Should I Have a Fluer Di Lis? (photo)

I'm 44 years old and i've lost justs over 45 pounds. I have this big lump just above my belly button and my PS says alot of loose skin that goes from hip to hip as well as the lump above my belly button down to my pubic bone.

Doctor Answers 10

Add a Vertical Incision for Tummy Tuck after Significant Weight Loss?

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Congrat's on the 45 pound weight loss. A standard or extended abdominoplasty may work well for you but the addition of a vertical incision will allow for more skin removal and a nicer result. The trade-off is an additional scar, a possibility of healing problems at the "T" incision, and perhaps more cost.

If you are seeing an experienced Board Certified Plastic Surgeon, then have a discussion about the pros & cons of each procedure before you make your choice.

Feel free to see some results of a vertical incision abdominoplasty on the website below.

Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Vertical excision tummy tuck vs traditional tummy tuck

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Losing 45 lbs is tough! Congrats. Prior to considering any surgical intervention it is important that you are weight stable for 3 months. When we evaluate the abdomen we look at skin laxity, fat, weakness of the abdominal wall and any fat on the inside around your intestines. We can help the first three. I reserve a "fluer di lis" for someone with both vertical and horizontal excess skin. While it is hard to tell on photographs alone, it appears that you could get a good result with a lipoabdominoplasty ( more traditional techniques). Go see an ASAPS member. They are board certified in plastic surgery and have expertise in cosmetic surgery. 

Jeffrey Kenkel, MD
Dallas Plastic Surgeon

Fluer de lis maybe?

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There are always options and that is one of them. A circumferential body lift is another great option as is a tummy tuck or extended tummy tuck both with lipo. You need to figure out what you want and what scars and amount of recovery and of course cost is right for you. Since I do all of these procedures I would have discussed them with you during you consult. Please seek out a board certified plastic surgeon who performs these for consultation! Good Luck!

Gregory T. Lynam, MD
Richmond Plastic Surgeon
4.9 out of 5 stars 62 reviews

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I would need to examine you to say for sure which technique would work best.  Generally an extended tummy tuck covers most situations.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

Fleur de lis abdominoplasty

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There are various approaches that can be used.  I think you would likely do well with an extended approach.  The vertical incision adds a more visible scar, and increases the risk of wound healing difficulties.

David A. Lickstein, MD
Palm Beach Gardens Plastic Surgeon
5.0 out of 5 stars 9 reviews

Do I Need A Fleur-De-Lis Tummy Tuck?

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While a fleur-de-lis tummy tuck always provides the flattest and tightest abdominal result, there is the trade-off of a vertical scar. In your case I think you would do fine with a standard tummy tuck and only the low horizontal scar. The use of the fleur-de-lis tummy tuck is best reserved for bariatric and massive weight loss patients who have multiple rolls of skin that extend into the back area as well as vertical skin laxity as well.

Fleur-de-lis or not fleur de lis..............that is the question

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Hi there,

  This one is easy question to answer in my practice.  I reserve the vertical component of the tummy tuck to very few  patients and they are mostly with massive weight loss.  Your weight loss is a great achievement but this does not put you into the category of the fleur-de-lis.

  I would do a standard agressive tummy tuck and pull your muscles together and the round out your procedure with liposcution of the areas that will enhance your result.  I think you can have a very nice outcome from this.  I have included an example of why you would NOT need the vertical component.

  Good luck with your procedure.  Pick your surgeon wisely.

               Steven M. Lynch, M.D.

Abdominoplasty after weight loss, no need for T incision

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In looking at your pictures, you do not need a "fleur de lis" abdominoplasty (tummy tuck), which is a "T" excision that in some extreme cases is sometimes necessary.  I routinely perform abdominoplasties in patients very similar anatomically to what your photos show and you would do well simply with a standard abdominoplasty or even an extended abdominoplasty.  The extra vertical scar (mid line scar) the T incision would add is unnecessary for you and this would be the most objectionable scar to avoid.  You can have a great result without this. 

The vertical incision of a fleur de lis may not be necessary for you

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Thank you for the question and photos.  Most of the skin laxity that you have is in the vertical direction and therefore should be addressed nicely by the horizontal incision of a tummy tuck.  The vertical incision of a fleur-de-lis will tighten in a horizontal dimension but I do not think the added result will be worth the vertical scar in your case.  The good news is that if you are unsure if the vertical part is needed you can choose to have it done down the road after having had time to assess the results with just the horizontal incision.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Fleur de lis?

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A standard, or an extended tummy tuck will remove excess skin and fat in the horizontal direction. Some patients, particularly after weight loss, also have excess tissue in the vertical direction which can not be removed with just the standard incisions. This decision is made base upon an in person consultation and exam. Based upon the photos, I think it likely that a "fleur-de-lis" pattern tummy tuck may be best for you.

When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.


Thank you for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.