Do I need a FDL, 360TT, or combined? (photo)

Question

Hi! I’ve consulted with multiple surgeons and I have had all three suggested to me of what it is I need. I’m bringing it the surgeons of RealSelf, what would YOU say I need? :)

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding "Which type of tummy tuck will you need?"  Thank you for your pictures and your history.  In analyzing your pictures, you have excess skin and fat on the abdomen, hips, and buttocks.  You need an extended tummy tuck to resect your abdomen's excess skin and fat and repair the six-pack muscle.  The tummy tuck establishes the belly button and lifts and reduces the mons or pubic region.  You do not need a Fleure-de-lis or FDL incision.  Your best results would be obtained with a 360 circumferential lower body lift.  This procedure would include an abdominoplasty (tummy tuck), hip lift and reduction, and buttock lift and reduction.  This would treat your buttocks and hips very well.  If you decide to undergo liposuction of your love handles and your lower back, you could be left with some residual skin because of your weight loss, history, and age.  Also, your skin quality shows stretch marks, indicating poor healing after isolated liposuction.  I would suggest a horizontal torsoplasty or a bra strap plasty for the upper back.  An incision is made across her back during the surgery, and excess back skin and fat are removed.  A large area in the shape of a butterfly is removed from the upper back.  Ideally, the scar is hidden under a bra strap.  The horizontal torsoplasty can be combined with an extended tummy tuck or a 360 circumferential lower body lift.  Good luck.   Thank you for your great question regarding "Which type of tummy tuck will you need?"
Sincerely, Dr. Katzen, MD, MBA.  (Plastic Surgeon, President of  the American Society of Bariatric 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, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

You would benefit from an abdominoplasty, and for the tightest result and best defined waistline a fleur de lys would be best - the trade off is an additional scar running vertically including above your umbilicus. It is difficult to assess your lower back based on the photos, but you may benefit from excision of tissue from the lower back in addition.

Ira H. Rex III, MD · Answer

The answer to this question fully depends on your expectations.  I think it would be straightforward in a consultation for the doctor to give you an idea what to expect with a circumferential body lift versus a fleur-de-lis, but certainly making your decision is not straightforward.  It all depends on what you are looking for and what trade-offs you are willing to make.  Good luck with your decision!

Daniel Barrett, MD · Answer

Dear yhhse,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Joel Patrick Maier, MD · Answer

You will definitely benefit from a circumferential body lift with significant rejuvenation of you’re midsection. In situations where there is massive weight loss, it makes sense to commit to a FDL with a midline scar; if not, there can be creasing due to the unaddressed vertical lskin laxity. Having said that. If you do not want to commit to a midline scar, you may be fine with the circumferential lift and stage a vertical skin excision if you are not happy. Another important issue is diastasis; if you do not have muscle have diastasis, then you can have this all done with local anesthesia, no drains and a much less involved recovery with less risk across the board. I hope this helps and thank you for inquiring.

Ramin Behmand, MD, FACS · Answer

Based on your photos, you’re a good candidate for either an extended tummy tuck or a circumferential tummy tuck, especially if you'd like to address the back as well. In the photos, I can see that the most significant excess skin appears to be in the lower area, below the belly button—all of that would be removed through a standard tummy tuck incision.

I don’t see a compelling reason to opt for a fleur-de-lis approach—the vertical midline scar it leaves is permanent and difficult to conceal. If you're going through the effort of surgery, it’s likely because you want to feel confident wearing clothing and swimwear that shows your stomach—not something you'd want to keep hidden.

-Dr.B.

Luis Suarez, MD · Answer

Thank you for your question!
Seeing your pictures, I do believe that the best option for you would be a lower body lift or also known as circular tummy tuck combined with the Fleur de Lis Incision, this will not only remove excess skin from the upper abdomen, but it will also further improve and even more your waist. I think this is the best option for you for the best outcome!

Gary M. Horndeski, MD · Answer

The reason people need a fleur de lis is they have excess horizontal width of the upper abdomen above the umbilicus. You do not have that and your horizontal width is within a normal range. I would begin with your breasts. The reason I would begin with your breast is it will lift the upper abdomen and make the tummy tuck much easier. The breast lift technique I recommend is 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. At the same time or later, a tummy tuck can be performed. You also have excess hanging back skin and arm skin. You may benefit from a back lift as well as a brachioplasty.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Carmina Cardenas, MD · Answer

Thank you for sharing your photos.

Based on your current anatomy and the amount of excess skin, you are a good candidate for a Lower Body Lift combined with a Fleur-de-Lis abdominoplasty. This approach allows for a more complete removal of excess skin, especially in the upper and central abdominal area, where traditional lower body lift techniques may not provide sufficient tightening.

The procedure will also help lift and reposition the gluteal area, improving shape, projection, and reducing the skin folds you currently have. In your case, a small amount of fat transfer can enhance volume and contour, restoring a more balanced and natural-looking figure.

This surgical plan is designed to address both functional and aesthetic concerns, helping you achieve a more harmonious and proportionate result.

To receive a personalized surgical plan and additional information about the procedure, you may schedule a virtual consultation, where I’ll be happy to evaluate your case in detail and guide you through every step of the process.

Warm regards,
Dr. Carmina Cárdenas

Gulcin Nujen Cardak, MD, FEBOPRAS · Answer

According to your pictures, you have massive excess skin on both vertical and horizontal planes. Because of this, we can surely say that FDL is inevitable for you. Comparing the benefits of FDL, scarring won’t be bothering for you. In my opinion 360 TT is not necessary for you.

Do I need a FDL, 360TT, or combined? (photo)

Answers (16)

More Tummy Tuck Questions

Does stomach gradually look natural again after tummy tuck?

I recently got a laparotomy in Nov of 2024. Am I a candidate for a tummy tuck? Would the scar be taken away? (photo)

60 more pounds to lose - Would a tummy tuck and lipo be beneficial? (Photos)

Tummy tuck damage to my vagina, 7 years post-op

5'4" and 104 lbs - Extended tummy tuck or full tummy tuck? (photo)

Ultrasonic cavitation and Coolsculpting made my skin texture change. Tummy tuck or lipo to fix it? (photo)

WE SEND PRETTY
EMAILS