After weight loss, is a fleur de lis tummy tuck my only option? (photo)

Most tummy tuck candidates have vertical excess (i.e. an abdominal roll). Some (often after massive weight loss), have transverse excess (i.e. upper abdominal midline excess).

In much the same way a horizontal incision/excision can address the traditional lower abdominal roll, a vertical incision (or inverted T/Fleur de Lis) can address the transverse excess. There is a greater scar burden and candidates must decide for themselves if this improvement is worth it.

Anecdotally, most patients will do well with a standard transverse incision tummy tuck. The addition of a vertical scar is much less common and is most typically encountered in the massive weight loss population.

Based on your photos, you will benefit from a Fleur de lis/T abdominoplasty. However, there is no replacement for an in-person exam. The decision is simply a question of skin excess in the vertical and horizontal dimension. For most weight loss patients, the goal is maximal skin excision. However, if the concerns surrounding scar burden outweigh skin related concerns a traditional abdominoplasty remains a viable option.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Donovan Rosas MD

Board Certified by the American Board of Plastic Surgery

Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons

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Dear CharismaShine,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello! Great question. Based on the photo you uploaded, you would be a great candidate for a fleur de lis. This procedure would not only address the skin laxity to the lower portion of your abdomen, but also a lot of the skin laxity to the upper portion and the sides. Not all surgeons are comfortable performing these procedures, so find the right plastic surgeon for you that can address all of your needs! Good luck!

Hello, and thank you for your question regarding whether a Fleur de Lis (FDL) tummy tuck is your only option after significant weight loss. First of all, congratulations on your incredible achievement of losing 166 pounds! That is an amazing accomplishment, and you should be very proud of yourself.

Based on your photos and history, you have excess skin and fat in your abdominal region, along with some degree of rectus abdominis muscle weakness (diastasis recti). This combination leads to a distended or loose appearance of your abdomen. While your surgeon has suggested a Fleur de Lis tummy tuck, which is effective for removing excess skin in both horizontal and vertical directions, it is important to know that this is not your only option.

A Fleur de Lis tummy tuck does carry higher risks, particularly a higher rate of wound breakdown, especially at the intersection of the horizontal and vertical incisions, often near the mons pubis area. Studies indicate up to 70% of patients experience some degree of wound healing issues with this procedure. Because of this, many experienced plastic surgeons reserve the FDL tummy tuck for patients with extreme skin laxity in both directions.

For you, a better alternative may be an extended tummy tuck. An extended tummy tuck can address most of your concerns without the vertical scar of an FDL. This procedure removes excess skin and fat, repairs the rectus abdominis muscles, lifts and reduces the mons pubis, and recreates a natural-looking belly button. Since most of your excess skin and laxity appear to be horizontal, an extended tummy tuck should provide dramatic improvement without the added risks of a Fleur de Lis.

Your current surgeon may not offer an extended tummy tuck, but that does not mean it is not an option for you. I encourage you to consult with other board-certified plastic surgeons who specialize in post-weight loss body contouring. Many highly experienced surgeons will offer alternatives to an FDL, such as an extended tummy tuck, which can still provide excellent contouring without the additional vertical scar.

I hope this helps clarify your options. Best of luck in finding a plastic surgeon who aligns with your goals!

Sincerely,
Dr. Katzen

Thanks for your question and picture. Congratulations on your weight loss! Great job in maintaining your new weight. Remove the excess skin can be the next step in your body transformation. Based on your picture, I would recommend a lower body lift. This procedure will address loose skin not only to your abdomen but also your lower back and hips. You will get a lift to the buttocks, hips, groin, and tummy. You would potentially still need a fleur de lis component with the vertical scar in the front. The fleur de lis tummy tuck or fleur de lis lower body lift can be done in one stage safely. Consult with another board certified plastic surgeon for an in person exam.

I believe that a regular tummy tuck is an option if you understand exactly what it can and cannot do. A plastic surgeon could let you know what to expect from a regular tummy tuck, and this might make you quite happy!

That’s an incredible amount of weight loss—well done! It’s great that you’re looking into options to address the excess skin.

You are a good candidate for a lower body lift, which is the best approach for removing excess skin, particularly on the sides. Secondarily, you may be a candidate for an extended tummy tuck, but the lower body lift would provide the most comprehensive improvement. The key is achieving a great contour with an aesthetic scar while avoiding the midline scar of a fleur-de-lis. Dr. B.

Thanks for your question! Congratulations on your weight loss! I would encourage you to you to strongly consider the FDL. You will still have quite a bit of horizontal laxity if you only commit to the full tummy tuck. Good luck!

A fleur- de-lis is a type of tummy tuck that combines the conventional lower abdominal horizontal incision of a tummy tuck with a vertical extension in the midline that allows the surgeon to pull not just in the up-and-down direction, but also in side to side direction. It’s usually reserved for patients who have undergone massive weight loss usually due to bariatric surgery. Based on your pictures, I would say that you are an excellent candidate for a fleur-de-lis if you have no medical contraindications. The severity of the loose skin that you have would be very difficult to correct with a conventional tummy tuck. Additionally, you have some mid back rolls which may need to be excised on their own.

Thank you for your inquiry and congratulations on your weight loss! You have excess abdominal skin making you a great candidate for an Abdominoplasty procedure. We would love to see you in person and help you reach your goals. Schedule a consultation with a Board-Certified Plastic Surgeon like myself and we can create a surgical plan for you!