Standard or FDL tummy tuck - would a standard tuck be sufficient to avoid FDL scarring? (Photos)

Question

Hi there, I'm a 53 yr old woman, 2 c sections 19 and 22 years ago and lost 84 lbs over the past 3 years. Stabilised for 9 months at 10 stone 12 and I'm 5foot 9 tall. I know i need a lot done, but initially looking at the tummy tuck and potential breast uplift and augmentation. I'm a bit nervous of the scarring from a FDL tuck but would a stabdard tuck be sufficient for my terrible stretch marks and overhang . Many thanks for any advice.

Robert M. Lowen, MD · Answer

Dear Optimistic,
 I would spare  you the very unattractive midline FDL scar.  Your skin quality in the upper abdomen is excellent, and then there is a band of  skin above the belly button that is very wrinkled, and the skin adjacent to the belly button is very wrinkled and loose.  However,  I have found that with an abdominoplasty  incision that goes from one midline to the other, the entire anterior abdominal skin in a case such as yours without a lot of excess skin just below the ribs, can be redistributed.  This will allow most of the central lower laxity to be pulled out and the excess skin removed.  Things would have be a lot more extreme to justify a midline scar, FDL, in my practice.  Your procedure would be drainless.

Ira H. Rex III, MD · Answer

From your photographs, it seems you would get a beautiful result from a standard tummy tuck.  The fleur-de-lis scar can be quite ugly, as you now.  As usual, I would need to do and in person exam to understand everything for sure, but if you have a consultation with a plastic surgeon, I think they would be very optimistic about a very nice result.

Semih Yildiz, MD, FEPOBRAS · Answer

From the photos, a standard or extended tummy tuck would likely improve the lower overhang and many of the lower stretch marks, especially the skin below the belly button. The limitation is that it mainly pulls skin downward; it does not remove as much side-to-side looseness or upper abdominal stretch-marked skin.
An FDL adds a vertical scar, which is the real tradeoff, but it can be helpful after major weight loss when there is looseness both vertically and horizontally. If avoiding that scar is your top priority, a standard or extended tuck may still be worthwhile, but you should be prepared for some residual upper or central laxity. I would ask your surgeon to do a standing pinch test and show which skin would actually be removed with each option.

Paul M. Parker, MD, FACS · Answer

Given your history and the pictures you submit, I think you would get a very nice result with a standard tummy tuck and not need a FDL tummy tuck. I have treated many patients like you with my version of a standard tummy tuck and am able to give them very nice results along with very acceptable scarring which can be concealed beneath revealing clothing. A FDL tummy tuck would leave you with a long high riding vertical scar which cannot be concealed beneath revealing clothing. In my opinion, I don't think that is necessary.

Daniel Barrett, MD · Answer

Dear Optimistic117513,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because 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

Kadir Berat Oyur, MD · Answer

First of all, congratulations on your incredible 84-pound weight loss journey and for maintaining that stability for nine months; that is a massive achievement that sets a great foundation for surgery. It is completely normal to see significant skin laxity and stretch marks after such a major change in volume, especially following two C-sections. While a Fleur-de-Lis (FDL) tummy tuck is excellent for addressing significant horizontal skin excess, a standard tummy tuck can often do a remarkable job of removing the "overhang" and many of the lower stretch marks by tightening the skin and repairing the underlying abdominal muscles. Regarding your concerns about scarring and a potential breast lift, the best approach depends on the quality of your remaining tissue and your personal goals for your silhouette. I would love to see you for a consultation so we can physically assess your skin elasticity and determine if we can achieve the results you want with a more traditional incision rather than the vertical FDL scar.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos.  A FDL is designed to tighten the central portion of the abdomen and help contour the waist.  Your waist contour looks excellent so adding the FDL would add scarring with no benefit.  A standard tummy tuck will do an excellent job of contouring your abdomen. If you have any consideration to shaping the lateral part of your thighs and lifting your buttocks, you could consider a circumferential lower body lift. Your photos do not show any ptosis of your breasts, and therefore a simple breast augmentation should be adequate to volume replete your breasts without the additional incisions of a breast lift.  Discuss all these options with your plastic surgeon. Best wishes.

Nicholas Lahar, MD · Answer

Hi Optimistic, congratulations on your incredible achievement of 84 pounds of weight loss! This will have incredible implications for your health in the future. Unfortunately you have been left with excess skin. There are a wide variety of abdominoplasty's that are appropriate for different situations. Fleur De Lis (FDL) tummy tucks are wonderful procedures for patients who have had large amount of weight loss and have resultant excess skin in both the vertical and horizontal direction. Usually they will have hanging skin on the front as well as multiple roles on the sides as well and pulling the skin in towards the center really improves their contour. 
Your waist contour right now is actually quite good and I think you would do fine with an extended tummy tuck with the incision hiding low inside your underwear line. I do actually think you would benefit from having a circumferential tummy tuck that involves elevation of the buttocks because it looks like they have dropped but the posterior portion can be done(if desired) at a second procedure if you are not ready for that.
Regarding scarring, a lighter skinned individual with major weight loss is frequently a recipe for someone with very light and hard-to-see scarring.

Danielle S. Hayes, MD · Answer

Thank you for your question, and congratulations on your weight loss. That’s a great accomplishment!
Based on what you’ve described and from your pictures, you look like a good candidate for a traditional tummy tuck. In many patients, this procedure alone can effectively address excess skin, stretch marks, and abdominal overhang without requiring a fleur-de-lis (FDL) incision.

Priya Bansal, MBBS, MS ,DNB · Answer

Hi. Your concern about FDL scarring is understandable, and based on what you've described, it's likely avoidable. A fleur-de-lis tummy tuck is typically reserved for patients with significant horizontal excess, and from your photos, that doesn't appear to be your primary issue.
A high lateral tension tummy tuck would address your concerns more cleanly. This technique manages the excess skin on the lateral sides within the tummy tuck scar itself, so you get comprehensive contouring without the additional vertical scar running up the abdomen. In my practice, patients considering tummy tuck surgery in India are often surprised by how much flank contouring changes the overall silhouette, and that's precisely what this approach delivers.
Looking at the fuller picture, given the buttock ptosis alongside the abdominal skin laxity after 84 lbs of weight loss, a circumferential lower body lift would address both areas together if you're open to it. If you'd prefer to focus on the abdomen alone for now, a tummy tuck is a completely reasonable starting point.
On the breast question, from the photos shared it looks more like deflation than sagging (ptosis). You'd likely benefit from augmentation alone, without the additional scarring of a lift.
A board-certified plastic surgeon can assess your skin quality, degree of ptosis, and breast anatomy in person to confirm the right sequence and technique for your goals.

Standard or FDL tummy tuck - would a standard tuck be sufficient to avoid FDL scarring? (Photos)

Answers (12)

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