Lipo or Tummy Tuck with an Upside-down T?

Without a picture it is hard to give specific advice. With abodminoplasty, there are many options. The inverted or up-side-down T is only necessary if there is not enough loose skin between your belly button and the low incision. It is rarely necessary to do this. In most cases, this skin can be excised (removed) without much difficult. Good luck with your surgery.

Hello, and thank you for your question about whether a full tummy tuck with an “upside-down T” incision or liposuction with skin excision would be better for your goals. You’re doing the right thing by asking these questions before moving forward, as surgical planning should always be based on both anatomy and aesthetic goals.

Based on your height and weight (5’3” and 110 lbs), you have a healthy BMI, which is excellent. However, even at a lower weight, patients can still have loose or redundant skin that affects the abdominal contour. Your surgeon’s suggestion of an “upside-down T” — also known as a fleur-de-lis tummy tuck — indicates that they may have seen excess skin in both vertical and horizontal directions, meaning skin laxity that cannot be corrected by a standard tummy tuck alone. In these cases, a vertical incision is added to remove skin from the upper abdomen and tighten the area more thoroughly.

It’s important to note that this is very difficult to assess without seeing your photos or performing an in-person evaluation. Sometimes what looks like a minor bulge or skin laxity from the outside can actually involve deeper tissue laxity or vertical redundancy that’s only obvious when the skin is manipulated during a consultation.

On the other hand, aggressive liposuction — including VASER — is primarily used to contour fat, but it does not tighten skin. If you have loose skin or poor skin elasticity, liposuction alone (even with a small lower excision) may worsen the appearance of skin folds, dimpling, or irregular contours. Patients who undergo liposuction when a tummy tuck is actually needed often end up disappointed with the result or needing a second surgery.

If your plastic surgeon suggested a fleur-de-lis tummy tuck, it likely means they believe a standard hip-to-hip incision alone would not provide a smooth result, and you may still be left with laxity or bulging in the upper abdomen. While the vertical scar may sound intimidating, many patients are very happy with their final results, and the scar tends to fade significantly over time. When the procedure is truly indicated, the improved contour often outweighs the scar tradeoff.

Ultimately, the best decision depends on a detailed evaluation of your abdominal tissue, skin quality, and goals. I recommend sending in high-quality photos or booking consultations with a few experienced, board-certified plastic surgeons for comparison.

Wishing you clarity and the best possible outcome on your journey.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FASMBS, FICS
(Certified by the American Board of Plastic Surgery and President of the American Society of Bariatric Plastic Surgeons; Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, International College of Surgery, and American Board of Metabolic and Bariatric Surgery; Member of the American Society of Plastic Surgeons, American Academy of Cosmetic Surgery, and RealSelf Hall of Fame)

Please consult a board-certified plastic surgeon with extensive experience in both tummy tucks and fleur-de-lis techniques. Reviewing detailed before-and-after photos and receiving an in-person evaluation will help determine the right procedure for your anatomy.

You are 5'3'' and weigh 110 pounds, so I assume your problem is not a big abdomen with a lot of fat.
I assume what you want is tight skin, but not having a lot of excess skin, the surgeon is worried the skin over the belly button will not reach all the way to the pubis.
Ask him how long the vertical scar will be. In my experience, I have found that 99% of the time, even when the skin does not reach the pubis, using the skin bordering the umbilicus as the "vertical element" of the upside down "T" is more than enough. This is only about an inch long, and can be excised later when the tissues relax.
The amount of tightening you will get from Vaser, or Laser lipo and a Mini Tummy Tuck will not make you happy. I know from experience, mine and others.

There are a couple of things to consider here. Usually, when we refer to the upside down T scar, it is a vertical line extending all the way from the navel to the horizontal scar which is low. This is done only for massive weight loss patients, which doesn't sound like you. The other version is a short, vertically oriented scar from closing the hole where the belly button was. This occurs because most often we remove all of the skin between the navel and the pubic area, which means that the skin above the belly button has to stretch all the way down to cover it. If this skin won't stretch enough, the the other alternative is to have the horizontal scar too high. In this instance, a short vertical T is a good tradeoff.
One thing to be wary of is claims about skin tightening from all of the various technologies with liposuction (smart, cool, laser, vaser, etc.) None of these does as much as a tummy tuck so it that is what you need there are no short cuts.

It seems as though you're caught in the middle of several tummy tuck options. For those that don't have a lot of excess skin and fat, but do have some abdominal wall laxity, a full tummy tuck is an option, but in order to keep the incision low you may have a "t" incision. This is because the incisions around your belly button may remain on your abdomen instead of being removed of you have a lot of excess skin. A new hole is made for your belly button in a full tummy tuck. To prevent this "t" scar liposuction is an option. What about a mini tummy tuck and floating your belly button? Talk to your plastic surgeon about this option, too. Good luck!

These are two very different options.
Although the upside down T may give you the overall best correction, I have had many patients complain about the vertical scar when performed by other surgeons. Therefore I tend to avoid it with the exception of massive weight loss or previous vertical scars or severe stretch marks

When considering to proceed with a surgical procedure you must feel comfortable with the plan and the surgeon. From the sound of your question you are not excited and are looking for another option. Perhaps you should seek another opinion before making a decision. The inverted t incision works well for removing lots of excess skin however the trade off is the incision.
Other options include incisions up your sides or an incision completely around your body. It really depends upon your individual goals and your anatomy as well as what works in your plastic surgeons hands. I try and avoid the T; however, it does address mid line and flank skin laxity and if this is a concern it certainly is an option.

In my opinion, few women are good candidates for the "upside-down" procedure you refer to. Most patients can get excellent results with the traditional horizontal lower abdominal scar, possibly with a small vertical extension if the skin laxity is not great enough to allow advancement of the point just above the belly button to the lower abdomen without too much tension.

It is difficult to suggest one option over another without examining you. I am not sure why your doctor suggested a "T" incision unless you had massive weight loss and you have significant skin laxity. If you are unhappy with the suggestions from the surgeon you meet with, get a second opinion.

Overdone liposuction will potentially cause damage to you that is not correctable and won't tighten your skin as well as a tummy tuck.  There are many scar patterns availablefor tummy tucks and usually we try to avoid a vertical as often as possible.