Extended or fleur de lis tummy tuck - which procedure would be best for me? (photos)

Hello and thank you for your question regarding an extended or Fleur de Lis tummy tuck.

Based on your history and picture, you need an extended horizontal tummy tuck, which involves an incision from hip to hip. You do not need a vertical component or a Fleur de Lis (FDL) tummy tuck. You have minimal fat in the upper abdominal area, and a well-executed horizontal tummy tuck should correct this defect.

With an extended horizontal tummy tuck, the rectus abdominis muscle is plicated from the sternum to the pubic bone. The excess skin and fat of the lower abdomen are removed, the pubic region is lifted and reduced, and the belly button is reoriented, with the surrounding skin mobilized.

I suggest you inform your plastic surgeon that you do not want a vertical incision due to the highly visible nature of the scar. Most plastic surgeons would agree that it is unnecessary to perform a vertical component tummy tuck on your abdomen. Good luck with your surgery.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

It is concerning that you are not meeting your surgeon in person until the day prior to your surgery, especially given your concerns about making a rushed decision. I would recommend meeting your surgeon in person at least once in advance of your surgical date, with enough time to reflect on your options and whether they are the right surgeon for you, before undertaking a major operation.

Dear Nice460216,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

I rarely perform a fleur-de-lis because of the unsightly vertical scar. Better to accept a little side-to-side skin elasticity. An exception may be a patient with massive weight loss and an existing midline scar. You are not such a patient. I would recommend a full abdominoplasty instead. With lipo of the abdomen and flanks.

It is not possible to give a definitive answer without an actual physical examination. Your photos suggest that a FDL would not be necessary and that a standard or extended tummy tuck would suffice.

If you are having a breast reduction as well as a tummy tuck then I would recommend The Bellesoma Method for the reduction. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This technique also lifts the upper abdomen. You do not need the vertical tummy tuck as you are not a candidate for that technique. You would benefit from a regular tummy tuck.

Best Wishes,

Gary Horndeski, M.D.

Your photos are very helpful. The Fleur de Lis procedure was quite popular among weight loss patients 15-20 years ago, but it does have several shortcomings:

1. The vertical scar above the umbilicus can be quite noticeable and might be disappointing if you want to wear a bikini with your new body.
2. The umbilicus often ends up with a stretched-out, flat appearance.
3. There's usually a disparity in skin tightness above and below the lower incision.

An extended tummy tuck or a lower body lift (circumferential skin excision) can provide significantly better results. The best option for you depends on the amount of skin laxity and a thorough discussion with your surgeon.

Dr. B.

I don’t care for the fdl tummy tuck and you in particular don’t need it . A standard tummy tuck will suffice just fine

Thank you for your query. The Fleur de lis Tummy tuck will give you a better shape as it will narrow your waist fom side to side. However , you will have an additional vertical scar. You may want to discuss this with your surgeon, and choose either an extended tummy tuck with a single hidden scar but with less of a tightening of the abdomen from side to side , or a. fleur de lis tummy tuck with a better shape and waist but with an additional vertical scar. All the best!

Just based on your photos, I think the extended tuck would work very nicely for you and give you good results.