Is a FDL Scar Worth It For Me?

Congrats on the weight loss! You have a choice. I don't like the long vertical midline scar of an FDL. My recommendation would be a full abdominoplasty. Also, subcutaneous mastectomies to treat your gynecomastia if you wish. In terms of "abs," the abdominoplasty will help but that also depends on the anatomy of your abdominal muscles.

Unfortunately, after such a massive weight loss, skin does not always contract back down.

You appear to have a lot of excess skin both up and down vertically, as well as around the waist horizontally. An extended tummy tuck only addresses the vertical part and will leave excess around your waist.

In my experience, best results would be a fleur de lis which will greatly reduce and contour your waist as well. Trade off is vertical midline scar which most patients accept. (Bear in mind, many plastic surgeons do not commonly perform this surgery routinely).

Chest reduction can be with Vaser ultrasound liposuction, removal of internal breast tissue and some skin, in my experience, periareolar or donut mastopexy to hide scars (instead of larger excision scars) can be combined with FDL.

An exam and consultation with a plastic surgeon who performs these procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

Dear Helpful875070,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. 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 photos. If your goal is simply to remove the redundant skin circumferentially around the lower portion of your body, then a lower body lift is a very powerful operation to do that. However, it is well known in plastic surgery that the further away your incision is from the skin meant to be smooth/tightened, the less effect there is on that skin. Therefore, the skin of your middle and upper abdomen, which appears to be very redundant in the photo that you sent when you were bending over, will be tighten some, but not completely. In order to achieve the best tightening of the skin a FDL pattern incision would need to be used because the midline incision for the FDL is very close to the upper and mid abdominal skin and will tighten that maximally. Whether this additional incision line is a good trade-off for the extra skin tightening, is up to you to decide. To minimize chest scarring, liposuction of the breast area could be done with direct excision of the glandular tissue and then a periareolar tightening of the skin should give good improvement.

Although not seen in photos, your buttock tissues are likely ptotic. Regardless, once your residual flank fat pads have been suctioned, you’ll have near circumferential skin laxity, so a LBL is necessary. As for your abdomen, it appears as though a vertical scar would be necessary, but an examination would confirm.

Congratulations on your impressive weight loss! You have significant skin laxity including laxity along the midline. If you are wanting the maximum contour an FDL would give that to you. The scars will fade but the contour will remain. An exam is needed to determine if an extended incision is adequate or if a circumferential would be recommended. I've included a video on a gentleman who had a circumferential tummy tuck that I hope you find helpful.

I personally do not like to add a vertical abdominal scar for tummy tuck surgery.
I would generally always start by extending the scar and making it a circumferential tummy tuck a.k.a. lower body lift.
I don’t think the term lower body lift is very good because it doesn’t describe the procedure well.
I personally used the term extended tummy, tuck, or wraparound tummy tuck.
When people lose a substantial amount of weight they develop skin laxity in both the horizontal and vertical direction.
The standard procedure only removes skin in a vertical direction. That means without adding the midline scar there will always be some skin redundancy and the horizontal direction.
Some of the excess abdominal skin in the horizontal direction can be moved towards the back during surgery making the abdomen look good enough to avoid the vertical scar.
From the surgeon’s perspective, the biggest drawback of doing a wraparound procedure is having to turn the patient during surgery.
Some plastic surgeons don’t like to do that and try to do everything from the front.
To me doing a wraparound should be the standard and a vertical scar. It should only be added if it’s absolutely necessary.
Different plastic surgeons have different ways of doing this.
I suggest having multiple in person consultations guide
Bring pictures of yourself to use as a reference during each consultation.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of the before, and after pictures of previous patients who had similar body characteristics to your own.
Take careful notes during each consultation, especially regarding the quality and quantity of before and after pictures shown.
There’s no right number of consultations to find the right provider.
The more consultations you have the more likely you are to find the better provider for your needs.
There are substantial differences in outcomes, depending on who you go to.
Some plastic surgeons are much better at this than others.
This is true Most things in life and definitely it is with plastic surgery.
The worst thing a patient can do is to have only one consultation and then scheduling surgery.
Scheduling only one consultation, more or less eliminates the ability to choose a better provider.
I do not think patients can adequately choose providers without having multiple in person consultations.
I highly recommend avoiding virtual consultations.
When in doubt, slow down and schedule more consultations.
Get a clear understanding of what quality result should look like a previous patients who had massive weight loss like yourself.
Bring copies of quality outcomes of previous patients with similar body characteristics to your own to use as a reference during the consultation as well.
Good luck,
Mats Hagstrom MD