5 years post-op - Should I have had a FDL tummy tuck instead of an extended one? (Photos)

Question

I had an extended tummy tuck in 2017 after losing a significant amount of weight in less than a year. My surgeon was adamant that the loose skin on the top and sides of my abdomen would be treated as he stated “I think you’ll get away with it”. However, the loose skin still remains. The loose skin makes it hard for me to clean my belly button as I have to try pull my skin to the sides to I am able to get my finger in. Should I have had a FDL tummy tuck instead of an extended one?

Jason Hess, MD · Answer

A fleur-de-lis tummy tuck addresses both vertical and transverse skin laxity.  Following substantial weight loss, a fleur-de-lis is a very powerful procedure and achieving maximal tightening of the abdominal skin.  One noteworthy downside is a vertical scar on the abdomen.  However when this is meticulously repaired, it should leave a fine line rather than a broad scar.  Additionally a fleur-de-lis abdominoplasty is capable of enhancing the waistline more so than a simple extended abdominoplasty.  Good luck with your upcoming surgery

Alan Gonzalez, MD, FACS · Answer

Hello @Katielouise187, thank you for your question. It is unlikely that the structure of the skin will change significantly after the elapsed time. At this time, I recommend that a new surgical plan be developed that meets your expectations and what the surgeon can accomplish. This is to take into account that there is still tissue to improve with an extended abdominoplasty with a complete muscle plication. For more information and recommendations, it is best to consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

J. Timothy Katzen, MD, FACS · Answer

Thank you for a question regarding what to do with the excess skin and abdominal fat area after having a tummy tuck. And thank you for your question regarding what to do in terms of having either an extended tummy tuck her fleur-de-lis examine your abdomen above the belly button. Most of your excess skin and fat is in the vertical dimension. That means skin and fat can be mostly bunched up when the skin is pinched in an east-west fashion creating an up-and-down vertical scar. You do not have much excess skin and fat below the belly button. You do not have much excess skin and fat in any horizontal dimension when you pinch the skin from north to south. Therefore, in my opinion, you have three options. You could have a vertical abdominoplasty. Has made from the bottom of the sternum or‘s iPhone to the belly button and then to the Mons for the pubic region. This would eliminate excess skin in front of your tummy. Another option could be a reverse tummy tuck, or an incision is made underneath each breast. Any extra-abdominal skin is pulled upward towards your breast and permanently eliminated. Another option is a bilateral lateral vertical torsoplasty for an incision to be made down the side of your torso. Extend from just underneath the bra line down to your waistline. This would also eliminate excess skin in front of your upper abdomen.
The benefit of the last two options is if the scars are hidden and are not visible on your abdomen—a disadvantage of the vertical tummy tuck. You do not need the fleur-de-lis abdominal plasty because you’ve already had the horizontal component. As you know, the verticals are the fleur-de-lis or FDL abdominoplasty has a vertical and horizontal member. Again, I don’t think you need a horizontal component. Therefore, in my opinion, you do not need the extended tummy tuck or the fleur-de-lis. It would help if you had a vertical tummy tuck, reverse tummy time, or bilateral lateral. Good luck. I hope this helps.

If you have any more questions regarding a tummy tuck, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy please contact my office. 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 100 tummy tuck or 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, tummy tuck or lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, 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 and RealSelf Hall of Fame.)

Dhaval M. Patel, MD · Answer

Thank you for your questions and photos. A tummy tuck will address excess skin & repair of the abdominal muscle. The abdominal wall can be weakened after pregnancy and (or) significant weight gain & loss. By repairing the muscle, not only does the appearance of your abdominal area improve, but your core strength as well. The repair of the muscle will cinch your waist like an inner corset, which will accentuate your curves. Liposuction will remove excess fat from unwanted areas with some skin retraction. Your expectations and health will dictate the best procedure(s) for you. I suggest a consultation with a board certified plastic surgeon to go over the options that best address your goals. Best of luck!

Dhaval Patel MD
Double Board Certified Plastic Surgeon
Chicago
South Barrington
Oakbrook
Orland Park

Dhaval Patel MD 
Double Board Certified Plastic Surgeon 
Chicago
 South Barrington 
Oakbrook 
Orland Park

Ajaya Kashyap, MD · Answer

Thank-you for your question. While an extended tummy tuck is preferable in most situations because of less visible scaring and ability to wear different kinds of clothes that expose parts of the abdomen ; post massive weight loss skin laxity may require a vertical component as well, for maximum tightness but  with more obvious scarring. It is ultimately a choice between skin tightness and scar  visibility.  Please discuss your concerns with your  Plastic Surgeon who can help you and address these issues. All the best!

Carmina Cardenas, MD · Answer

Patients develope different vectors of excess of skin, especially after a significant amount of weight loss. 
You had double vector: excess of length which have the appearance of the apron on the bottom of the abdomen, but also you have excess of width which is the saggy skin above the belly button. 
So, yes, you are a perfect candidate to convert the regular TT into a Fleur de Lis to remove the excess of width. Your waist line will look nicer, tapered and tight. 
Be encouraged!!
Dr. Cárdenas

Thomas Trevisani, MD · Answer

In person exam is needed . Without pre-op photos -it's difficult to comment accurately, especially since it's been over 5 years since your surgery- your skin elasticity may have weaken since that time . You may be a candidate for Revision TT, including possible vertical component .

Ronald J. Edelson, MD · Answer

I don’t think the fleur de lis tummy tuck would have given you enough addditional improvement to justify the additional scar. It’s the rarely patient on whom I’ll perform the fdl

Daniel Barrett, MD · Answer

Dear Katielouise187,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jayanthy Ravindran, MS, DNB, MRCS · Answer

Hello, thank you for sharing your photos. Yes, you should have had a full thickness flap (FDL). This means that the entire layer of skin and subcutaneous tissue is lifted up and moved to cover the defect. In addition, the muscle layers are tightened. We recommend doing a FDL tummy-tuck if you have any remaining loose skin and fat.
We recommend you to consult with a board-certified plastic surgeon who specializes in abdominoplasty to determine whether you need a FDL tummy tuck or not.