Been to 3 dr's for a consult, each has given me a different opinion regarding the amount of skin above my belly button.

HI cfunyny, I think that you would do fine with a full tummy tuck and get a very nice result You also get a great benefit with the tightening of the rectus muscles. Congrats on your weight loss too. Best,Dr. Christine Rodgers

Thank you for your question and photographs and congratulations on your weight loss!  It appears that you would do well with a full tummy tuck and not a fleur de lys.  The tummy tuck will tighten your stomach muscles, helping to achieve a flatter appearance, while removing excess skin and adipose tissue in a vertical direction.  Hope this helps.

Congratulations on your weight loss; As mentioned in previous posts, the best way to determine this is in the operating room. However, a surgeon with experience will be able to tell you the chance of requiring a small vertical incision.  I personally do not like the top down approach as the lower scar can then end up higher than optimal. Hence, you could end up with the entire scar located above your underwear line. The key to the procedure is having the final scar low such that it is well concealed; a small vertical extension to a well placed low scar will be well concealed and unnoticeable with clothing. Pictures can be deceptive; I have had patients who appear to have such tight skin on the photo but have not required a vertical incision(patients # 3 and 4 on my website under tummy tucks). Surgical technique to appropriately loosen the tissue is important too. With good technique a vertical incision can be avoided in many patients. 

Generally, in a tummy tuck, the skin of the tummy up tp the belly button is removed during the surgery. In certain cases, when patients are skinny, the amount of skin to be removed reaches bellow the belly button, thus leaving a small vertical scar secondary to the closure of the original belly button opening. This is common in patients undergoing tummy tuck revision. In my practice, skinny patients may be able to remove all the lower tummy skin up to the belly button when they undergo either a traditional or brazilian butt lift. For that the patients usually have to walk and remain bent for at least 2 weeks. However. I advice my patients that there is always a possibility that the skin above the belly button may not stretch that much and that a vertical scar may be necessary in order to keep LOW the tummy tuck horizontal scar.

Thank you very much for your question.Based on the pictures, I think you would be an excellent candidate for a full tummy tuck with muscle tightening.  If you are left with a vertical scar, it would be a very small one, and located very low in your abdomen and easily covered by your underwear.  If after 6 months, the small vertical scar still bothers you, it can usually just be cut out and you would only be left with the low horizontal scar.Again, this is based on the pictures alone.  Regarding the surgeons, I would pick the one that you feel has the best approach and can deliver the result you desire through that approach.  Best of luck!

You need a standard tummy tuck with a suprapubic scar. I do not think you need a vertical scar at all.An examination would be helpful

Dear cfunyny,

Based on the position of you belly button relative to your
groin and the amount of skin from your belly button to your ribcage, I do not
think it will be a problem to avoid the Inverted T scar with your
abdominoplasty. Now, other surgeons may
have a different opinion, as their comfort level and experience in performing
abdominoplasties may vary. Additionally,
there can be some confounding issues that may modify how aggressive a surgeon
will feel about pulling your abdominal skin tight (eg: smoking).

Technically, an abdominoplasty is normally started from the
lower incision (especially if you have an existing c-section scar), and the skin
is lifted off the abdominal wall up to the rib margin. It is then stretched down to see how much can
be removed. Only at this stage can a
surgeon be sure that the old belly button hole can be pulled past the lower
incision, thus avoiding the inverted T.

Another option (for patients with no existing scars on their
abdomen) is to start with the upper incision, and then see how low the scar can
be made prior to making the lower incision.
This “Top Down” abdominoplasty guarantees that you will not have an
inverted T scar, and can allow the surgeon to pull the skin tighter due to a
better overall blood supply to the distal skin flap.

Based on the anatomy shown on your photographs, I would
suggest avoiding the surgeon who does not think you have enough skin, as I question
their experience level with tummy tuck operations.

Dear Ms. Cfunyny,I applaud your search and different answers.Thank you for your question and information about yourself. Unfortunately without photos and a examination I can advise you in general terms, however I hope you will find them helpful.Bottom line: it is difficult to give a 100% answer based on your anatomy and skin "stretch"   that can only with certainty be dtermined intraoperatively.In general:1) incisions are usually placed as low as possible.personally gave the patients bring a bathing suit bottom or panties of their choiceto ensure the placement of the incision is where they want it.2)in thin patients with long torsos and little redundant skin may require a a small vertical scar centrally located. This is where the your orginal umbilicus was located. The trade off is to have a lower horizontal scar for a temporary small vertical scar. This small vertical scar can often be resected under local anesthesia and converted/combined with the horizontal scar 9-12 months later when the skin loosens3)there are four types of abdominoplasties. A-C All have horizontal incisions and D has a significant vertical compotent.A) mini- muscle tightened below umbilicus to pubic boneB) standard- muscle tightened from breast bone to pubic boneC) extended as in standard but incision longer to excise excess skin/fat in outer thigh area D) fleur de lis- same as standard but in addtion excess skin/fat excised in a vertical directionPlease make sure your chosen Plastic Surgeon is experienced and Certified by the American Board of Plastic Surgery and in addition ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).My best wishes,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600

The lower the incision the greater the chance that you might need the vertical scar, usually called an "inverted T".  I find that more patients are willing to accept the inverted T in order to  get the lowest possible scar but the truth is, every human's skin has it's own elasticity and the amount removed can differ from person to person. That can only be determined once the skin has been peeled away from the muscle. At that point in the operation I typically split the flap from the belly button down and advance it as far as I can with the table in flexion. When the skin is fully stretched it just stops coming and the skin excision is defined. At that point the decision is made (for doctor and patient) and if part of the split remains, that defines how tall the inverted T will be. If the incision is a little higher above the pubus the scar will be higher but may avoid the "T". I draw this on my patients skin with a water color if it is unclear. Once you pick your surgeon you might consider asking him to do that as he may offer a choice. Some patients do prefer a higher scar option over a "T".

Based on your photos I find it hard to believe a well trained and experienced surgeon would not do a full TT with a low scar and no vertical scar.