Is a fleur-de-lis my only alternative for a midline crease after TT? (photos)

When I decided to have a TT earlier this year, both surgeons I consulted said they would opt for an extended TT although I might be left with some redundant skin due to laxity (a FDL had been recommended previously). Now I am left with a midline crease. I was given the option of having the MR "loosened" to help ease the crease or undergo a FDL (ie: no crease, but with midline pudginess vs scar which will eventually lighten). I am 9 months PO. Your insights are appreciated. Many thanks!

Doctor Answers 7

Post of midline abdominal crease.

Congratulations on the weight loss and the success of the original mommy makeover . The next step is simple liposuction of the abdomen. Underneath the indention should not be suctioned. This will bring the hills down to the valley and also help the skin to appear tighter with no additional scarring. 

ALTERNATIVE FOR FDL

You have a very nice result and the crease in the midline can improve if liposuction is done on the upper abdomen, so the fat deposits are less and the crease will not look that deep. Ask your surgeon for this option, especially if you do not want to have a scar in an area where the scar will be hard to hide.

Midline Crease After Tummy Tuck

Hello,

You would need to be examined to confirm, but you might be a good candidate for liposuction of the abdomen. This would make the crease appear less deep and rather normal/athletic looking. If skin laxity is still a problem, this might not be the best remedy though. Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Fleur-d-lis tummy tuck the only answer?

Thank you for asking about your tummy tuck.

  • First of all, congratulations on the weight loss and your excellent surgical result.
  • I would not have your muscle repair released - it will not look natural and will ruin your result.
  • The fleur-de-lis skin excision will work well if in fact the skin is loose in that area.
  • If the skin is fairly tight and you want to limit what is done, ask your surgeon if a very little liposuction on eitehr side of the crease might improve the indentation and avoid another major surgery.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Is a fleur-de-lis my only alternative for a midline crease after TT?

Thank you for your question and photos. You have an excellent result from what you started from. The midline crease in the upper abdomen is a desirable feature of an athletic abdomen. I would consider talking to your surgeon to do some additional liposuction to decrease the depth and widen the crease slightly to appear more natural. I would not consider a FLD revision to your abdominoplasty or "loosening the MR"; it would be a mistake to change this to a scar from the breast bone to the pubic bone. The muscle repair does not create the crease. Often, this scar widens, can end up being raised and certainly unattractive. Discuss this with your surgeon, who did a great job for you. Good luck.

Addressing a midline crease after a tummy tuck

Thank you for including your preoperative and postoperative photos. That is extremely helpful!  The decision about the style of tummy tuck to have (mini, full, extended, fleur-de-lis) is always dependent on two factors - the amount of volume/fat on your abdomen and the amount of (and quality of) your abdominal skin.  Looking at your preoperative photos, you were an excellent candidate for a tummy tuck but you are quite right that you always had some redundant skin in the upper abdomen.  Because of the way that a traditional tummy tuck is performed, the skin is pulled down, which means that there is excellent tightening in an up-down direction, but not tightening in a left-right direction.  The result is often a midline crease, which you have.  The scarring from a fleur-de-lis is significantly more than a traditional tummy tuck, and harder to hide in clothing and bathing suits, so often if someone is borderline between the techniques, a surgeon will recommend trying the traditional method.  You have a very good result from the lower abdomen perspective but clearly have developed a midline crease. At 9 months post-op, this is unlikely to change. If this bothers you, trading the crease for the midline scare of the fleur-de-lis is likely the only option. Good luck!

Midline crease

The crease looks like it could probably be "released" by breaking or undermining the connections to the deeper tissues causing the crease, but that would require going through your old incision and in my estimation, you might still have skin laxity in the upper part of your abdomen.

A FDL incision could correct both laxity and the crease, but it would leave a scar.

Tough choice, but that is often the nature of what we do. Best of luck.

Joel M. Stewart, Jr., MD
Newnan Plastic Surgeon
5.0 out of 5 stars 10 reviews

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