Can a FDL be combined with a lower body lift? (Photos)

Question

I have lost 125lbs and researching for a MMO. Currently I am 190lbs and 5'7". Would I benefit more from a lower body lift or a fleur de lis? Can the 2 be combined? I don't care about the scar. I want my mid section to be as small and tight as possible. Also, I am currently a 38DDD and I will choose gummy bear implants. To maintain my current cup size how many cc's would you suggest? Under or over the muscle for the most natural shape? Thank you in advance!

Carmina Cardenas, MD · Answer

It is almost impossible to determine quality of tissues on photos, but based on yours, I consider you will be a great candidate for a Lower Body Lift (Circumferential TT, Muscle repair, Buttocks lift) in order to achieve the best result. I may also combine with some liposuction to waist and lower back and a mild fat grafting to buttocks, just to add some curves to your body shape.Based on photos, I consider the FDL might be unnecessary.Be encouraged.Dr. Cardenas

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding whether a fleur-de-lis (FDL) tummy tuck can be combined with a lower body lift. Congratulations on your impressive 125-pound weight loss!

A fleur-de-lis (FDL) abdominoplasty can absolutely be combined with a lower body lift. The FDL tummy tuck involves both a horizontal incision (like a traditional tummy tuck) and a vertical incision from the sternum down to the pubic region. This removes excess skin from the central abdomen, creating a more dramatic waist reduction. Some plastic surgeons refer to this technique as an inverted-T tummy tuck due to the shape of the incisions.

A lower body lift is a more comprehensive procedure designed to tighten and lift the abdomen, hips, outer thighs, and buttocks. The incision runs circumferentially around the waist, removing excess lower abdominal, flank, and back skin, which the FDL alone does not address. Combining both procedures offers the best of both worlds—a tight, defined waistline and complete lower body contouring.

For the most "snatched" waistline, many experienced, board-certified plastic surgeons recommend combining the FDL with a lower body lift. This approach removes excess skin from both the front and back while also narrowing the waist more effectively than a lower body lift alone.

Regarding your breast augmentation, if you wish to maintain your 38DDD cup size, most plastic surgeons would recommend an implant size of approximately 600cc, depending on your breast tissue and the amount removed during a full anchor mastopexy (breast lift). Silicone (gummy bear) implants are an excellent choice for a natural, long-lasting result. For the most natural shape, most plastic surgeons would recommend placing the implant in a dual-plane position, meaning the implant is partially under and partially over the pectoralis major muscle. This technique provides a natural slope while supporting the implant to reduce sagging over time.

I hope this helps answer your question regarding whether an FDL tummy tuck can be combined with a lower body lift, as well as your concerns about breast implants and maintaining cup size. Best of luck on your transformation!

Sincerely,
Dr. Katzen

Juan Pablo Cervantes, MD · Answer

hi!! Yes a body lift can be combined with an fdl. We do this type of procedure when lenght and width are the problem. In fact to decide we have to feel or touch the skin/ fat so we can relay on skin quality. We dont do combination with breast surgery when doing an fdl. We only do it with a normal body lift. Thank you!! Dr C.

Jonathan Amspacher, MD · Answer

Congratulations on your massive weight loss.  With or without surgery that is a stunning accomplishment. You will want your weight to be stable for about 6 months in most cases before surgery.  If you continue to lose large amounts of weight (more than 15 lbs) then you can lose some of the benefits of surgery and have a recurrence of the loose skin.   You can usually achieve a great outcome with a lower body lift in the hands of a skilled surgeon that is used to working with massive weight loss patients.  I would not recommend a fleur de lis(fdl) incision unless you already have a large midline scar.  The fdl incision will limit your choice in swimwear and not give you enough extra improvement in most cases to warrant how bad the scar looks.  Also the lower body lift goes all the way around and gives the chance to perform a purse string gluteoplasty or buttock augmentation that can greatly improve your buttock profile at the same time as surgery.  
A breast augmentation and lift will help correct the deflation that you have after your massive weight loss.  Most patients end up getting an implant in the 350-500 cc range based on their Breast dimensions.  I will usually measure a patient and then I make a recommendation of a range of implants that would fit their breast profile.   I will let you try implants in a snug fitting sports bra to let you make the final decision about which size works best for your desired goals of fullness. I usually recommend below the muscle placement of breast implants because that consistently gives the best outcome with the lowest risk of complications.

Manuel Ventura Gonzalez, MD · Answer

Thanks for your question, mrsangieross. After evaluating your photos my recommendation would be to perform a tummy tuck in the abdomen area which allows to remove all excess of skin while repairing the muscles inside without resulting in a horizontal scar, only a vertical scar would be visible, said scar would be more conservative-looking and could be covered with a bikini.
In the breasts area I would recommend a breast lift without using implants since you have a lot of skin on your breasts which would perfectly allow a lift, although they will be reduced a bit.
If you want to have the same size you could place the breast implants of your choosing, their size could be determined in a personal consultation.

Paul C. Dillon, MD · Answer

I think you are a great candidate for a lower body lift. In order to really get the result you want you will need to reduce skin on the abdomen hips an buttocks. Let me congratulate you on your weight loss results! The next step is skin reduction. You will need to take a week off from strenuous activities and someone will need to check in on you during your first week of post operative care. I hope that helps but feel free to post any other questions regarding your concerns.

Thank You.

Thank You.

Peter Fisher, MD (retired) · Answer

Hello and thank you for your question. Congratulations on your weight loss. You would certainly get best results from a lower body lift which in my hands includes : 1. A full tummy tuck. 2. A mons lift. 3. A strong lateral thigh lift. 4. A buttock lift. 5. Auto augmentation of the buttocks and hips. The hip flap is designed to help increase or maintain your hip / waist ratio. A fleur-de-lis can be performed with this. Beware implants when performing a breast lift in large breasts such as yours. Would use small about 250 to 300cc if any at all.Peter Fisher M.D

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