What is the difference between a fleur de lis and extended tummy tuck and which technique would be best for me? (photos)

Question

I am 5’9 290 lbs. lost 130lbs from weight loss surgery and have had 5 children; no c sections. Would like to have as close to hourglass figure as possible with good definition on waist line. Working on dropping 30-40 more lbs until surgery Thank you

Andrei Rios, MD · Answer

Hello and congratulations on dropping those 130 lbs! While you're definitely noticing changes related to massive weight loss, I'd recommend waiting more time and allowing your body to lose more weight. When a surgery is attempted with patients who are above a certain BMI (which is not the best way to assess a patient, but it's a standard that is usually used), there's higher risk of complications around your surgical process. There's also a chance for you to continue losing weight, and if the skin was tightened as much as possible, it will become loose again. I'd recommend continuing to monitor your weight loss journey and waiting until you're around a 30 BMI before attempting skin removal surgery. Your body will change and that will make the decision whether to do an extended, circular or fleur de lis abdominoplasty more accurate in your case. Have a great day!

Semih Yildiz, MD, FEPOBRAS · Answer

An extended tummy tuck mainly lengthens the lower horizontal incision toward the hips to remove more lower abdominal and flank skin. A fleur-de-lis tummy tuck adds a vertical midline incision, which allows tightening both downward and inward; it is often considered after major weight loss when there is significant central looseness that a horizontal-only incision cannot flatten or narrow well.

Your photos show substantial lower and central abdominal skin laxity with fullness extending toward the sides, so a fleur-de-lis may give better front-of-abdomen tightening and waist definition than an extended tummy tuck alone. The tradeoff is the vertical scar. Continuing to lose the planned 30-40 lb and then staying stable for several months is important, because a lower, stable weight can improve safety and help your surgeon judge the best incision pattern. To get closer to an hourglass shape, the plan may also need flank/waist contouring, but that has to be balanced against BMI, skin quality, and wound-healing risk.

Jose Telich, MD · Answer

Dear Genuine541607 congratulations on your weight loss journey! Surgical terminology can be confusing and very technical at times, but here is a very short description about the differences between procedures:

The Fleur de Lis tummy tuck involves both horizontal and vertical incisions, allowing for significant skin removal and contouring in both directions. This is ideal for patients with excess skin vertically and horizontally after massive weight loss.

The Extended tummy tuck extends the traditional horizontal incision towards the flanks, providing more lateral skin removal, which can enhance waist definition but does not address vertical excess as effectively.

Given your significant weight loss and multiple pregnancies, the Fleur de Lis might be more suitable to address the excess skin in both planes, potentially offering a better chance at achieving an hourglass silhouette. However, the final decision would require an in-person consultation to assess your skin elasticity, muscle condition, and specific areas of concern. Your goal of further weight loss before surgery is wise, as it can improve outcomes and reduce risks. Please consult with a board-certified plastic surgeon who can examine you and discuss your goals in detail.

Chet Mays, MD · Answer

Thank you for your inquiry and congratulations on your weight loss! You have excess abdominal skin making you a great candidate for an Abdominoplasty procedure without additional weight loss. We would love to see you in person and help you reach your goals. Schedule a consultation with a Board-Certified Plastic Surgeon like myself and we can create a surgical plan for you!

Eric Swanson, MD · Answer

Congratulations on your weight loss. Yes, you need an extended abdominoplasty or a near-circumferential lower body lift. A fleur-de-lis is definitely an option and will remove skin side-to-side in addition to top-to-bottom. However, it comes with a long midline scar. In my own practice, I only use a fleur-de-lis approach in patients who already have a long midline scar (which is unusual). Also, there can be more wound healing issues with this additional scar. My advice would be to look at photos of both procedures.

Daniel Butz, MD · Answer

Congratulations on your weightloss journey. The terminology can be confusing and often overlaps or can be combined. 
An extended abdominoplasty is just longer on the sides compared to a traditional abdominoplasty - which is normally hip to hip. This is beneficial if there is skin laxity along the hips. 
A Fleur-de-lis abdominoplasty removed additional skin from the central abdomen - bringing the waist skin in. 
A Torsoplasty or lower body lift - is an abdominoplasty that removes skin all around the entire waist - lifting the butt and hips at the same time. 
Give your degree of weightloss and skin laxity a torsoplasty with or without a FLD is what I would likely recommend. The FDL component would help achieve more of the hourglass shape but does come with the tradeoff of a vertical scar. So that has to be okay with you. 
Seek out a few consultations with board certified plastics surgeons. Make sure they do massive weight loss body contouring on a regular basis.

Gary M. Horndeski, MD · Answer

The fleur de lis tummy tuck has a vertical component. This is required if there is excess circumference high on the chest wall. Often times, a patient who lost 130 lbs will also benefit from a breast lift. If a breast lift is done first using The Bellesoma Method then the upper chest wall is pulled higher and decreases the circumference. This may make it possible to do your surgery using a circumferential tummy tuck rather than the fleur de lis. The fleur de lis unfortunately leaves the vertical scar and cannot be concealed. in your case, at the time of surgery, you will probably remove 10-15 lbs. so if your goal is to lose more weight then some will be done surgically.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Matthew C. Camp, MD · Answer

I often see patients like you, and opt for a circumferential lift. The fleur-de-lis pattern is effective and contouring the waist, but there is a significant risk of skin break down at the intersection of the vertical and horizontal scars. Also, the FDL pattern does not address the back rolls. The result is a nicely contoured front, but the back is still needs correction - a second surgery.  A circumferential lift addresses the back rolls, and contours the waist - all at one time. Seek experienced board certified plastic surgeons who do this surgery routinely, look at before and after photos, and ask lots of questions. You have a great result waiting on you if you choose well.

Gerald Minniti, MD, FACS · Answer

A fleur de lys TT (FDL TT)addresses excess circumferential laxity that either a standard or extended TT can't. The latter two primarily address vertical skin laxity. Judging from the photos and the amount of weight loss, it is likely you'll need a FDL lower body lift, the ultimate of 'extensions'.

Harry T. Haramis, MD, FACS · Answer

In my experience, with so much weight loss and resulting extra skin, both up and down as well as around, a fleur de lis would give best outcome to restoring figure. (Not all plastic surgeons perform this frequently). Trade off is lower waist and vertical scar but usually worth the outcome.

An extended tummy tuck will only go towards waist and not address the side to side loose skin. This would likely require a second surgery.

An exam and consultation with a plastic surgeon who performs fleur de lis  procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

What is the difference between a fleur de lis and extended tummy tuck and which technique would be best for me? (photos)

Answers (16)

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