Hello FreshStart0311, Thank you for your question about the possibility of combining a lower body lift with a Fleur de Lis (FDL) procedure, and for providing your pictures and history. Let's clarify what each procedure involves: A 360 Circumferential Lower Body Lift includes a tummy tuck, rectus abdominis muscle plication, pubic lift and reduction, hip lift and reduction, and a buttock lift. The Fleur de Lis (FDL) involves both horizontal and vertical tummy tucks, removing excess skin and fat from the abdomen in both directions, along with pubic reduction and rectus abdominis muscle plication. The primary distinction between the FDL and the 360 circumferential lower body lift is the vertical removal of abdominal skin and fat in the FDL, whereas the lower body lift includes a posterior lift. Therefore, it is indeed possible to combine a 360 circumferential lower body lift with an FDL. Essentially, the surgery you are considering is a 360 circumferential lower body lift with an additional vertical incision extending from the mons pubis to the xiphoid process. Most plastic surgeons would recommend a 360 circumferential lower body lift for addressing issues with the pubic region, rectus muscle diastasis (particularly below the bellybutton), and excess skin and fat around the abdomen, hips, and buttocks. However, experienced board-certified plastic surgeons specializing in 360 circumferential lower body lifts generally observe that there is not a significant amount of vertical excess skin and fat in cases like yours. The vertical excess is often due to rectus muscle distention rather than loose skin, leading many to conclude that a vertical tummy tuck component may not be necessary. I hope this clarifies whether a combination of a 360 circumferential lower body lift and an FDL is advisable in your case. Sincerely, Dr. Katzen