Can I get really flat with just a Belt Lipectomy or do I need a FDL also? I believe it comes with muscle repair. (photos)

Lost 228lbs looking to get flat as possible. I do have a mesh in my belly from a umbelical hernia. Do I need a FDL also or just Belt lipectomy? Please tell me what you recommend.

Doctor Answers 9

FDL it is...

Hello,  thank you for your question and photos.  Massive weight loss patients usually have horizontal loos skin that can only be addressed with the FDL.   A full conventional TT will leave that extra skin and will not have a good outcome. 

Dominican Republic Plastic Surgeon
5.0 out of 5 stars 58 reviews

Contouring the Body After Weight Loss

Hi and thank you for your question.  First and foremost, congratulations on your incredible weight loss!  I think whether to perform a FDL or belt lipectomy depends on your goals.  If you want the flattest, tightest abdomen possible, I would recommend a Fleur-de-lis abdominoplasty.  It will optimally contour your abdomen in both the vertical and horizontal dimensions.  However, you will have the vertical scar that runs above and below your belly button.  These scars can be greatly improved with postoperative laser treatments, but they will always be present.  If you want the flattest abdomen, but you are okay with sacrificing some tightness, a belt lipectomy, with or without an upper body lift, will be preferable.  This will keep your scars will hidden under your clothes, bathing suits, or underwear.  Congrats again and good luck!

Ryan Marshall, DO
Missoula Plastic Surgeon
5.0 out of 5 stars 6 reviews

Do I need FDL with my belt lipectomy

 Thank you for your question. Your pictures are very helpful. A belt lipectomy or a lower body lift only addresses "vertical" laxity of your trunk. It does not address any "horizontal" laxity which you have in your pictures.  Because of this, you will need a FDL procedure to correct your horizontal laxity in your abdominal skin. Hope that helps.  Please consult with a board-certified plastic surgeon who has performed many of these type of procedures on the massive weight loss patient. Good luck. 

Mehdi K. Mazaheri, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 20 reviews



A belt lipectomy, like a standard tummy tuck, only pulls and tightens in the vertical vector. A FDL pulls in both the vertical and horizontal (circumferential) directions. This is what you will need to get the best result.  In fact, your horizontal laxity is enough to warrant a 'corset FDL', which leaves you with an H shaped scar, with an upper horizontal incision that spans below each breast in the inframammary fold. This is the only way to adequately tighten the upper abdomen's laxity. 

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Can I get really flat with just a Belt Lipectomy or do I need a FDL also? I believe it comes with muscle repair

I think you would have a better result on your abdomen with the FLD tummy tuck, but that will not correct any sagging skin on your back.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

Abdominal Contouring

Congratulations on the weight loss!  In order to deal with the loose skin that remains, you should start with an in-person consultation with a board certified plastic surgeon.  There are different options like you talk about in the FDL or Belt.  Ideally we avoid the vertical incision of the FDL when we can, but for the amount of laxity that appears on your pictures, it may end up being needed to achieve the flattest results possible.  

Tummy Tuck - Circumferential body lift

Thank you for your question and photos. Congratulations on your weight loss! You appear to be an excellent candidate for a circumferential body lift. I prefer to not add a vertical scar on patients similar to you.The circumferential skin excision and abdominal muscle tightening could give you an excellent contour as well as improve the tone of the anterior abdominal wall.  Please see a board certified plastic surgeon for an in-person examination to discuss the specific details of the procedures. Ask to see before and after photos to get an idea of what can be achieved. Hope this helps!

Lower belt lipectomy and upper body lift

Since the FDL results in a vertical scar, it is not desirable. Instead, a lower belt lipectomy combined with an upper body lift will be able to remove laxity in both the horizontal and vertical dimensions thus avoiding the FDL incision lines. In addition, the upper body lift will correct your lateral breast droop that is evident in your photos. You can combine these procedures safely. Please see results below. 

Arian Mowlavi, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 41 reviews


Hello and thank you for your question. Congratulations on your weight loss. You are an excellent candidate for a lower body lift which in my hands includes : 

1. A full tummy tuck. 

2. A mons lift. 

3. A strong lateral thigh lift. 

4. A buttock lift. 

5. Auto augmentation of the buttocks and hips. The hip flap is designed to help increase or maintain your hip / waist ratio. 

I don't believe that you need a fleur-de-lis. 

You need to see a ps who specializes in post massive weight loss body contouring. 

Peter Fisher M.D 

Peter Fisher, MD
San Antonio Plastic Surgeon
4.9 out of 5 stars 46 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.