Finding a surgeon: Standard TT vs FDL experience/photos? (Photos)

Question

Based on how much weight I've lost (212lbs) and what I think is horizontal laxity (less than ideal photos attached), I suspect I may be recommended to get an FDL tummy tuck over a standard one. I’ve had a bit of a hard time researching surgeons because it seems very few display pictures of multiple FDL results. There are plenty, however, who showcase excellent standard TT results. I have two questions: 1. Is a surgeon’s skill/results with a standard tummy tuck likely to translate well to an FDL tummy tuck? 2. Is it rude or unusual to ask a surgeon’s office directly if you can come and see any FDL results they have, if they don’t have many posted? This would be before deciding to book a consult. Thank you for your help!

Joel Patrick Maier, MD · Answer

It looks like a majority of your skin laxity is below the umbilicus and pubic area. Your muscles are tight and flat. I would opt for skin removal with umbilical transposition and avoid the midline scar and no muscle plication. Sure, you can get additional skin tightening with a vertical extension, but it behooves you to carefully consider . . . unless you simply do not care about a midline scar. What you may want to consider is a circumferential lift to address buttock/outer thigh laxity (if present). Thank you!

Guray Yesiladali, MD, FEBOPRAS · Answer

After a large weight loss, it is common to need a fleur de lis (FDL) tummy tuck to address skin laxity both vertically and horizontally. This is an extension of the standard tummy tuck technique, and surgeons who achieve excellent results with abdominoplasty usually carry those skills into FDL cases as well. What matters most is choosing someone with experience treating massive weight loss patients, since these procedures require more planning and judgment about scar placement.
It is absolutely appropriate to ask a surgeon’s office if they have FDL results you can review, even if they are not posted online. Many patients do not consent to public posting of photos, but surgeons often keep before and after examples available privately for consultations. Asking to see these is not considered rude &mdash; it shows that you are being thoughtful in your decision making.
I have also shared a detailed video where I explain the differences between standard and FDL tummy tucks, and how surgeons plan for the unique needs of massive weight loss patients.
&mdash; Güray Yesiladali, MD

Luis Suarez, MD · Answer

Firstly should always do what feels best for you. It’s an important decision. You should have all the information possible in order for you to feel comfortable with moving forward. 
As far as the FDL incision, it’s not mandatory, usually it’s only recommended when the surgeon is not able to remove all the excess skin pulling down and there’s additional skin left in the upper abdomen in those cases you can have it done and it would definitely improve if you are comfortable with it and it doesn’t bother you then you can proceed without having it done, or later down the road, you want to have it done you can have it done separately. You have many options but overall, if you decide to have it done, you should definitely be comfortable with the surgeon that you choose to make sure that they give you the best outcome.

Michelle Zweifler, MD · Answer

There are several options of tummy tuck after massive weight loss.  A “standard” abdominoplasty usually removed skin downward with scars ending at the hips.  An extended tummy tuck may include remove the front abdominal and flank excess skin.  A lower body lift extended the abdomen and lower back helping to lift the buttock and often decreases the waist.

While a fleur-de-lys you are removing excess skin downwards and centrally with an additional vertical scar.  Fleur-de-lys helps narrow the waist.  Often plastic surgeons perform FDL tummy tuck if there is already a vertical scar and that the patient heals well.

George Marosan, MD · Answer

Thank you for your question and photos. You would do very well with a lipoabdominoplasty with a low pubic bone level incision. You already show good underlying muscle definition and this can be further enhanced with VASER Hi Def Lipo technique. You do not need an FDL! It would be a mistake if you'll take that route. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

Ira H. Rex III, MD · Answer

Many surgeons who specializes in tummy tucks would probably only infrequently do a fleur-de-lis pattern.  A standard or extended tummy tuck will often give the same or similar were better results without the ugly midline scar.  In very few cases do you need to do this much horizontal excision.  It seems to me from your photograph you may not need or want a fleur-de-lis pattern.  Having a consultation with a plastic surgeon certainly sounds like a good idea and after a good examination could they explain the benefits of each type of surgery.  Good luck.

Alper Eskalen, MD · Answer

Hi, I’m Dr.Eskalen from Istanbul/Turkey. FDL has a permanent and visible midline scar which is impossible to hide it. Your current form doesn’t need a FDL abdominoplasty. Only abdominoplasty is enough for you. I hope my message helps you. 
Best regards,Dr.Eskalen.

Mehmet Tapan, MD, FEBOPRAS · Answer

The FDL (Fleur-de-Lis) tummy tuck is an excellent option for patients who have significant laxity and excess skin above the belly button, particularly after massive weight loss. I frequently and confidently perform this procedure for my post-bariatric patients who say, “I don’t care about the scar &mdash; I just want tightness.”
However, in women and younger patients who only have mild to moderate looseness above the belly button, I usually don’t recommend the FDL because the vertical scar may not be worth it aesthetically.
It’s important to know that the scar will initially appear red or brownish. If you're a non-smoker, protect the area from sun exposure, and have lighter skin, the scar is more likely to fade to a pale color over time &mdash; but even then, it will still be visible up close in a bikini or similar clothing.
To answer your questions:
A surgeon’s skill with standard tummy tucks doesn’t necessarily translate directly to FDL (Fleur-de-Lis) tummy tucks. While the procedure isn’t overly complex from a technical standpoint, it does have its own nuances &mdash; especially when it comes to scar placement and tension management.The reason you often don’t see FDL results posted is not because surgeons don’t perform the procedure, but because long vertical scars down the center of the abdomen aren’t considered aesthetically appealing on social media or promotional pages. In plastic surgery, success is often judged by how discreet the scars are &mdash; and FDL scars are, by nature, more visible.That said, it’s absolutely not rude to ask if the surgeon has FDL results they can share privately. It's a reasonable and appropriate question, especially if you’re considering the procedure. Most offices will understand and respect your interest in seeing real outcomes before you book a consultation.

Ahmet Bilirer, MD · Answer

Hello, frankly, nowadays fdl is a method used more for people who have lost a lot of weight. In these days when the perception of beauty is very much at the forefront, the vertical scar on the abdomen causes anxiety in most of the patients. Especially since extended tummy tuck stretches the abdominal skin in the anterolateral plane, it continues to be popular as a good option for many patients like you. Apart from this, there is not much difficulty in tummy tuck surgery with fdl in terms of technique. You can trust a surgeon whose tummy tuck results you like in this regard.
However, when I look at your situation, although it is difficult to examine without a physical examination, I believe that a good result can be obtained with extended tummy tuck without a vertical scar.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  You can ask your surgeon for photos specifically related to FDL  approach.  You may have more luck with photos if researching board certified plastic surgeons who have helped patients after major weight loss.  I appeared on TLC's program Skin Tight which helped those who have lost significant weight restore their appearance.  I've included a video I hope you find helpful.

Finding a surgeon: Standard TT vs FDL experience/photos? (Photos)

Answers (11)

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