Can the fleur-de-lis panniculectomy cause a look like a front bum as you age and lose collagen in your skin? (Photos)

Dear ducky654,
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. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for your question regarding what to do with your abdomen after massive weight loss. Also, whether you would have a front bum as you age and lose collagen in your skin after a fleur-de-lis panniculectomy.  First of all, congratulations on your significant weight loss. Truly, this is a great achievement. In regards to your abdomen, I would suggest either an extended horizontal tummy tuck or high lateral tension abdominoplasty. During both these procedures, an incision is made in the lower abdomen, dissection is made to the lower rib cage, and the rectus abdominal muscles or intra-abdominal muscles are sutured together permanently. Then, the excess abdominal skin and fat is pulled down and removed. Typically, the area of skin from the top of the pubic region to above the belly button is removed. During the high lateral tension abdominoplasty or extended abdominoplasty, your skin and fat is pulled down and mobilized in such a way that an upper incision is not needed. In my opinion, I think you will get excellent results just with an extended tummy tuck or high lateral tension abdominoplasty with rectus abdominis muscle plication.  The reason you get that front bum look after a panniculectomy or “fleur-de-lis” panniculectomy is that the muscles are not sutured together.   You do not need a vertical scar; you just need a good extended tummy tuck or high lateral tension abdominoplasty with rectus abdominis muscle plication.  I think these procedures would be far better than a “fleur-de-lis” panniculectomy.  
I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the panniculectomy, tummy tuck, extended tummy tuck, high lateral tension tummy tuck, abdominoplasty, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or extended tummy tuck are big procedures, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or extended tummy tuck. Do your research.  Make sure they have performed at least 100 panniculectomies or extended tummy tuck surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, panniculectomy or extended tummy tuck surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

You will have to decide whether the vertical scar is worth the improvement in smoothness and contour. The fleur de lis TT is for patients with extremely redundant abdominal skin after massive weight loss or bariatric surgery. Often, candidates for the fleur de lis have an abdominal region that is wider than the hips. In a fleur de lis, excess skin and fatty tissue are removed and abdominal muscles can be repaired through a standard TT incision as well as a vertical incision in the center of the abdomen.  Photos do not indicate that you need a FDL; a TT should provide the results you are seeking.