Is this excess skin or fat? Would I need a fleur de lis? (Photo)

Hello!
This is a great question! Congratulations on your weight loss journey!
It seems that you do have some thickness of your abdomen, as well as loose skin. Since you are now taking semaglutide, this can cause further weight loss and it is best to be steady with your weight before deciding to undergo surgery.
From your photos, it seems as though you may be a candidate for liposuction and a tummy tuck. As for FDL, that would require an in person consultation, after you are done losing the weight, as sometimes our bodies have a way of retracting after weight loss.
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

Thank you for your questions and photos. Congratulations on your weight loss! From your photos, you would be a good candidate for a tummy tuck (below bikini line/horizontal not FDL scar) with liposuction. A tummy tuck will address excess skin & repair of the abdominal muscle. The abdominal wall can be weakened after pregnancy and (or) significant weight gain & loss. By repairing the muscle, not only does the appearance of your abdominal area improve, but your core strength as well. The repair of the muscle will cinch your waist like an inner corset, lift your pubic mons area and accentuate your curves. Liposuction will remove excess fat from unwanted areas with some skin retraction. Your expectations and health will dictate the best procedure(s) for you. I suggest a consultation with a board certified plastic surgeon who has experience with high weight loss patients to go over the options that best address your goals. Best of luck! Dhaval Patel MD Double Board Certified Plastic Surgeon South Barrington Oakbrook Terrace Orland Park

"Congratulations on your incredible weight loss journey! With the amount of weight you've lost, and your pictures, it's common to have both excess skin and some remaining fat. The Fleur de Lis tummy tuck might indeed be a great option for you, as it's specifically designed to help with the kind of excess skin that results from such significant weight loss. You may need to extend the tummy tuck incision completely around your lower back in what is called a circumferential tummy tuck or lower body lift. That procedure also has the benefit to elevate your outer thighs and buttock. There is a visible back bra roll which extended into the upper abdomen and will remain after these procedures unless you add an additional procedure such as an upper body lift with a partial reverse tummy tuck as a second stage surgery. There may be additional procedures down the road such as a breast lift, arm lift, and/or thigh lift to completely remove all of the residual excess skin. These are all powerful and transformative procedures that can offer you great results. As you consider your options, research out several board-certified plastic surgeons, look at their before and afters and reviews on cases like yours to make sure they have a vast experience treating patients for body contouring after massive weight loss. Ultimately, a personal consultation with a board-certified plastic surgeon will provide the best guidance for your individual case. Good luck continuing your journey!!




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Yes, in your case an extended tummy tuck with a vertical extension would address the skin laxity. There is too much lax skin in the upper abdomen to avoid the vertical extension.

Thank you for your question and providing the photos. You have stretch marks all over your abdomen. You have a lot of excess skin on both upper and lower abdomen. You still have some fat in your abdomen. There is also a serious amount of skin sagging in your waist area. I recommend a 360 body lift. In this way, you can get rid of both sagging in the abdomen and sagging in the waist in one session.
Kind Regards

The need for a fleur de lis tummy tuck is based on the circumferential width of your abdomen above the umbilicus. However, this can be changed by a breast lift, which will lift the breasts higher and pull up the skin from the upper abdomen and some of the side skin, as well as a circumferential body lift. You may not need a fleur de lis but it is a possibility.

Best Wishes,

Gary Horndeski, M.D.

Dear Fresh567,

Thank you for reaching out with your question and providing both your history and photos. First and foremost, congratulations on your remarkable weight loss journey!

Upon examining your abdomen, it's evident that you have an excess of both skin and fat in both horizontal and vertical dimensions. It's essential to note that while further weight loss may reduce fat, it will not address the excess skin. Given your current state, I believe you are at a point where reconstructive plastic surgery, especially body contouring after significant weight loss, would be beneficial.

For your specific case, a fleur-de-lis incision might provide the most optimal results. However, if you prefer not to have the vertical component (which is the incision running from the sternum to the pubic region), you have the option to undergo a horizontal tummy tuck or even a 360 circumferential lower body lift. The advantage of the 360 circumferential body lift over the tummy tuck is that it addresses not just the abdomen but also the hips and buttocks.

Later on, if you so choose, you could undergo a vertical tummy tuck with the incision extending from the sternum to the pubic region. Alternatively, there's the option of a vertical torsoplasty, where the incision runs from your armpit to the top of your hips, providing more of an hourglass shape and bypassing a vertical scar on the abdomen. Some of my colleagues refer to this as a lateral tummy tuck.

In my opinion, starting with an extended tummy tuck or lower body lift seems prudent. Afterward, a reassessment of the abdomen would be beneficial. You might find that a secondary procedure with vertical incisions on the side of your torso, known as a vertical torsoplasty or hourglass procedure, would yield the desired results.

Best of luck with your decision and journey ahead. I'm here to support and guide you through each step.

Sincerely,
Dr. Katzen

Thank you for sharing your question and photographs and congratulations on the impressive weight loss. Based on the pictures alone, it does appear that you will most benefit from a FDL abdominoplasty as you have excess abdominal skin, and some residual adipose tissue. Depending on your goals I would continue your regimen of diet and exercise until you reach your goal weight/size before pursuing surgery but a nice level of improvement could be obtained now. Hope this helps.

Thank you for your question and congratulations on your weight loss! It is always best to seek an in-office consultation and be examined in person by a board-certified plastic surgeon. I would first recommend that you complete your weight loss journey before seeking surgery. Allowing yourself to complete your weight loss journey before surgery will decrease your surgical risk profile and also give you your best cosmetic results from surgery. I would recommend seeking consultation once your weight has been stable for several months.
You could consider having a traditional abdominoplasty or a fleur-de-lis abdominoplasty depending on your wants and expectations. A fleur-de-lis procedure would result in a long vertical scar, but would help to remove additional skin and fat. After either procedure you will still have visible stretch marks and the fleur-de-lis would likely not be able to remove all of the stretch marks.

Fleur-de-lis abdominoplasty is a good options for patients who have lost signifiant weight. It removes excess skin and fat in the vertical and horizontal dimension.