360 FDL tummy tuck vs 360 tummy tuck - which will I need after 200 pound weight loss?

Question

Male, 21, 6ft 2in. I lost about 200 pounds and have been looking into surgery and was wondering if I needed the regular 360 or the fdl 360. I don’t really want the central incisions.

Harry T. Haramis, MD, FACS · Answer

After such a tremendous weight loss, in my experience, FDL is a powerful procedure to remove excess skin both up and down as well as around the waist.

Traditional tummy tuck only removes skin up and down or vertically.

So it’s like wearing an over sized shirt and tucking it into your pants- it’s still too big around or horizontally.

The FDL addresses this, including those extra upper bulges- trade off is the extra midline scar.

If you are really opposed to the FDL scars, you can do a traditional tummy tuck with good result.

Those stubborn bulges will be improved, but likely remain smaller even with 360 liposuction.

We have had similar patients return for second stage FDL as well.

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.

Warren Schutte, MD · Answer

In person consultation is needed but you should have options for FDL, vs standard extended tummy tuck. You have some vertical laxity and education about some excess skin, vs the added vertical scar will help you make a decision. It is likely that you will need some kind of back lift but I advise doing these surgeries at different times. Front as stage one, and back as stage 2 for your best aesthetic outcomes on both surgeries.

Gerald Minniti, MD, FACS · Answer

A traditional tummy tuck mostly serves to remove skin excess in the vertical vector. Although some horizontal skin excess can be captured as well, you would be best served with a FDL which captures both vertical and horizontal skin excess.

Daniel Barrett, MD · Answer

Dear Dxny173,

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. Flanks liposuction would give you a better shape. 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

Jeffrey M. Darrow, MD · Answer

Congratulations on your weight loss and thank you for your photos. I believe a regular 360 body lift would remove the majority of your loose skin and help you avoid the central incision. The central incision is performed to tighten the upper abdominal skin and pull in the waist. You have only a small amount of upper abdominal laxity/redundancy, your waist is already very well contoured from your weight loss and should be corrected with the regular 360 body lift.

Gary M. Horndeski, MD · Answer

I do not believe you will need a fleur de lis. A fleur de lis is for horizontal excess. Your excess appears more vertical. You would benefit from a 360 body lift. It can be in 2 stages, the anterior first and then the posterior second, if needed.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Semih Yildiz, MD, FEPOBRAS · Answer

After a 200-pound weight loss, the choice is usually based on the direction of the loose skin. In the photos, there appears to be both circumferential lower trunk laxity and a significant vertical excess through the central abdomen, which is the situation where an FDL component is often considered.

A 360 body lift can improve the waist, lower abdomen, hips, and back, but it may leave central abdominal looseness if there is too much side-to-side excess. An FDL adds the vertical scar you are trying to avoid, but it can remove and tighten skin that a horizontal-only incision cannot address as well. If the central scar is unacceptable to you, a 360-only plan may still be possible, but you should be prepared for a less tight central result or possible staged revision after an in-person exam.

Yasemin Aydinli, MD · Answer

Congratulations on a 200-pound weight loss &mdash; that is a huge achievement. The core difference between the two is the direction of skin they remove. A standard circumferential (360) tightens your whole trunk from top to bottom and removes a belt of skin all the way around, but it does not take in side-to-side (horizontal) looseness across the upper abdomen. The FDL adds a vertical midline incision specifically to remove that horizontal excess and cinch the waist. So the real question is how much side-to-side loose skin you have, especially in your upper belly.
Looking at your photos, a few things stand out. You have lost the weight beautifully and are now slim, so this is about loose skin, not fat. On your front view, the laxity is not only up-and-down &mdash; there is clear horizontal, side-to-side crinkling and redundant skin extending across your upper abdomen, not just a lower apron. That upper-abdominal, transverse looseness is exactly the pattern a standard 360 tends to leave behind, because a circumferential tuck mainly tightens vertically and around the trunk rather than across the width of the belly. From these images, you look like someone who would most likely get a noticeably flatter, tighter upper abdomen with the FDL component, whereas a 360 alone could leave residual horizontal crinkling up top.
I do understand not wanting the central incision, and it is a fair priority &mdash; the vertical scar is permanent and visible, and that is a real trade-off against a flatter contour. What I can tell you from photos is only an estimate; the definitive test is an in-person exam where the surgeon pinches your upper abdominal skin to see how much it gathers side-to-side versus up-and-down. If most of your excess turns out to be vertical, a 360 may be enough; but given the horizontal looseness visible in your photos, I would want you to go into your consultation prepared for the likelihood that an FDL would give you the result you are hoping for, and to weigh that against your wish to avoid the midline scar.

Ramiro Morales, Jr., MD · Answer

Thank you for your questions and pictures and congratulations on your weight loss.  While a FDL 360 will correct better that vertical looseness that your picture demonstrates, I believe that with good distribution of the skin during closure you could achieve a decent result and still avoid the vertical scar.  Which, by the way, could be added in the future to convert the TT to a FDL TT if necessary. 
Be sure to see a  Board-Certified PS for your consult.

David Shokrian, MD · Answer

Hello and thank you for your question. Upon reviewing your photos, a Fleur de Lis Tuck would be a superior technique for you as it addresses both the midline laxity of the skin as well as the skin hanging downwards in the horizontal position. This would give you maximum skin pull and a very nice result. It’s a technique often used in patients with your level of skin laxity and weightloss. Make sure you’re nutritionally optimized and that your surgeon checks your albumin and pre albumin levels before surgery to ensure proper post op healing.

360 FDL tummy tuck vs 360 tummy tuck - which will I need after 200 pound weight loss?

Answers (10)

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