I have lost over 180 pounds - FDL VS Extended Tummy Tuck? (Photos)

Thank you for your question. After a weight loss of more than 180-lb loss, the recommendation for an FDL abdominoplasty is on track because patients usually have both horizontal and vertical laxity. A standard tummy tuck only pulls horizontally and will leave residual central/upper-abdominal looseness, dog-ears, a boxy waist, and midline wrinkling, often prompting revision to an FDL later. A “Mommy Makeover” can be staged for safety (especially after duodenal switch, where nutrition and healing are critical). During your consultation, your surgeon may recommend optimizing labs (albumin, Hgb, vitamins), then do Stage 1: FDL abdominoplasty (± limited flank lipo); Stage 2: circumferential lower body lift to tighten the back/flanks and lift the buttocks instead of a BBL. If you go against the FDL plan and choose a standard tummy tuck to avoid the vertical scar, expect a flatter lower abdomen, but persistent upper/central laxity and less contour.

From your photographs, it seems either a FDL or extended tummy tuck would be reasonable. It depends on your desires and expectations. You may have a little loose skin with an extended tummy tuck, but not a long vertical scar. A lower body lift might be a good procedure for contouring of that area. I agree that fat grafting to the buttocks would probably not be a good choice.

A comprehensive approach like a mommy makeover would likely give the most harmonious outcome. Planning combined procedures allows the whole body to be shaped in balance rather than focusing on one area only. In your situation a 360 tummy tuck together with procedures such as inner thigh lift can help address the skin laxity that remains after major weight loss. A full BBL does not seem like the best option right now since the priority should be correcting the skin excess and achieving a smoother contour first.
I have also shared a detailed video below where I explain the full process and show examples of my patients with different types of incisions and healing patterns. This may help you better visualize the possible outcomes and understand why a comprehensive plan is often recommended.
— Güray Yesiladali MD

You are an excellent candidate for a lower body lift, also known as circular tummy tuck. I can’t see the upper area of the abdomen with this picture but with major weight loss in most cases yes the FDL incision is needed however, in some cases, we have been able to avoid it Would depend if we can we would, but if loose skin is still very much there even when pulling down then yes the FDL incision will help eliminate that and give you an amazing outcome. However, if you don’t feel comfortable and doing it the first time around, you can definitely do it at a later time!

Congratulations on your impressive weight loss! An examination is needed for the best recommendation, however you appear to be a good candidate for a circumferential tummy tuck. This would remove excess fat and skin from the front and back as well as lift the lower body. An FDL is advised if there is significant skin laxity along the midline of the abdomen. I've attached a video I hoep you find helpful.

Congratulations on your weight loss accomplishments !

I think the amount of excess scheme you have would probably make an FDL the best option

I would combine this with a hip buttock in front of leg lift, which I call a "lower body lift."

Unfortunately, you have blacked out your breasts in the photographs. I address the breasts before I consider doing a tummy tuck. The reason is because a breast lift will pull up the upper abdominal skin and this will eliminate the need for a fleur de lis. 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, a tummy tuck can be done. You will probably need a circumferential lift because you have excess skin posteriorly as well.

Best Wishes,

Gary Horndeski, M.D.

I think you would be happy with a circumferential abdominoplasty I do not like the FDL, because it leaves that vertical scar down the middle of your abdomen

Thank you for your question! After massive weight loss and the resultant skin ptosis and excess, surgery with a circumferential body lift would help address some of your concerns. A BBL will add volume and assist with shaping mostly if there is adequate fat stores. Going on several consultations until you are comfortable with the surgeon and the plan will help you on your journey. Best of luck!

In my opinion, a belt lipectomy is generally recommended for patients who have experienced massive weight loss and are left with excessive skin that extends circumferentially from the front to the back. This procedure can help remove the redundant tissue, improve body contour, and enhance both function and comfort.