Excess Skin Removal After Massive Weight Loss; LBL or Fleur-de Lis Abdominoplasty? (photo)

I have lost 160 lbs with the aid of gastric bypass. I have consulted with three plastic surgeons, and two have recommended a vertical abdominal incision (one w/fleur-de-lis abdomioplasty, one w/belt lipectomy and added vertical cut), while the third thought the added vertical incision would be the wrong choice for my body type (pear shape). I know I have a lot of skin to be removed but I am afraid of the additional scar. Would I still be able to get a good result with just the lower body lift?

Doctor Answers 14

Massive Weight Loss Surgical Options

From your photos, it appears that you will have a great result with a standard body lift surgery. Adding a vertical component has a very noticeable scar, a"T" component to your incision which often has a problem healing and it will unnecessarily tighten your waist leading to a more noticeable "pear" shape of your lower half. Not treating the posterior segment will only lead you to having a very disproportionate shape and a second surgery to correct this (just look at your photos). After a 160 lb weight loss, your skin needs excision to fully treat your issues. Liposuction alone will not successfully treat any area of your body so do not choose this approach alone. Best of luck, Vincent Marin, MD San Diego Plastic Surgeon

San Diego Plastic Surgeon
5.0 out of 5 stars 47 reviews

Your loose skin extends circumferentially, so your skin excision must also be circumferential. Vertical component? Maybe.

The best way to determine if your circumferential beltlift will benefit from an additional vertical component (fleur-de-lis) in the abdominal portion of the beltlift would be to measure the incision lengths of the planned lower incision and compare this length to the planned upper incision. It is common for a difference of about 10cm or so to be noted and dealt with appropriately, but if the discrepancy is greater, then adding a vertical incision will tighten your abdominal skin in two dimensions, and will likely improve your overall results. The vertical incisions and resultant scar do not impair blood flow to any great extent, though there can be some additional healing issues at the junction of the vertical and horizontal incisions above your pubic area. This is a judgement that your surgeon would need to make, and this should be possible PRIOR to surgery. I do not believe that this is something I would tell a patient "will need to be decided in the operating room." Experience with enough lower body lifts (beltlifts) should permit this assessment to be made prior to surgery in most cases.

Notice that I would not plan a fleur-de-lis abdominoplasty instead of a beltlift (lower body lift); this would just require another operation to perform a completion beltlift (buttock and thigh lift, or posterior lift). After this much weight loss (Congratulations!), you would not be well-served by a "front-only"operation, which may be offered if a surgeon is inexperienced with lower body lifts.

You should be less concerned with a possible vertical incision (which may well be unnecessary with a skillfully-performed lower body lift and experienced pre-operative assessment), and more with finding an ABPS-certified plastic surgeon who does lots of lower body lifts. For several examples (including a patient who looks surprisingly similar to your anatomy), click on the web reference below. Best wishes! Dr Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Massive Weight Loss Surgery Options

The abdominal wall contour can undergo significant changes when women have undergone significant weight loss. Under these circumstances, it's not unusual for women to develop loose excess skin, weakened muscles, fat accumulation and stretch marks. When choosing a surgical procedure, it's important to realize that no two patients are ever exactly alike and for this reason, it's important to individualize care.

Although it's hard to make a specific recommendation without a physical examination, your history and pictures suggest that you have excess skin in both the vertical and transverse dimensions. In addition, there's probably laxity of the underlying muscles. Under these circumstances, several surgical options exist. The choice of procedure not only depends upon your anatomic findings, but your aesthetic goals as well.

The fleur de lis abdominoplasty removes excess skin in both the vertical and transverse dimensions. This leaves the patient with a vertical abdominal incision.

In contrast, the lower body lift removes excess skin by extending the abdominal incision circumferentially. This removes excess skin from both the abdomen and back while simultaneously lifting the buttocks in an upward direction. It avoids a vertical abdominal incision by avoiding transition zones during the closure.

Based on your history and pictures, I believe that a body lift procedure would represent your best surgical option. The final decision will depend upon your physical examination and aesthetic goals. It's, therefore, important to consult a board certified plastic surgeon. This surgeon should be able to perform a physical examination and formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

LBL or Fleur-de Lis Abdominoplasty?

Congratulations on the weight loss.

Without having seen you or knowing too much about your personal health, I would be inclined not to do a full lower body lift and vertical excision at one setting, due you concerns for safety.

