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

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.)

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.