an in-person consultation, based on your photograph alone, I think you are very accurate with you assessment -- you would be a great candidate for an abdominoplasty (tummy tuck) WITH 360 liposuction.  I prefer to not perform FDLs because of the appearance of the midline scar.  The 360 liposuction of your torso will balance out the "tuck" you will get from your tummy tuck to provide a great result.  I routinely perform 360 liposuction with my tummy tucks, which includes liposuction of the flanks, hip roll, upper back, mid back, bra roll, and presacral triangle.  I find that this balances the entire trunk – both your back and your front.  Be sure to seek a consultation with a board-certified plastic surgeon who specializes in aesthetic plastic surgery and be sure he/she addresses all your concerns about an abdominoplasty and discusses the surgery details including the risks and benefits of the procedure, recovery time, and post-operative course.  In terms of the abdominoplasty details -- the necessary skin and fat is removed, the abdominal muscles are plicated (tightened), a small umbilical incision is made that is not externally visible (to give you an "innie" belly button), and a short, low waistline incision is designed to be easily hidden by your underwear or bikini.  Please view plenty of before-and-after pictures in real women (and not just computer-generated images) who have a similar abdominal appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.  And lastly, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For further information on tummy tucks, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS

Harvard-trained Board Certified Aesthetic Plastic Surgeon