Do I need a fleur de lis? (Photo)

In my opinion and extended tummy tuck would give you a very nice result without the vertical incision.

The complication rate from a FDL is substantially higher than an ETT or CTT. The recommendation would depend on your goals, acceptance of risk, and would require a physical examination of your tissues. It appears that you have done your research, and it is now probably time for a consultation with a board-certified plastic surgeon.

Based on the photos I would suggest a fleur-de-lis because it tightens your soft tissues in two dimensions - horizontally and vertically. It will also improve the waistline appearance. Good luck!

Based on photos, you have a lot of excess skin up and down as well as across. As such a fleur de lis would give best results. The vertical incision allows for narrowing of the waist which would be limited with an extended tummy tuck.

Unfortunately, after massive weight loss, some stages may be required as skin and tissue healing can have limitations. Hopefully, the fleur de lis would address as much as possible in one surgery. Trade off is larger scar but end result usually justified.

An exam and consultation with a plastic surgeon who performs this procedure is recommended to confirm you are a candidate as well as discuss your options and expectations.

Thank you for your inquiry! We love to meet with you to discuss your concerns. Schedule a consultation with a Board-Certified Plastic Surgery to help you reach your goals.

Hello amyk26,

Thank you for your question regarding the best approach to address your concerns after significant weight loss. Based on your history and photos, I think you would be an excellent candidate for either a 360 body lift or an extended tummy tuck.

A 360 body lift is particularly effective because it addresses excess skin and fat around the abdomen, hips, and buttocks, ensuring that all these areas are tightened and contoured. This procedure provides balanced contouring, creating a more natural and proportional shape by addressing both the front and back of your body.

However, if the excess skin on your backside doesn’t bother you, an extended tummy tuck would be a suitable option. This procedure will address the excess skin on your abdomen and hips. For those with significant skin laxity in the central abdomen, a fleur de lis (FDL) tummy tuck could also be considered. The FDL adds a vertical incision to remove excess skin from the central abdomen, providing a smooth and tight result.

Choosing the appropriate procedure initially can reduce the likelihood of needing revisions in the future. While the 360 body lift and FDL tummy tuck involve more extensive incisions, they offer the best results for those with significant excess skin. The scars from these procedures are strategically placed and can often be concealed with clothing and undergarments.

In summary, a 360 body lift would be the most comprehensive solution to address the excess skin on your abdomen, hips, and buttocks. If your backside doesn’t bother you, an extended tummy tuck or a fleur de lis tummy tuck can still provide excellent results. Good luck with your decision! I hope I’ve answered your question thoroughly and provided useful information.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Hello!
Congratulations on your weight loss!
You may not require a fleur de lis in your case, but will have an extended cut, from what I can see in the photos you have provided.
As always, an in-office consultation is required to really examine your abdomen and your own unique anatomy, as well as discuss the procedure and any questions you may have.
Best,Dr. Tanovic

I think you are going to get some split opinions here. I personally can see why some people would recommend a fleur de lis....but I think you could get a very nice result still from doing a traditional tummy tuck and pulling the skin downward. I don't like to do a fleur de lis unless the patient truly has a lot of midline skin because you are trading it off for a visible scar. I do think you would need an extended tummy tuck for sure because of the skin sagging that goes around the side. You might also benefit from a back lift or gluteal lift for that back skin depending on what your goals and in-person exam is. I would personally first do the extended tummy tuck and then see what further goals you have (if any) for your body. Great job on losing weight and best of luck on your journey!

hello,
Based on your photos, you would definitely benefit from an Extended Tummy Tuck. This is because you have excess skin over your hips. The ETT will also help your buttocks look better, as it will raise them slightly. Regarding the fleur de lis tummy tuck technique, it is possible that your surgeon may need to have a short vertical incision at the midpoint of the horizontal incision. This should be clarified on your initial examination . The morning of surgery, the surgeon should go over EXACTLY where the incisions will be so you are both on the same page.

I would also urge you to consider the Total Body Lift. This would add the Posterior Buttock Lift to the Extended Tummy Tuck. With the ETT you get a full TT + Outer Thigh Lift. If you did a Total Body Lift you would be doing that combination of procedures, plus the removal of loose skin in the posterior back.
The issue is that once your abdomen and hip areas look good, you will notice the back more!! I have been in practice for 30 years, and after surgery I have seen patients start paying more attention to the areas they actively didn't decide to improve .
If you did the Total Body Lift, the recovery would really only be up to 1 week more. However, you can always go back later and just do the Posterior Buttocks Lift.

Hope this helps!

Ricardo L Rodriguez MD
Board Certified Plastic Surgeon
Baltimore, Maryland

Hello and thank you for your question. For starters, congratulations on losing all that weight, that's quite an accomplishment and you should be very proud! From the pictures you have provided, you have a significant amount of striae (stretchmarks) diffusely present throughout your entire abdomen and extending to your sides and even into your back. You also have a severe amount of excess skin and subcutaneous fat present throughout your entire abdomen and flanks (sides) with excess skin predominating in your lower back. There is a significant amount of both horizontal and vertical excess tissue present to your abdomen. Based on all this, you would most benefit from a fleur-de-lis abdominoplasty (tummy tuck) and staged 360 liposuction and possible upper back vs lower body lift to improve your abdominal/trunk contour.
The fleur-de-lis (FDL) abdominoplasty differs from the traditional abdominoplasty in that you will end up with both the standard horizontal lower abdominal scar, as well as a vertical scar extending from the horizontal scar up the middle of your abdomen to the bottom of your ribcage, as you know. In your case, there is such a significant amount of horizontal excess skin and fat, that it would not be adequately addressed with a traditional or even extended abdominoplasty- therefore in order to resect this additional tissue and greatly improve the resulting trunk contour would require the additional vertical scar (instead of just the standard horizontal scar). The horizontal scar should be well hidden within your bikini or underwear, and if you adhere to proper scar care and sun avoidance after surgery, both the horizontal and the vertical scars should eventually heal to be minimally noticeable.
Liposuction is a great adjunct which would definitely provide some additional benefit, particularly to the contour and symmetry of your flanks and back. In your case though, since there would be such a large amount of tissue dissected and resected (cut out) with the FDL, I would recommend delaying the liposuction to be performed at a later time (at least 6 months later). Separating liposuction into a separate procedure is important- this would minimize the risk of wound healing issues during the FDL because the extensive dissection involved compromises the blood supply to the tissues, and liposuction there results in further disruption, increasing the risk of complications. Delaying the liposuction would also allow for a better overall aesthetic result- any asymmetries from the initial surgery could be better corrected during the later liposuction procedure, and the liposuction can be more aggressive, especially to the anterior trunk (abdomen) as everything should be healed by this point so liposuction would not cause issues. This means you could do full 360 liposuction during this second procedure (instead of just liposuction to the flanks and back). Keep in mind, if there is still a significant amount of excess back skin at the time of this second procedure, this would need to be resected at the same time as the liposuction- liposuction alone might otherwise result in a further deflated appearance to your back giving you a poor contour with floppy back skin.
With all that said, it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from any photos and descriptions provided. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon