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

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.

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.