What’s With all the Extra Skin and Flab? Would I need a fleur de lis to improve these results? (Photos)

Thank you for your question. The residual wrinkling and lack of flatness you’re seeing are most consistent with unaddressed vertical skin laxity plus residual subcutaneous fat (and, in some patients, a small visceral-fat component that no surgery can remove). An extended tummy tuck pulls horizontally; when there’s true vertical excess, the only definitive way to tighten is a fleur-de-lis (FDL) revision with a vertical scar. So yes, you may need an FDL.
Targeted liposuction can improve flank/upper-abdominal bulk and refine contour. Still, if skin is lax, it may highlight crepiness unless paired with additional skin excision (or, at best, yields modest tightening with energy devices). Arrange an in-person consultation with a board-certified surgeon experienced in post-abdominoplasty revisions to assess skin quality, fat distribution, any residual diastasis, and to review scar trade-offs and staging options.

What you’re experiencing is residual loose skin and soft tissue redundancy after an extended tummy tuck with hernia and muscle repair. This can happen when there’s significant pre-existing laxity, multiple C-sections, or when liposuction wasn’t performed at the same time. The result looks improved compared to before, but not yet as flat or smooth as many patients expect.
Surgical options that help most: 1. Revision abdominoplasty: A secondary surgery can remove additional excess skin and tighten the contour more definitively. This often gives patients the flatter, firmer look they were hoping for initially. 2. Fleur-de-lis abdominoplasty: Adds a vertical scar in addition to the horizontal one. This is especially useful in cases with central skin redundancy or significant laxity from weight fluctuations or multiple pregnancies. It allows more skin removal but does mean a longer, visible scar. 3. Liposuction (VASER or standard): Can contour the flanks and upper abdomen to reduce remaining fat deposits. However, if skin elasticity is poor, removing fat alone may make looseness more obvious—so it’s often combined with excision. 4. Scar and skin quality improvement: Techniques like Renuvion (plasma) or radiofrequency tightening can sometimes be added during revision to improve skin tone and reduce wrinkling.
Expectations: A second surgery often gives a much more definitive result. Whether you’d need a fleur-de-lis depends on your tolerance for additional scarring versus your desire for maximum flatness. Many patients who feel their first tummy tuck was “conservative” are much happier after revision when more aggressive tissue removal and contouring is done.
I’d recommend consulting with a plastic surgeon who frequently performs tummy tuck revisions and fleur-de-lis abdominoplasties, so they can guide you on the best balance between scar trade-off and contour improvement.
Dr. M. Mustafa Aydınol, Plastic Surgeon (Istanbul)

It appears that a combination of skin excision and liposuction would be a good combination to consider. A second opinion, in person, consult with another plastic surgeon would help. Good luck.

Based on your post photos, though still with clothing and cannot see the incisions you had from the previous surgeries, I would recommend either a virtual consultation or reposting nude photos, so the incisions can be determined. Plus, I would recommend an abdominal ultrasound to see if the repair of the hernia was effective Then most likely do a revision full tummy tuck with extension and liposuction and combination for the lateral portions of the waist and flanks. Best to do virtual consult as previously stated. Expect fees to range from $10,000-$20,000 since it’s a revision. Regards.