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.

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.

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

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.

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

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

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.

 

Sincerely,

Anire Okpaku MD FACS

 

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 lbs 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!