Circular TT with corset vs Fleur De Lis

Question

When comparing how the two procedures differ, is it realistic to hope for the same "narrowing" waist shape with the circular TT and corset shaping to avoid the linear scar of the FDL?

J. Timothy Katzen, MD, FACS · Answer

Hi 72arasd in Henderson, NV. Thank you for your question about the circular TT with a corset vs. the Fleur De Lis (FDL) in the hope of achieving the same "narrowing" waist shape with the circular TT and corset shaping and avoiding the linear scar of the FDL. A circular tummy tuck (TT) is a tummy tuck that goes completely around the body 360 degrees, like a belt. Some plastic surgeons call the circular tummy tuck a "belt abdominoplasty" or a "360 circumferential lower body lift." The circular tummy tuck (like most tummy tucks, even the FDL) includes rectus abdominis muscle plication. Rectus abdominis muscle plication is also called a corset abdominoplasty or rectus diastasis correction. In general, to maximize "narrowing" of the waist, most plastic surgeons would recommend a high lateral tension 360 circumferential lower body lift with rectus abdominis muscle plication. This will yield the best snatched waistline. The high lateral tension 360 circumferential lower body lift means that the incision is placed low in the pubic region (mons), high over the hips, on the top of the buttocks, and meets at the top of the vertical buttock crease. This incision pattern yields far better waistlines than a traditional FDL with rectus abdominis muscle plication. Of course, every patient is different. Such variation is why an individualized consultation is necessary. To get an accurate assessment of what exactly you need, schedule a free virtual consultation. Most plastic surgeons offer free virtual consultations.
I hope I have answered your question regarding the circular TT with a corset vs. the Fleur De Lis (FDL) in the hope of the same "narrowing" waist shape with the circular TT and corset shaping to avoid the linear scar of the FDL. If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, FDL, or belt dermolipectomy, please contact an experienced plastic surgeon. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research. Make sure they have performed at least 150 circumferential lower body lift surgeries and have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. If you cannot find an experienced, lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (President of the American Society of Bariatric Plastic 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.)

Don W. Griffin, MD · Answer

Both techniques performed on the correct patient can produce excellent results. The best option is really dependent on your anatomy with regards to skin thickness, amount and location of laxity and whether you have a curved torso or a square shaped one. There are pros and cons to both and you should speak with a surgeon who is familiar with and does both procedures to discuss the best option for you. The flour-de-lis is better when you have a significant amount of horizontal laxity in the central abdomen, but does leave a more noticeable scar and may limit clothing options when wearing clothing that shows your abdomen. This scar is also more prone to thickening due to its location.

Semih Yildiz, MD, FEBOPRAS · Answer

A circular tummy tuck with strong muscle repair or corset-style plication can improve the waist from the front, back, and sides, especially when the main problem is circumferential laxity and loose lower abdominal/back skin. It can give a more balanced trunk contour without adding a vertical midline scar.

A fleur-de-lis tummy tuck is different because it removes horizontal excess as well as vertical excess through the central abdomen. That vertical removal is what can create more powerful front-to-back narrowing in patients who have significant side-to-side looseness across the upper and central abdomen. If that type of excess is present, a circular tummy tuck alone may improve shape but may not create the same central waist cinching. The best choice depends on the direction of your skin excess, scar tolerance, muscle separation, and how the tissues move on exam. An in-person pinch test and review of your goals usually makes the tradeoff much clearer.

Tyler Sbrocchi, MD · Answer

Hello, this is a great question, they are very different procedures and can accomplish different things. A lot of this decision depends on you and your goals and where your skin laxity is. The circumferential tummy tuck can help with the posterior or back of the buttock, waist and hips as well as the abdomen but if there is loose skin on the upper part of the abdomen this is usually better addressed with a fleur de lis. It is best to have an in person consultation with your plastic surgery to do an exam and determine the best plan for you, good luck!

Yasemin Aydinli, MD · Answer

The vertical excision in a fleur-de-lis is what most powerfully narrows the waist, because it physically draws the two sides of the abdomen toward the midline. A circumferential or belt tummy tuck excels at lifting the flanks, back and buttocks, but its pull is mainly horizontal, so it will not cinch the waist to the same degree, although a strong internal corset plication can add meaningful definition. If your skin laxity is mainly vertical and maximal waist narrowing is your priority, you may not fully replicate a fleur-de-lis result without that vertical scar. So it really comes down to how much narrowing you want versus how much you wish to avoid the midline scar.

Paul M. Parker, MD, FACS · Answer

These approaches really should be individualized based on the patient's history of weight loss, anatomy as well as their concerns regarding ultimate outcome and scars. A FDL will reduce this abdomen in both a horizontal and vertical direction leaving both a horizontal and vertical scar--it will have little effect on the hips, outer thighs and buttocks posteriorly. A circumferential abdominoplasty will reduce the abdomen in a vertical direction as well as reducing the hips, outer thighs and buttocks in a vertical direction. It will improve the abdomen somewhat in a horizontal direction from the rectus abdominus muscle tightening but not as aggressively as a FDL.

Jeffrey M. Darrow, MD · Answer

A circular TT will correct the entirety of lax tissue around your trunk, with the best tightness in the lower areas, as the best tightening is always closest to the incision. The tissues of the mid/upper abdomen get slightly less tightening and this is the rational for the FDL, which places a midline incision up the abdomen to tighten the mid/upper abdominal tissues as they are closest to that incision. With rare exception I have found the circular TT is fully satisfactory for the majority of patients. This is why there should be a full examination and a detailed consultation with your plastic surgeon about exactly what you wish to achieve. Your surgeon will be able to help you understand the best option for you. Best wishes.

Gerald Minniti, MD, FACS · Answer

In addition to vertical skin excess, the FDL addresses circumferential or horizontal skin excess that neither a traditional tummy tuck nor a body lift ('circular TT') can do. The latter two only effectively address vertical skin laxity of the belly, with the body lift also vertically repositioning thigh and buttock skin and tissue. So, an expert body contouring surgeon will be able to tell you if you need an FDL component to either a traditional TT or body lift.

Ronald J. Edelson, MD · Answer

Without pictures I can’t speak specifically about your case. However I feel the circumferential belt lipectomy is of greater benefit that the fleur de lys.  The benefit if the for de lys for the surgeon is that you won’t need to be repositioned on your stomach to complete the case

Gary M. Horndeski, MD · Answer

The fleur de lis has a vertical component. The reason it has that is to take out excess horizontal width of the abdomen. If you do not have excess horizontal width then you do not need a fleur de lis. The circumferential tummy tuck takes care of vertical excess by pulling the abdomen and body down lower. Unfortunately, you have not provided photographs.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Circular TT with corset vs Fleur De Lis

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