Extended TT with or without an FDL? (Photos)

Question

I met with 4 surgeons that all have GREAT reviews and expected to be able to easily make a decision from there but became even more confused after they each had very different opinions. 1 said 360 TT, that I did not need the FDL. 2 others said only an extended TT, that I would be very happy with my results without the vertical scar. The 4th said that I would not be happy without the FDL, that I would still have quite a bit of loose skin at the top if I did not do the FDL. Thoughts?

Ross Blagg, MD · Answer

Hello,For better or worse there are lots of options for abdominal contouring. Typically, if a patient with your amount of skin is not concerned about scars and wants the best contour, I offer either FDL or a corset trunk plasty (an extension of the FDL). If you want the least amount of scars and are okay with having some excess skin on the upper abdomen (as opposed to a scar), then a standard tummy tuck with extension around the sides and back (a "belt lipectomy" or "lower body lift") would be the better option. So, it can be confusing because there are several options based on your desires. I'll attach a free e-book I wrote about these options that can hopefully help it make sense. All the best in your decision!Dr. BlaggAustin, TX

John LoMonaco, MD, FACS · Answer

You most definitely have a circumferential excess of lose skin...I can see the roll extending around to your backside which is very common after you have lost 90 or more pounds. For that reason, I feel the LBL is a must.
You will have a lot nicer waist contour and less excess when you bend forward of you also do the vertical incision or FDL.  You need to decide if that extra scar and possible slower healing is worth the improved shape.

Aldo Guerra, MD · Answer

Thanks for sharing your experience.I see horizontal and vertical excess of skin in your tummy photos. I would say that adding an FDL to your tummy tuck would be highly beneficial. Speak with your plastic surgeon about the risks before making a decision. See my video link below.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Though we can not see your gluteal region it does appear that you would benefit from a belt lipectomy (360 degree skin removal) with a tummy tuck.  The vertical incision of an FDL can only be determined based on the amount of skin excess you demonstrate in a horizontal dimension.  Hope this helps.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, the best shape and contour could be achieved with a circumferential belt lipectomy, without need for a FDL.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, I agree with recommendation #1. An abdominoplasty with a belt lumpectomy would give you the best results. Revisit your first surgeon and see his/her results by viewing before/after photos. Good luck.

Curtis Wong, MD · Answer

and it appears you have a lot of loose skin, presumably from a major weight loss.  When there is loose skin and you don't want the circumferential body lift, then a FDL is superior to a traditional tummy tuck as for most people that lose weight, they want the skin gone.  The FDL allows for maximum skin removal and also pulls the sides in.  Otherwise if your skin goes around to the backside, then the circumferential procedure would be best for you.  So what do you want???

Cain R. Linville, MD, FACS · Answer

What they probably should have said is that either way you will have a good result, but if you really want to narrow your belly and torso, then you'll need a FDL.  It is basically up to you, and if you're willing to accept the trade off of the scar for that result.  Some surgeons will have certain feelings about leaving someone with that scar.

Karl William Schwarz, MD · Answer

Looks to me like you would be a candidate for an extended abdominoplasty and you would not require any vertical incision because I don’t see a lot of horizontal laxity at the upper part of your abdomen.
 The only question is to whether to do a circumferential versus just an extended tummy tuck but it’s hard to tell from the photos. One thing to keep in mind is that you can always start with an extended tummy tuck and then if you were unhappy in a year or so with the posterior aspect, or the back of your body with excess skin, you can always have a completion circumferential belt lipectomy, meaning you can just do the back part of the operation at the second setting. But I definitely  do not see any evidence from your photos that you would need to have a vertical scar.

Bao L. Phan, MD · Answer

Judging from your pics, you have the appearance of someone who has undergone massive weight loss with gastric bypass surgery.  Usually in this scenario there is significantly more loose redundant abdominal skin to have to deal with than our typical tummy tuck patient.  Most traditional tummy tuck patients have redundant skin along vertical axis, and hence the traditional tummy tuck with the low transverse abdominal scar (bikini line) is sufficient to eliminate this excess with just that scar.  Massive weight loss patients usually also have excess loose skin along the horizontal axis as well, which cannot be addressed adequately with just the transverse scar.  Hence the vertical mid- line abdominal scar can be utilized to remove skin along the horizontal axis (to tighten the skin more circumferentialy arond the waistline to give you tighter skin and accentuate your hourglass figure).  The FDL scar is a lot more visible and there is greater risks for wound healing issues and numbness so that is the downside but it might be worth it if you desire maximal skin tightening and contouring of your waistline.  I would ask to see your surgeons' before and after pics of their traditional vs. FDL tummy tucks to see how the results differ and how the patients looked like before surgery that would require the FDL component.  Best wishes.

Extended TT with or without an FDL? (Photos)

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