What are my options to fix indentation from horizontal skin laxity? (Photos)

Question

I’m currently a 30 y female who lost 130 pounds at age 22 and underwent a long line tummy tuck to remove excess skin (as well as breast reconstruction which also didn’t yield good results.) Ever since the procedure I have had a large horizontal indent above my belly button. I’m aware that this is because the surgeon pulled my skin down and it didn’t fix the horizontal skin issue. I should have gotten a full fluer-dis-lis procedure. Even when I got to an underweight BMI, the large indentations were still there. I wanted to know what my options could be.

Emre Guvercin, MD, FEBOPRAS · Answer

What you’re describing is a classic result of vertical-only skin excision in a patient who had significant horizontal laxity from massive weight loss. A standard long-line tummy tuck removes excess vertical skin (up–down), but if there was also excess side-to-side (horizontal) skin redundancy, pulling the skin downward alone can create a fixed indentation or tethered contour above the umbilicus. This is not something that improves with weight loss, as you’ve already experienced, because it’s a structural skin distribution issue rather than fat.The most definitive correction in cases like this is a revision abdominoplasty that addresses the horizontal component&mdash;most commonly a fleur-de-lis abdominoplasty. This adds a vertical excision to remove excess side-to-side skin and redistribute tension more evenly, which can smooth out the indentation. In some cases, selective scar release with fat grafting can soften the contour if the indentation is primarily due to tethering rather than excess horizontal skin, but if the issue is true skin redundancy, grafting alone will not correct it.
In short, if the indentation is due to unresolved horizontal laxity, a properly planned fleur-de-lis revision is usually the most reliable and permanent solution, whereas minor procedures or non-surgical treatments will not meaningfully fix the structural imbalance.

Jacob Carlson, MD · Answer

Congratulations on your weight loss! That is very impressive.
I agree with your assessment that there is persistent excess skin circumferentially around your torso. That could be address by performing the vertical component of a fleur de lis abdominoplasty. The tradeoff for that is that it would result in a long midline abdominal scar, similar to a laparotomy incision. But that would allow the surgeon to remove skin from both sides to address the redundant/lax skin in the center of the abdomen. Do you know if abdominal wall plication was performed during your first abdominoplasty? Your surgeon could also perform plication during this secondary procedure as well, if necessary.

Kadir Berat Oyur, MD · Answer

Thank you for your question.
A reverse tummy tuck could be a suitable option for addressing upper abdominal skin laxity and improving the horizontal indentation.
To determine the best approach for your needs, a consultation with clear photos is recommended.
Hope this helps!

Laura Roider, MD · Answer

Thank you for sharing photos. Based on the photos submitted and your surgical result it seems likely that you would have benefited from a FDL procedure. It is still possible to address your concern! 
Based on your photos you seem to have residual laxity in the abdomen above your belly button in addition to the indentation in the upper abdomen. If the only thing that bothers you is the indentation, I would recommend doing a vertical excision in the upper abdomen (from belly button to sternum). The significant trade off to this would be the resulting scar (similar to the FDL scar).

Mehmet Ozdemir, MD · Answer

Hi and thank you for your question.
Based on your description, you are suitable for a reverse tummy tuck. This procedure can address upper abdominal skin laxity and help improve the horizontal indentation.
A consultation with clear photos is necessary to confirm the best approach for you.
Hope this helps!

Guray Yesiladali, MD, FEBOPRAS · Answer

As you mentioned, this condition is related to horizontal laxity that typically develops after significant weight loss. Standard abdominoplasty techniques are often insufficient in these cases because the excess is not only vertical but also transverse.
To properly address horizontal laxity, a fleur-de-lis abdominoplasty is required. This technique includes a vertical incision extending from the lower chest toward the pubic area, incorporating the umbilicus. It allows removal of excess tissue in both horizontal and vertical directions.
Without this vertical component, achieving adequate tightening in cases of significant horizontal redundancy is generally not possible.
A detailed examination is necessary to confirm the degree of laxity and plan the appropriate surgical approach.
I wish you a smooth planning process and a result that restores both contour and comfort.
&mdash; Güray Yeşiladalı, MD

Camille Cash, MD · Answer

Congratulations on your impressive weight loss and maintaining it!  Based on your photos and description of your concerns the best correction is to revise your tummy tuck.  Weight loss will not fix the situation as it is related to skin laxity and not excess fat.  Visit with a board certified plastic surgeon near you to learn more.

What are my options to fix indentation from horizontal skin laxity? (Photos)

Answers (7)

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