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

Question

I have lost over 180 pds after having DS weight loss surgery. I had a consultation the Dr recommended that I do a FDL tummy tuck. I ideally want the Mommy Makeover because I want be able to combine procedures. If I go against the Dr recommendations essentially what would my results look like? Would love to hear your recommendations based on my pics. He also said I would not be good candidate for BBL, he thinks my next procedure after the FDL needs to be a lower body lift. Is this on track?

Elisa Stein, MD · Answer

Coxoxoxo,Congratulations on your weight loss!! Having lost over 180 pounds you appear to have horizontal laxity in addition to vertical laxity in your anterior abdomen. A traditional abdominoplasty would not agree the horizontal laxity and would likely leave you with excess skin. A fleur-de-lis abdominoplasty resects skin in both a vertical AND horizontal plane. Once you have recovered from that surgery, you will see what excess skin remains along you lower back and hips. That will be the time to determine next steps, lower body lift vs BBL.Dr Stein

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear Coxoxoxo

Congratulations on your weight loss.  Based on your pictures, I agree with your previous surgeon that a FDL tummy took would be the best procedure for you. Additionally, I agree that a lower body lift after your abdominoplasty would serve you better than the BBL.

Seek several consultations from for certified plastic surgeons.

Best wishes,

Earl Stephenson, Jr MD, DDS, MBA.

ESJ Aesthetics
"Where Confidence Takes Place!"

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. Congratulations on your weight loss and maintaining your weight. You have loose skin circumferentially around your entire body. A lower body lift will correct your abdomen, some of your inner thighs, your lateral thighs, your flanks, and your buttocks in a single operation.  Having this done in two operations, increases your cost and creates two recovery periods instead of one.  As the markings for the lower body lift are all done as a unit the incision lines will flow naturally into each other instead of trying to match up the back incision with the front incision at some point in the future.  A FDL is an option, however does increase scarring that can’t be camouflaged easily.  This procedure can be done as an outpatient and typically takes approximately 5 to 6 hours. Recovery is around 2 to 3 weeks.

Gregory Lakin, MD · Answer

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.

Ira H. Rex III, MD · Answer

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.

Guray Yesiladali, MD, FEBOPRAS · Answer

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.
&mdash; Güray Yesiladali MD

Luis Suarez, MD · Answer

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!

John LoMonaco, MD, FACS · Answer

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."

Gary M. Horndeski, MD · Answer

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.

Best Wishes,

Gary Horndeski, M.D.

Tuan A Truong, MD, FACS · Answer

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!

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