Extended tummy tuck or fleur de lis? 120 pound weight loss (Photo)

This is often a tough decision for patients with a similar degree of skin laxity. An extended abdominoplasty, (I'd probably recommend a torsoplasty) would likely get you a very good result and improvement it would not address the superior vertical excess. So afterwards you would still have a significant degree of laxity in the side to side direction. The FDL would address this laxity and improve your waist contours. The scars do fade and would improve your shape/skin laxity dramatically.

I typically will do torsoplasty with or without FDL in a drainless fashion.
Get a few additional consults to make sure you're getting the best option for your anatomy. Make sure they do a lot of body contouring procedures and have experience with FDL and torsoplasty. Doing the "easier" extended often leaves you with residual skin laxity that you may want or need to address later.

In my experience, after tremendous weight loss, there is a lot of skin excess up and down but also side to side.

The fleur de lis addresses all the lose skin 3D, it is more than T tummy tuck and as such, is not performed routinely by many plastic surgeons.

Trade off is lower waist scar plus vertical , but will drastically contour abdomen and waist.

Some patients will undergo extended tummy tuck and if they want more waist definition, will return for secondary fleur de lis months later. Unfortunately, after massive weight loss, staged procedures are common. Trying to pull all the skin to the sides to avoid the vertical scar can be limited.

Further exam and consultation with a plastic surgeon who performs these procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

Thank you for your question and for sharing your history and photos. Based on the information you've provided, it's understandable that you want to avoid the vertical scar associated with a fleur de lis (FDL) procedure. While the FDL offers dramatic results by removing excess skin both vertically and horizontally, it does leave a noticeable vertical scar.

Your surgeon’s suggestion of an extended tummy tuck sounds promising, and it is possible to achieve excellent results without the need for a fleur de lis in many cases. The key to achieving great results without the vertical scar is proper undermining during the tummy tuck. By extending the dissection up to the sternum and ribs, more skin can be tightened horizontally, reducing the need for a vertical incision.

Additionally, rectus muscle repair is crucial, especially after significant weight loss. By tightening the abdominal muscles with permanent sutures, the overall contour of the abdomen improves, helping to address any laxity above the belly button.

An extended tummy tuck or, even better, a 360 circumferential lower body lift may give you the results you're seeking without requiring the vertical scar. It’s important to work closely with a skilled and experienced plastic surgeon who can tailor the procedure to your specific anatomy and goals.

I hope this helps you make an informed decision, and I wish you the best of luck in achieving your desired outcome.

Sincerely,
Dr. Katzen

Dear Helpful526443,
it is hard to tell for sure without an examination. Based on your photos, it looks like you have a lot of loose skin so you will most likely need fleur de lis incision. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Congratulations on the massive weight loss and thank you for sharing your question and your photos. Based on your photographs, you have a massive amount of skin redundancy and laxity of the abdominal torso in both the vertical and circumferential dimensions. A tummy tuck procedure, even an extended one, pulls the redundant skin downward, but does nothing for the circumferential dimension. Avoiding the vertical scars of an FDL, the skin will be pulled downward, but you'll still have skin redundancy in the circumferential dimension, meaning around your abdominal torso. I understand that your goal is to avoid having the vertical scars of a FDL, but if you're trying to achieve a flat tight abdomen, a FDL is exactly what you need. I am not aware of any surgical technique to excise the redundant skin in the circumferential dimension without leaving a vertical scar.

We can sometimes be surprised by a standard skin resection in these scenarios, however, with the degree of laxity seen in the photos, you would likely have a crease down the middle of the skin afterwards due to the downward pulling and excess vertical skin excess.

It does appear that you have a significant amount of skin laxity both horizontally and vertically. An extended abdominoplasty with FDL would help you achieve the most skin removal.

I've had a lot of experience with massive weight loss patients over the years, and while I believe an extended TT may give you a great improvement, it will definitely not correct the excess skin in your upper abdomen. I'd normally recommend AT LEAST a circular TT for a case such as yours, and even then, I'd tell you that most likely, if you want the skin in the upper abdomen to be corrected completely, we'd need to see how you heal, but we may end up needing to do a vertical incision at some point. Most patients have great results without the vertical, but if you want it to be fixed AS MUCH as possible, you need to have some amount of skin remove in the central abdominal area.

The fleur de lis requires a vertical scar. This is because there is excess skin circumference high on the chest wall. If you did a circumferential lift it would most likely take care of the problem. Unfortunately, you did not provide photographs of your breasts or told us your bra size. However, there is a breast lift technique called The Bellesoma Method. This will lift the breasts higher which also lifts the upper abdomen and may eliminate the need for the fleur de lis. This technique reshapes your breast tissue creating upper pole fullness without implants, elevates 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.

Best Wishes,

Gary Horndeski, M.D.

Hello, thank you for your photos and question! You have a great amount of loose skin on your upper abdomen. I feel your best outcome would be the fleur de lis. I understand that scaring can be a turn off to this procedure, but this is what is going to remove most of the loose skin. Best of luck !