Which procedure would be recommended in my case: 360 tummy tuck or fleur de lis? (Photos)

Hello,Although you'd benefit from an extended tummy tuck, or even a 360 degree belt lipectomy, neither procedure will address your bra strap wings. These extra folds of skin can be treated very well with an 'upper body lift', which runs from the side of one breast, around the back at the bra strap line, to the side of the other breast. Go visit a few ABPS certified/ASAPS member surgeons who specialize in bariatric plastic surgery. Best of luck!

Congratulations on the weight loss. Based on the photos, I would suggest a lower body lift for the first procedure. For the second procedure, I would suggest a reverse abdominoplasty combined with a bra line back lift. This will address the loose upper abdominal skin as well as the loose skin under the arms an on the back. Good luck!

Hello and thank you for your question.  Congratulations on your weight loss.   The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with a circumferential bely lipectomy.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Based on your circumferential skin and soft tissue laxity along the trunk, I would recommend a circumferential body lift (belt lipectomy).

Thank you for your pictures and questions. Congrats on your amazing weight loss! As to which procedure might be right for you it depends on what bothers you the most. The FDL abdominoplasty will do a better job at addressing the anterior abdominal contour while the body lift will do a better job at addressing the flanks and buttocks. Also, another option would be a corset trunkplasty (link provided below). Often times with massive weight loss patients, multiple procedures are necessary to remove the skin in stages. For example, a patient might have a FDL abdominoplasty and then 3-6 months later complete the skin removal by adding the flanks and buttocks to combine the body lift and the FDL. This is not an uncommon approach and one that I find to be rather successful in patients who have lost a large amount of weight as you have. Hope this helps!

This really can only be determined with a physical exam and a long discussion about your goals.  I would note that the hanging skin at your upper back will not be addressed by either.  This would need an additional scar up by the bra line.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

This can only be determined with a physical exam.  Sometimes after massive weight loss, the laxity is not only in the vertical direction but in the horizontal direction as well.  Depending upon the amount of horizontal laxity, fleur de lis may give the best contour.   By creating the vertical scar, you are devascularizing the tummy tuck flap further, and the main complications would be the result of that including wound healing problems. In almost all patients, the vertical scar associated with the fleur de lis is not worth the tradeoff in the amount of excess removed. You will have to decide whether the vertical scar is worth the improvement in smoothness and contour for you.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Hello and thank you for your question and photographs.
Based on photographs , i would suggest  stage procedure.
 1 st belt lipectomy  to shape abdomen and back
2nd  upper body lift to take out upper back roll and loose arm skin
 please consult board certified plastic surgeon and discuss.
Best of luck
 Dr Milan Doshi

Great job on the weightloss!
As for the excess skin, based upon the pictures and the areas of concern that you marked, I believe a belt lipectomy/lower body lift/360 degree incision would suit you best. That will address skin in horizontal and vertical planes AND even address and lift lateral thigh skin.  A bra line lift +/- mastopexy/augmentation will address upper back laxity. This is usually a second procedure.
Best of luck!

Thanks for including such good photos. Body contouring after such massive weight loss is not a cookie cutter operation but must be thoughtfully tailored to each patient's situation. Of course it really takes an exam to be sure but based on your photos you would do best with with a Fleur De Lis pattern of skin excision to tighten the central abdominal skin and take away the skin excess under the breasts. For circulatory safety we would do a second stage procedure called a "bra-line" back lift to remove the loose skin of the sides of the chest and a lower back lift to take away the loose skin of the lower waist and back. If you want to go over details sometime feel free to call for a complimentary consultation.