Hello, and thank you for your question regarding whether you can pay to have the abdomen muscles tightened while insurance is covering a fleur de lis panniculectomy. Also, what is the cost for isolated rectus abdominis muscle tightening or plication during a fleur de lis (FDL) panniculectomy? The answer is “yes, you can have isolated rectus abdominis muscle tightening or plication during an FDL. Usually, muscle tightening is performed during an FDL. Regarding the isolated costs for rectus abdominis tightening, this varies from plastic surgeon to plastic surgeon. Also, muscle tightening costs depend on factors like is the procedure is being performed in a hospital or a surgery center. Hospitals cost more. Another factor to consider when deciding whether to perform muscle tightening during an FDL panniculectomy is whether mesh is being used. Also, how long will the muscle repair take, because that will require additional anesthesia time and expense? You need to ask your FDL plastic surgeon what he/she would charge. Good luck. I hope that I have answered your question regarding whether you can pay to have the muscles tightened while insurance is covering a fleur de lis panniculectomy. Most plastic surgeons offer free virtual or in-office physical consultations. Therefore, explore what other plastic surgeons have to say. If you have any more questions about a panniculectomy, tummy tuck, abdominoplasty, or abdominal liposuction, contact an experienced plastic surgeon. Since the tummy tuck surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing panniculectomies and tummy tucks. Do your research. If you cannot find an experienced plastic surgeon for a panniculectomy or tummy tuck in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)