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

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

Hello, and thank you for your question regarding whether you need a lower body lift (LBL) or Fleur-de Lis Abdominoplasty (FDL) for excess skin removal after massive weight loss. Thank you for your history and your pictures. Due to the distribution of your abdominal excess skin and fat, fortunately, you do not require a vertical incision. Most experienced board-certified plastic surgeons would recommend a 360 circumferential lower body lift. The lower body lift will address the excess skin and fat of the abdomen, hips, and buttocks. During a 360 circumferential lower body lift, the rectus abdominis muscle is imbricated or brought together. Suturing the rectus muscle will flatten your upper and lower abdomen. Again, you do not need the vertical cut. In addition, you do not need the Fleur-de Lis or FDL. The FDL will not address your hips or buttocks. Your hips and buttocks must be addressed with the lower body lift or in a separate surgery. Therefore, most plastic surgeons who are experienced with reconstructive plastic surgery after massive weight loss would highly suggest you undergo a 360 circumferential lower body lift without vertical extension. Good luck. I hope I’ve answered your question regarding whether you need a lower body lift (LBL) or Fleur-de Lis Abdominoplasty (FDL) for excess skin removal after massive weight loss. I hope this information helps you find answers regarding the 360 circumferential lower body lift.
If you have any questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact an experienced, board-certified 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. Ensure they have performed at least 150 circumferential lower body lift surgeries and have the before and after pictures to prove it. Please carefully review 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. Sincerely, Dr. Katzen. (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.)

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.

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.

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.