Fleur Di Lis Abdominoplasty? (photo)

A fleur de lis abdominoplasty is a tummy tuck that not only has the standard bikini line incision but also a vertical midline incision.  The advantage to this procedure is that it not only tightens your abdomen in the vertical direction but also in the horizontal direction.  For patients like yourself who have lost a lot of weight and who already have a vertical midline scar, this can be the perfect operation. 

 

 

Your question about combining liposuction with your abdominoplasty is really one of surgeon preference.  I personally always combine liposuction of the love handles with all of my abdominoplasties but I know many surgeons that never do it. If you are comfortable with your surgeon and his/her before and after pictures, I would trust their judgement on this.  Good luck.

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. 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 as well.

                Under
these circumstances, the Fleur de Lis abdominoplasty is an excellent surgical
option.  This procedure removes excess
tissue in both the vertical and transverse dimensions.  Unfortunately patients are left with a
vertical and transverse scar at the conclusion of the procedure.  This procedure is occasionally combined with
liposuction of the flanks. 

                The
need for supplemental liposuction when patients undergo Fleur De Lis
abdominoplasty is based on the patient’s anatomic starting point and aesthetic
goals. Not every patient needs liposuction and this decision often needs to be made
in the operating room when patients undergo this procedure.

                If
you’re concerned about this issue, further discussion with your surgeon is
appropriate. Your surgeon should be able to address your concerns and alleviate
your anxiety.

   Fleur de lis tummy tuck can be combined with liposuction.  However, whether the liposuction would add anything would be determined by the amount of fat on your flanks.

Since you have lost 40 kilograms your abdominal wall has been damaged by stretching.  Fascia is the support layer that provides abdominal tone when you are not contracting your muscles.  I recommend a new technique called Ultimate Tummy Tuck to repair your damaged fascia.  This technique helps you lose weight and maintain the reduced weight.  This can be done using the standard size abdominoplasty incision, it does not require circumferencial or vertical extensions.  I do not recommend simultaneous liposuction since it is usually not necessary.  There have been several recent articles published in Plastic and Reconstructive Journal desribing Abdominoplasty with Mesh Reinforcement.

Best Wishes,

Gary Horndeski, M.D.

The Fleur De Lis approach is great when a patient already has a vertical scar. It works very well to remove most of all the skin in the center, which is where most patients carry most of their weight. You probably will not need any additional liposuction. Judicious liposuction can be added to the flanks but sometimes it is safest to do this at another time. Trust your surgeon if you like his/her results. Good luck.

Liposuction is a nice tool and may be helpful for your surgery. It is not a needed to perform your surgery. I am sure your doctor has it available should he or she think it is appropriate to use. Good Luck!

Hello,

Thank you for the question and the photos.  The more excess skin that you have the longer the incisions need to be to achieve optimal results.  Since you have laxity in the vertical as well as the horizontal dimensions as well circumferentially around your waist you would likely be best served by a circumferential lower body lift (tummy tuck in the front, thigh lift on the sides, and buttock lift in the back) as well as a fleur de lis.  The fleur de lis part will improve the horizontal laxity of your abdomen.  This will all result in an incision around your waist all the way around as well as a vertical incision from pubic bone to xyphoid (area in the middle bewteen your rib cage edges).  Liposuction of the flank mat be performed as well but I suspect this would be of secondary importance compared to the removal of tissue in the manner discussed above.

All the best,

Dr. Remus Repta

I think your surgeon has made a good choice of procedure for you. From the photos I do not see any localized areas of excess fat accumulation, and base just on the photos I don't see any pressing need for liposuction, which does add some risk to an already large operative procedure. 

Thanks for your question, best wishes. 

The real question is the liposuction could add additional risks to a very long operation. Not that it is not required. Best to re discuss with your surgeon to fully understand the risk/benefit ratios. 

Certainly some liposuction with the tummy tuck will give you an improved results.  I always include this with the tummy tuck procedure and do not charge extra as most surgeons do.  It is simple and does not require that much time.