The options then would be a first stage fleur-de-lis TT, followed by posterior LBL, or, a full LBL, followed by the vertical resection.

I would favor the later choice, since I am quite certain that if you did the fleur-de-lis first you would absolutely feel the need for the posterior LBL after. But if you did the full LBL you might find that there was enough correction that the vertical TT doesn't add enough to do another procedure. 

Someone who has actually examined you has a better framework from which to make recommendations.

Thanks for the question, and for the photos. Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews




Congratulations on losing the weight, you have many options to have your excess skin removed. You can do a lower body lift, tummy tuck and thighs lift. Without examining you it’s hard to give you accurate information. Getting a vertical scar we believe it’s not necessary you can get great results from a lower body lift and or an abdominalplasty (tummy tuck). Make sure you see a Certified Plastic surgeon to get accurate information.


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon
3.3 out of 5 stars 9 reviews

Options depend on goals

Both your surgeons are right.  You could go either way with which procedure you choose, but, ultimately, it depends on your goals.

If you are more concerned with your thighs and anterior abdomen, an extended abdominoplasty with a vertical incision is the best option.  If your outer thighs and buttock are areas you "have" to have addressed, a belt lipectomy/body lift is the best to address these.

In truth, the choice of procedures is one to make in conjunction with your surgeon, and should be designed to meet your goals.

Hope this helps,

Dr. Hall

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 11 reviews

Removal of Excess skin after Massive Weight Loss

You definitely need to have a combination of procedures performed, but safety and operative time must be considered first. I would recommend the extended abdominoplasty with vertical incision (Fleur-de Lis) and liposuction to the flanks.  You will need to recover from this for 6 months then return to the operating room for the posterior body lift and butt lift. Some patient also add the Brachioplasty (arm lift) at that time as well.

 You deserve plenty of praise for your hard work and major weight loss. This is quite an accomplishment and you will be so much healthier now.  Eat well and get plenty of healthy protein and vitamins in your diet before surgery.  Good luck.

Erez Sternberg, MD
Jacksonville Plastic Surgeon
4.9 out of 5 stars 32 reviews

Excess Skin Removal After Massive Weight Loss; LBL or Fleur-de Lis Abdominoplasty?

No based upon your posted photos you need both operations at different operative times. First do the Fluer-de-Lis abdominalplasty. Than see how you appear after 3 months to decide if to proceed with LBL

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Body Lift vs. Fleur de Lis Tummy Tuck

Both procedures are valid treatment options for a patient who has lost lots of weight.   My answer would depend on your goals.  In addition to the excess skin in your anterior abdominal wall and waist, are you concerned about the excess skin/laxity in your lateral thighs, posterior waist/flanks, and buttock area?   If your answer is yes, then I would most likely advise you to consider the circumferential body lift procedure.    Although the fleur de lis tummy tuck option has its advantages, I prefer not to leave patients with a visible mid-abdominal scar.   I rather strive to hide the circumferential scar in your belt/bikini line.     In the end, I think you should select treatment plan based on your goals (areas of concern), your tolerance of scar position/location, and ultimately your comfort level with your plastic surgeon and his/her staff.   Hope this helps.  Good luck!

Dr. Basu

Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 211 reviews

Excess skin after massive weightloss

Congratulations on losing all that weight.  Now you need to get rid of all that excess skin.  In my opinion you need a combination of procedures to get the optimal results.  Due to massive weight loss just doing a tummy tuck will not come close to giving you the results that you need.  The procedures that I recommend sound extreme but when everything heals up will look awesome.  The scars can be minimized and will bill be very happy to be able to fit into regular clothes.  You will require an abdominioplasty for the lower abdomen with a reverse abdominioplasty for the upper abdomen.  Along with a corsetplasty to remove the mid abdomen skin and give you a nice waist line again.  Along with these procedures I would perform a beltectomy and a bra roll excision.  I would perform these procedures on an outpatient basis (if you’re healthy) in one surgery.  Customarily take around 4 hrs in my practice.  We can also address the breast at the same time.

Please see a board certified plastic surgeon who specializes in these type of procedures for the best results.


Good luck and thank you for your question.



Anire Okpaku MD FACS


Anire Okpaku, MD FACS
Miami Plastic Surgeon
4.5 out of 5 stars 29 reviews

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