Should I Have a Fleur De Lis?

I'm about to have a full tummy tuck on the 21/03/08, so only a few days! My surgeon suggested the possibility of a fleur de lis to remove the fat pad above my belly button. I hate that part of my stomach but I don't want to have a large vertical scar. I'm having my surgery on the NHS so I'm not sure they can remove this by lipo. However, I have read that fat pads can be removed by hand. Is this possible? What would be best for me? I'm 21 & have recently lost around 46lbs. I've always had excess skin since I can remember being conscious of it. I was always over weight as a child & lost 3 stone when I was 15/16 but gained this again, until my recent weight loss.

Doctor Answers 9

Fleur de lis vs. conventional tummy tuck

Thank you for your question.  Though it is somewhat difficult to tell without a front-view photo, I would lean against a fleur de lis tummy tuck as the right choice for you, opting for conventional abdominoplasty.  Fleur de lis is best utilized when there is a large amount of excess skin both horizontally and vertically on the abdomen - often in cases of weight loss of 100 pounds or more.  It produces a sculpted waistline, but at the cost of a long vertical scar down the midline (in addition to the lower abdominal tummy tuck scar).  It doesn't appear that you have excess skin to a degree that warrants this, and would benefit from a well-performed traditional tummy tuck.

What are your aesthetic goals? This could dictate procedure.

The abdominal wall contour can undergo significant changes when women have undergone significant weight loss.Under these circumstances, it’s not unusual for women to develop loose excess skin, weakened muscles, fat accumulation and stretch marks.It’s important to realize that no two patients are ever exactly alike and for this reason it’s important to individualize care.
Although it’s hard to make a specific recommendation without a physical examination, your history and pictures suggest that you have excess skin in both the vertical and transverse dimensions.In addition there’s probably laxity of the underlying muscles.
Under these circumstances, several surgical options exist.The choice of procedure not only depends upon your anatomic findings, but your aesthetic goals as well.
The fleur de lis abdominoplasty removes excess skin in the transverse and vertical dimensions.This leaves the patient with a vertical scar.In contrast, the full abdominoplasty only removes excess skin in the vertical dimension.Patients who undergo this procedure don’t have a vertical scar. Under these circumstances, the choice may come down to the patient’s aversion to excess skin in the transverse dimension verses a vertical incision.
The final decision belongs to the patient, but the vast majority of plastic surgeons would probably perform a traditional abdominoplasty in this situation.This choice probably also makes sense for you, since you don’t want a vertical scar.The fleur de lis abdominoplasty is usually reserved for massive weight loss patients and a vertical excision can always be performed as a secondary procedure if it should prove to be necessary.
It’s important to consult a board certified plastic surgeon with experience performing abdominoplasty surgery.This surgeon should be able to help you formulate a treatment plan that meets your aesthetic goals.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Fleur-de-lis Abdominoplasty

There are many different options when it comes to tummy tuck.

It is more likely that the fullness you see above the belly button is loose/redundant skin and not a "fat pad". Therefore any attempt to remove the fat pad is not likely to result in elimination of the fullness you see there. It won't matter if it is done with lipo or "by hand"; the skin will remain loose and hanging.

Express your concerns to your surgeon. Depending on how high your incision will be placed you could eliminate the upper umbilical redundant skin using a traditional abdominoplasty with/without a small vertical scar. This could obviate the need for the larger vertical scar seen with a fleur-de-lis.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Should I have a Fleur-de-lis?

It is hard to render an accurate opinion without the ability to examine you and determine the need for a vertical resection of your skin. If you have significant skin laxity that remains after a conventional tummy tuck you may be disappointed in the results. Some patients absolute refuse the vertical incision and are willing to accept a less comprehensive result. It would be best for you to have another discussion with your surgeon weighing the benefits of an additional incision against the opportunity for better contouring. Good luck!

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 112 reviews

Should I Have a Fleur De Lis Tummy Tuck


The answer lies in the physical examination of your tissue. At your age and size I would not put a Fleur de Lis incision since the upper abdominal incision will not be as cosmetic as the horizontal incision.  At some point later you may need the additional excision with a vertical approach.


Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 108 reviews

Fleur de-lis tummy tuck

If you have severe laxity in the midline this may be a good option for you. I usually reserve this for massive weight loss patients.  Your skin looks significantly lax at such a young age.  Hard to say definitively without an exam.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Fleur de lis tummy tuck - there are better options for you...

A Fleur de lis tummy tuck is a tummy tuck that has a vertical incision at the midline as well. In our practice, we often perform this procedure on patients who already have a scar in this area from a previous surgery. If you do not have a scar in this area, I would recommend to avoid placing a scar here as it would be prominent and noticeable. However, if you have had a previous surgery this midline incision is an excellent way to tighten the abdomen and to limit the extension of the lower abdominoplasty incision.

To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 101 reviews

Fleur de lis abdominoplasty

In considering a fleur de lis abdominoplasty, one of the most important factors is the age of the patient and the acceptance of a vertical scar.

Considering your age and the 46lbs weight loss, I would try to avoid this scar. I have done the fleur de lis for massive weight loss patients (120 pounds and more), and I tend to do it as a second procedure. On many occasions, this could be avoided.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Vertical scars on the abdomen don't look as good as horizontal ones

When doing an abdominoplasty, the lower abdominal horizontal scar usually heals quite well and is easily concealed. Occasionally in the masive weight loss patient a vertical scar is also necessary to optimize the result but at the expense of worse scar. Fro your photo it does not appear as though a vertical scar would be necessary. The tissue above your umbilicus is extra skin and not a "fat pad" and it will look flatter and tighter when it is unfurled and pulled down to reach the lower abdominal scar.

Usually, tummy tucks are performed when you are done having children so if you are anywhere near considering having a family, I would suggest you wait until afterward.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

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.