Please help! FDL or Circular Tummy Tuck? (Photo)

Hi there and thank you for your question regarding whether you need a fluer de lis or a circumferential lower body lift. First of all, congratulations on an extraordinary weight loss. That's incredible and takes so much hard work and discipline. I've heard many success stories similar to yours from my patients over the years. It's always so exciting to see someone so close to the end of their weight loss journey.

By examining your photos, I think you'd greatly benefit from the 360 lower body lift (with muscle plication). This would address the tummy, hips, and buttocks. This can be combined with a thigh lift and reduction if you wish. The thigh lift includes liposuction of the inner thigh. An incision is then made from the groin down to the knee (on the inseam of where your pants would be).

If you choose to come back for the upper body, you'd benefit from a vertical torsoplasty. The incision would go down your sides and it would get rid of back rolls. This can be combined with a brachioplasty or arm lift and reduction (with liposuction).

I hope this helps to answer your question regarding what type of tummy tuck would be best after your massive weight loss. Congratulations again!

I specialize in reconstructive plastic surgery after weight loss. If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy please contact my office. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research. Make sure they have performed at least 100 circumferential lower body lift surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Congratulations on the progress on your journey. There are a number of options and pro's and con's to each, though on preliminary assessment just from your photos a FDL abdominoplasty and staged upper body lift might be appealing to you. Be sure to see a body contouring plastic surgeon with experience after massive weight loss.

Hello @urbanfloraxo thank you for your question. Without a proper assessment an expert opinion is not possible. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD FACS

Dear urbanfloraxo, thanks for sharing your pictures and concern. After evaluating your case your best option to remove this skin excess is a FDL. Make sure you go on consultation with a board-certified plastic surgeon. Hope this helps and best of lucks. Dr. Luis Mejia.

Dear urbanfloraxo,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. 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

Congrats on your weight loss! Based on your photos it looks like you have excess skin in both the vertical and horizontal vectors. The midline incision of the FDL will help remove the horizontal excess and the lower transverse incision will help remove the vertical excess. Because the extra skin extends around to your back, you would benefit from an incision that extends all the way around your waist. A consultation with a board certified plastic surgeon should help you to understand the risks and benefits of doing those procedures at the same time or separately.

Wow! Congratulations on your impressive weight loss! Due to the amount of skin laxity you will likely need to stage your procedures. You have redundant skin on the upper abdomen that would be best addressed with a FDL incision. The excess skin on your back and lower body may be addressed in a separate stage. I've included a video I hope you find helpful.

You actually need both cuts (lower body lift + a vertical excision) on a body shape like you present with.

Usually we would suggest doing that in two procedures with the body lift done first for maximum vertical skin excess removal and then coming back to take the horizontal excess left a few months later. It would be very hard to do a good job on both simultaneously as you have to give up a lot of skin resection in one of the two directions

You need a total body lift. No question. That will take care of all your redundunt skin all around.
this will give you the results you are wishing for.

You have significant skin laxity and doing a wraparound 360 tummy tuck a.k.a. body lift would serve you well.

Whether you need a vertical scar in addition is another question.


Personally I’m not a big fan of vertical abdominal scars and I think if it was me I’d rather live with a little horizontal laxity and avoid that scar. If you were my patient I would without question do a wraparound.

That may still leave you with horizontal laxity but it would probably be sufficient.

If having tight skin in every direction is important then the skin laxity needs to be dealt with both horizontally and vertically.

Check your scars from previous surgeries and ask yourself if having that type of scar up-and-down your abdomen is OK versus still having some skin laxity side to side.

When doing extended tummy tucks the discussion during a consultation should make it very clear if the surgeon is going to turn you and have your face down during the procedure. Without properly turning the patient face down during surgery the extent to how far can be reached on the backside is limited.

In the end picked a surgeon you think is the most talented and go with their recommendations.

Also ask yourself which would bother you more having some lateral skid laxicity or an extended scar?

You can always convert a wraparound tummy tech and add vertical scar later but once you have the scar you’ll have it for life.

Obviously it’s better to not plan on having two operations but it is one way to view the decision making process.

Judge plastic surgeons based on who gets the most natural looking bellybuttons and their history of outcomes with massive weight loss patients like yourself.

Best,

Mats Hagstrom MD