Is an extended tummy tuck with liposuction of the flanks and possibly the upper abdomen the right choice for me? (Photos)

Question

I am considering an abdominoplasty following significant weight loss and two pregnancies. Despite losing 72 pounds and maintaining a consistent workout routine (4–6 times per week), I continue to have excess abdominal skin that has not responded to exercise. My aesthetic goals are to achieve a flatter abdomen, a more defined waistline, and improvement of the lower abdominal “apron” area. During my consultation, the surgeon recommended an extended tummy tuck with liposuction of the flanks and possibly the upper abdomen. I would like clarification on whether this approach will also result in a smooth, flat contour in the upper abdomen, as I am concerned about avoiding a boxy appearance. My preference is a more contoured, hourglass shape. Additionally, I am interested in understanding whether a fleur-de-lis (FDL) abdominoplasty might provide improved contouring outcomes in my case, based on similar results I have seen. Could you please provide guidance on which procedure would best align with my goals?

Robert M. Lowen, MD · Answer

Dear Polite,
   As you can see from the attached photo, an extended tummy tuck with 360 liposuction is an excellent option for you.  The hour glass figure is only possible if your native anatomy allows it, and will be revealed when the muscles are repaired. A flat contour in the upper abdomen also depends somewhat on the anatomy of your rib cage and the muscle attachments, but in my practice, in addition to liposuction, we make it more predictable by bring the muscles together tightly from top to bottom with baby towel clips before placing any sutures.  This avoids the post op problem of too loose in the upper abdomen and too tight in the lower abdomen.  Pulling the muscles together with a running suture will tend to bulge the upper abdomen because it is easier to tighten the muscle below the belly button.  You then get a compensatory bulge above the belly button.  By manually tightening and adjusting the upper abdomen, the tightening is more predictable.  Then the clamps are individually replaced by permanent sutures.

Semih Yildiz, MD, FEPOBRAS · Answer

From your photos and history, an extended tummy tuck with flank liposuction sounds like a reasonable plan to address the lower abdominal apron and improve the waist. The upper abdomen is the key variable: liposuction can refine fat thickness, but it will not tighten loose skin, and it should be done conservatively around a tummy tuck to protect blood supply.
An FDL can be better when there is loose skin both up-and-down and side-to-side after major weight loss, because it removes central vertical excess and can reduce a boxy contour; the tradeoff is the vertical scar. I would ask your surgeon to show you, with markings or a pinch test, whether your upper abdominal skin would be adequately tightened by an extended tuck alone or whether the added scar of an FDL is likely to improve the shape enough to justify it.

Paul M. Parker, MD, FACS · Answer

I believe an extended tummy tuck with liposuction of the abdomen and flanks would give you a very nice improvement with more of an hourglass shape. The scarring from this procedure can be concealed nicely beneath revealing clothing. While a fleur de lis tummy tuck can improve your shape significantly, it will leave you will a long vertical scar that cannot be concealed beneath revealing clothing and so I would discourage that approach. Hope this helps.

Daniel Barrett, MD · Answer

Dear Polite290144,

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

Ira H. Rex III, MD · Answer

From your photographs, it seems are and excellent candidate for an extended tummy tuck.  Liposuction is almost always used for additional contouring and to perhaps accentuate the hourglass contour.  I do not think you need to even consider a fleur-de-lis abdominoplasty given the distribution of your excess skin.  I think you can be very excited about getting nice results.

Nicholas Lahar, MD · Answer

My dear, congratulations on your remarkable achievement of significant weight loss after two kids! You are still going to the gym and taking care of the family. This is not easy! Many of my patients express frustration that despite working out, they hit a plateau and are unable to get past a certain point. They are frustrated by excess skin in their lower abdomen. Be certain that this skin will not go away reliably without skin excision.
Based on the images shown, I believe you are a nice candidate for an extended abdominoplasty with circumferential liposuction around your trunk. You mentioned avoiding a boxy appearance and this is best done by bringing the waist in with a combination of skin removal (the extended part of the tummy tuck) and additional fat removal around the waist.
As for the Fleur de lis abdominoplasty, I think that is overkill for you and leaves you with a vertical scar. It is appropriate in some patients but you dont have enough horizontal laxity to really warrant it and i don't think it would bring your waist in much more than what i previously mentioned.
Exercise and nutrition optimization after surgery will continue to enhance your result and improve any surgical result beyond surgery alone. 
Congrats and I'm rooting for you

Mehmet Ozdemir, MD · Answer

First, congratulations on your incredible 72-pound weight loss and your commitment to fitness; your hard work has laid a perfect foundation for body contouring. For your goal of an hourglass silhouette, an extended abdominoplasty with flank liposuction is generally superior to a standard tummy tuck, as it addresses the skin laxity that wraps around toward the back. While a Fleur-de-lis (FDL) procedure provides significant vertical tightening, it is typically reserved for cases with massive skin redundancy in the mid-abdomen; given your photos, an extended incision combined with aggressive flank and upper abdominal liposuction should provide the smooth, flat contour and waist definition you desire without the additional vertical scar. To avoid a "boxy" look, the focus should be on thorough liposuction of the waist and potentially muscle plication (diastasis recti repair) to narrow the abdominal wall from within, ensuring a sleek, contoured finish that complements your athletic frame.

Jeffrey M. Darrow, MD · Answer

Your lower abdominal skin excess would be corrected with a tummy tuck.  Your area of excess skin folding extends out toward your flanks and for the incision to be contoured optimally, the incision would extend just past that point.  Flattening your upper and lower abdomen and achieving a trimmer, more defined waist line would require liposuction to thin these areas.  Additionally, after weight loss and/or pregnancy some patients rectus muscles are separated causing the abdomen to bulge forward.  Repair of these muscles also helps flatten the abdomen.  A FDL is an option to provide additional skin tightening by pulling the waist line skin inwards but this choice must be balanced against a central scar, which is difficult to conceal.  Best results and highest satisfaction rates are always achieved with patients who are as close to their ideal body weight as possible, so your workout routine is very important.  Best wishes.

Priya Bansal, MBBS, MS ,DNB · Answer

Additional photos of the back would help for a fuller picture, but based on what you've shared, a 360-degree liposuction combined with an extended tummy tuck looks like a great match for your goals.
Looking at your photos, you have more excess in the vertical direction than the horizontal, which means a fleur-de-lis tummy tuck isn't something you'd need.
A tummy tuck surgery is alwasy paired with liposuction for the best results. A lot of patients who travel for tummy tuck surgery in India come specifically because they want this combination done right, not just the abdomen treated in isolation. It's really the key to getting that contoured, proportionate silhouette and helps avoid a boxy result while creating a much smoother transition into the waistline.
Based on what's visible in your photos, this approach should put you well on your way to the hourglass contour you're after!

Camille Cash, MD · Answer

Congratulations on your significant weight loss and dedication to your health!  An extended tummy tuck with liposuction for contouring seems to be a good option for you.  This will remove excess subcutaneous fat and skin as well as correct abdominal wall laxity.  The result will be a flatter, tighter tummy.  As for the fleur de lis, an exam is needed for a specific recommendation but based on the photos it doesn't seem to be necessary.

Is an extended tummy tuck with liposuction of the flanks and possibly the upper abdomen the right choice for me? (Photos)

Answers (11)

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