Do I need an FDL or a reverse tummy tuck? (Photo)

Question

Hello, I use to weigh over 300lbs and had lots of loose skin due to it. I had the 360 tummy tuck done and chest lift as well. I know the scarring is bad but I'm already looking into a scar revision surgeon for that. Before that though I need to figure out what to my next procedure would be. Looking forward to your feedback. Thanks

Gary M. Horndeski, MD · Answer

Your scarring is quite bad. An extended scar over the sternum area for a reverse tummy tuck would result in even worse scarring and will be highly visible. I recommend a scar revision which will take up some of the extra skin and redo your tummy tuck. You do not want a fleur de lis.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Careaga, MD · Answer

massive weight loss can bring about its own issues, specifically loose skin in all parts of the body. You have a significant amount of hypertrophic scarring from your chest surgery. Scar vision will remove the scar, but you have to be very proactive to try and minimize the scoring subsequently. This can be done through laser treatments, micro, needling, and steroid injections, but you have to be prepared for not having ideal scarring. As such, I do not feel that the significant improvement of the flleur-de-lis over a conventional tummy tuck is worth the large vertical scar that would be running up and down your abdominal wall. This most likely would become hypertrophic as well and would be impossible to hide without a shirt on.

Chet Mays, MD · Answer

Thank you for your inquiry!  Congratulations on your weight loss!  The only way skin can be removed is through excision. We would love to help you through your journey. Schedule your consult with a Board- Certified Plastic Surgeon.

Emmanuel Mallol Cotes, MD · Answer

Thanks so much for your inquire,

If you have significant excess skin and fat both above and below the belly button, a Fleur-De-Lis tummy tuck or a Full Tummy Tuck might be more suitable. If your main concern is primarily the upper abdomen, a reverse tummy tuck may be more appropriate.

It’s crucial to discuss your specific situation with a board-certified plastic surgeon. They can assess your condition, review your surgical history, and recommend the most appropriate procedure based on your needs.

Sincerely,
Dr. Emmanuel Mallol

Arif Eroglu, MD · Answer

Hello; Reverse tummy tuck scar; it will be under the breast. However, after your previous surgery; a serious keloid formation has occurred. You will probably experience with similar problems; after reverse abdominoplasty. Since you have a scar; reverse abdominoplasty is implemented ; afterwards, I recommend for you to start treatment to decrease for scar composition.

Jeffrey M. Darrow, MD · Answer

The tissue laxity of your upper abdomen could be addressed with a reverse abdominoplasty at the same time as revision of your scars.  The upward pull on the tissues of your upper abdomen, would help to smooth and flatten your upper abdomen.   The resulting incision line would be exactly where your present incision line is with a short extension between your breasts to connect the 2 sides for best contouring.  Best wishes.

Scott C. Lindsay, DO · Answer

Thanks for your question! Other than the scarring, you did get a nice result surgically. Every single person has rolls when they sit down. I understand feeling self conscious about it, but it's just part of being human. I would suggest doing nothing other than maybe some Morpheus treatments for liberal tightening. Good luck!

J. Timothy Katzen, MD, FACS · Answer

Hi Haniel,

Thank you for your question regarding whether you need an FDL (fleur-de-lis) or a reverse tummy tuck. I appreciate the background information and the photos you provided. Firstly, congratulations on your impressive weight loss!

Addressing the scarring, I would highly recommend a scar revision or considering treatment with a Fraxel Laser. This type of laser treatment can significantly minimize scarring. Concerning the roll on your abdomen, it's essential to maintain realistic expectations. Despite losing a substantial amount of weight, achieving an entirely flat tummy is not always possible. It's common for even slender individuals, who have never been overweight, to have some skin roll on their abdomen when seated. If the abdomen was entirely flat in a sitting position, standing up straight would be challenging. Hence, some skin roll is natural when seated.

When considering procedures to address the skin roll above your umbilicus, there are several options. Firstly, I don't believe you require an FDL. A reverse tummy tuck could be a suitable option, as it simultaneously addresses the chest scar. This procedure would treat two concerns at once, which seems the most logical approach for you.

Another possible procedure is a vertical tummy tuck, involving an incision from the sternum, passing through the umbilicus, and extending to the pubic region. However, given your history of scar formation and challenges with healing, I wouldn't recommend this.

An alternative is a lateral torsoplasty. This procedure involves an incision extending from your armpit down the sides of your chest to the top of your hip. This would pull the stomach laterally, addressing the skin roll effectively.

In conclusion, my top recommendation for you would be the reverse tummy tuck, combining both scar revision and elevation of the upper abdomen. I hope this provides clarity on whether you need an FDL or a reverse tummy tuck. Best of luck with your decision!

Sincerely,
Dr. Katzen

Ronald J. Edelson, MD · Answer

Overall your result is good. It’s not surprising  that you have some loose skin in the upper abdomen. A reverse tummy tuck is a much better option than a fleur de lys. You’ll get more improvement without the nasty midline scar

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  An exam is needed to know for sure, but it appears that a revision to your tummy tuck should address more of the loose skin.  Your scars should improve with scar revision.  Scar treatments are helpful but be sure to use them consistently for best results.