Had 1st consult. I had planned on LBL or extended TT, but surgeon concerned with vascularization of tissue above my belly button & below an 8" horizontal scar about 3 inches above my belly button. I had a WLS 19 months ago & lost 160lb. Vascularization concern due to lifting of skin b/w these areas, thus can't pull down my upper roll of excess skin where this 8" scar is at the bottom of it. After some discussion/options, decided fleur-de-lys best -my back area is not bad 4 excess skin.
LBL, TT, or Fleur-de-lis Given 8" Horizontal Scar 3" Above Belly Button?
Doctor Answers 7
Lower body lift
You look like you have severe skin laxity in all dimensions and would probably benefit from a fleur-de-lis with a circumferential component.
Horiontal scars from previous surgery and abdominal contouring
Previous incisions, especially horizontal incisions can affect the blood supply to abdomen. Your surgeon needs to carefully plan your operation as a result. The concern is the area that will lie between the previous scar and the incision made for the tummy tuck. In my practice, I do not undermine the tissue near one of these horizontal scars if a patient has one due to the concern of damaging the blood supply to skin beneath the old scar. A fleur-de-lis incision or vertical incision, may allow most the old scar to be excised giving the patient the contour they desire in a safe manner. It is best to see a plastic surgeon that has a lot of experience with patients that lost significant weight and who have performed many fleur-de-lis procedures. The complications from this procedure are higher than those of a regular or extended tummy tuck. Best of luck.
Considering a bodylift with prior abdominal scars
Hi Lisey, I would suggest a 360 bodylift. I would suggest this type surgery because it would remove the concern of vascularity. This procedure removes skin and fat from the central torso and should result in a flat abdomen and tighter lateral thighs. I would place the incision high on the pubic region to be sure to completely eliminate the 8 inch scar you describe. I believe your scar may have been from a gall bladder removal. Best wishes in completeing your weight loss journey. Sincerely, Dr Katzen
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Fleur-di-lis excision is a thoughtful and good surgical option for this situation!
I have performed many tummy tucks and lower body lifts in patients with various abdominal scars that give rise to concern about circulation. The length of the scar, the location of the scar, and the length of time since that surgery was performed all play a role in deciding if the circulation may not be enough to prevent healing issues (dead skin). Your surgeon is wise to not only consider this, but also to recommend an excision pattern that will help to reduce these vascularity concerns, but also give you a better and more thorough skin tightening.
Follow your surgeon's advice--it seems right on! Best wishes!
Abdominal Wall Vascualtiy
A fleur-de-lis is a fine option for you because of the horizontal laxity that you have across your upper abdomen. It can definately be done as part of a lower body lift. There are also options for staging your procedure to increase the vascularity.
Congratulations on your weight loss and good luck with your surgery. You should have a beautiful result.
Application of fleur-de-lis incision in abdominoplasty
Based on the picture you submitted, a fleur-de-lis (inverted T) incision may be a good choice, particularly if the 8 inch horizontal scar can be excised within the vertical incision. This would eliminate the problem of poor blood flow below the 8 inch scar. To minimize wound healing problems, it would be better if the skin of the abdomen is not widely undermined.
Compromised Abdominal Wall Circulation
Your pictures demonstrate a tremendous amount of loose saggy skin following massive weight loss. There's no question that you would benefit from surgical intervention. This is especially true in your trunk area where significant rolls of fat and skin exist.
Unfortunately, the presence of an old upper abdominal transverse skin incision complicates the surgical approach. This incision potentially limits blood flow to the area beneath the incision. This area is especially vulnerable because during abdominoplasty it's detached from the deeper sources of blood supply and relies on blood flow from above. This situation can result in skin necrosis and wound breakdown. For this reason, it's important to modify the surgical approach to avoid this type of complication.
Under these circumstances, it's probably reasonable to modify the approach to this problem. By performing a midline excision along with a standard abdominoplasty, most of the old transverse incision can be removed. This would decrease the potential for skin necrosis and removes excess skin in multiple dimensions. This procedure is known as a fleur de lys abdominoplasty.
If you're considering massive weight loss surgery, it's important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.