Would I need a Fleur de Lis or could a regular tummy tuck take care of most of my loose skin? (Photos)

After losing 145 lbs., it is most likely that your breasts are drooping. The reason I mention the breasts is that there is a breast lift technique called The Bellesoma Method, which lifts the breasts and also the upper abdomen. By lifting the upper abdomen then there is less loose skin and you will not need a fleur de lis. I always do the breasts first because doing the abdomen first makes it harder to lift the breasts as high as possible. You will not need a fleur de lis as you do not have enough horizontal width. You will need a regular tummy tuck with a circumferential body lift. I would recommend doing the breast lift and tummy tuck at the same time and if needed then a posterior continuation for the circumferential body lift.

Best Wishes,

Gary Horndeski, M.D.

Hello and congratulations on your weight loss!You do have both vertical and horizontal skin laxity. A FDL would excise more skin and lead to a tighter result but you will have a vertical scar. If you want to avoid the vertical scar, you will still have a nice result with a standard abdominoplasty with a hip to hip incision.

Your photos seem to indicate transverse laxity sufficient enough to warrant a FDL tummy tuck. However, you don't burn any bridges having a conventional tummy tuck and seeing the results first. No harm except for having a second surgery, which isn't too uncommon for massive weight loss patients anyway.