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.