When is a fleur di lis Tummy Tuck vs a traditional incision indicated? (photos)

Question

I am a 55 year old woman who has lost over 125 lbs in the last year (no surgery). I am seeking a tummy tuck to remove the loose skin and flab that won't go away on their own. Both surgeons I saw recommended the fleur di lis because of the excess skin on my upper abdomen. Can you please discuss pros and cons? Thank you!

Shlomo Widder, MD · Answer

Dear VAPaula,     Thanks for submitting your picture.  Your picture reveals quite common condition and is ideal for tummy tuck. I have been in practice for over 27 years and performed over 1000 tummy tuck. I have never done the Fleur de lis procedure because it is not necessary in situation like yours. There is no justification for the vertical scar, which in addition to the unsightly scar, increases the possible wound healing problems. Consult with additional plastic surgeons until you find a surgeon who can do the traditional tummy tuck. Make sure that the surgeon is board certified in plastic surgery and perform surgery in accredited surgery center for your safety. Most importantly, check the before and after pictures , to ascertain that they are numerous, consistent and attractive. Check also the 'realself' reviews for positive patients experience which provides important information on the surgeons.              Best of luck,                               Dr Widder

Scott C. Sattler, MD, FACS · Answer

A FDL TT allows substantial skin reduction in the both the vertical and horizontal domains - a few patients benefit from this type of TT - you might be one of them. A consultation is recommended to make this important decision.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your picture. Congratulations on your weight loss. The pros Fleur-de-Lis  abdominoplasty versus a traditional abdominoplasty are the same. The one big deception is that with the fleur-de-lis abdominoplasty you have a long vertical scar that's readily seen if the mid-drift is exposed

Leila Kasrai, MD, FRCSC · Answer

The fleur de lis technique will allow for the most amount of skin to be removed in both the vertical and horizontal planes.  However it will leave you with scars that cannot be covered by under wear or bikini and it has a higher risk of delayed wound healing.

Carmina Cardenas, MD · Answer

You have to acknowledge when someone develop central obesity and the majority of the volume Is located in the abdominal area, the skin got stretched not only on the length but mainly on the width, so the need of the vertical incision is a reality.You have developed a lot of skin on the width but I think you may get away just with the traditional horizontal incision and get a great result. If after several months you make the decision to do the vertical, it will be a much easier recovery, less aggressive  just to do that procedure.Be encouraged.Dr. Cardenas

Mark Deutsch, MD, FACS · Answer

Thank you for your very good question. A fleur de lis tummy tuck is indicated when there is too much loose abdominal skin for simply pulling it down toward the pubic area and removing the excess. A fleur de lis will not only pull inferiorly but will tighten the abdomen in a side-to-side direction. The downside is you will have a T-shaped scar on your abdomen as opposed to the low horizontal scar with a traditional tummy tuck. It is best that your surgeon shows you some before and after pictures to help with your decision.

Robert S. Houser, DO · Answer

First, congrats on your weight loss!  That's the best way to do it!!You never want to get in to something that can't be "undone."  Once that scar is up your belly, it can't be taken off.  In someone like yourself, I would tend to start with the traditional tummy tuck.  That will satisfy 90% of women and leaves them with scars that can easily be covered by a not-so-conservative bikini!  Also, horizontal scars always heal better than vertical scars on the abdomen.  In women with a SEVERE skin excess in the upper abdomen (NOT you), I sometimes will take them back to surgery 3-6 months after the first surgery and perform a "reverse TT" to further tighten the upper abdomen, thereby still avoiding the vertical scar.  You really need to think about how you want to show off your belly after surgery.  If you simply want to look better in your clothes, then the Fluer-de-Lis may be best for you.  If you want to minimize scarring and hit the beach in a 2-piece, strongly consider the more traditional scar.  Find someone experienced in performing surgery on patients who have had major weight loss.  Good luck!!

Stephen M. Chen, MD · Answer

Thanks for your question and for including the photographs.  With 120  pounds of weight loss you fall into the massive weight loss category.  When I assess patients and counsel them on the pros and cons of various body contouring scarring is a main concern and I balance this with the amount of laxity present.  Even with circumferential procedures, I find myself utilizing midline incisions.  I do this when the main concern is to get rid of the largest amount of redundant, lax skin.  Abdominoplasty is a very individualized procedure.  There is not a single one size fit all operation.  You need to find a surgeon whom you are comfortable working with.  Best of luck with your decision and subsequent operation.

Lewis Ladocsi, MD, FACS · Answer

Hi VAPaula.  It is hard to know from your picture, but if both surgeons recommended the fleur de lis scar pattern, then you have both vertical and horizontal soft tissue excess.  That situation is common with massive weight loss patients.  In that case you must choose between the benefits of correcting the excess soft-tissue and the trade-off of the scars.  You can choose to: 1. Not have any surgery  2. Have the greatest correction with the greatest trade-off (the fleur de lis procedure) or 3. Have a traditional tummy tuck with only the horizontal incision, and accept a lesser improvement for the benefit of a lesser trade off.

Darryl J. Blinski, MD · Answer

The amount of surgery and surgical time is almost doubled, thus higher risk of complications in the Fleur technique. Plus more scarring and longer hireling. Best to see a few boarded PSs in person...

When is a fleur di lis Tummy Tuck vs a traditional incision indicated? (photos)

Answers (13)

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