Should I get a Fleur de Lis or a belt lipectomy? (Photos)

It appears as though you could get great results with the belt lipectomy/circumferential abdominoplasty.  This would spare you the vertical scar and still give you a flatter belly, narrower waist, and removal of the excess skin.  The recovery is about 2 weeks with minimal pain due to the new pain medicine Exparel that is injected while you are asleep!
Thank you for your question,
Dr. Schreiber, Baltimore plastic surgeon

Based on your pictures I would recommend an extended tummy tuck and lower back lift for best results.Always see a  board certified PS.

Based on your photos - you may need both. At your physical exam- the excess skin above your buttocks on your back will help determine whether or not the belt excision would be beneficial. You may need a vertical component which will require pre-operative consent because this final decision may be only determinable while you're asleep during surgery. So as stated, you may need both if you desire your best outcome . I suggest that you seek an experienced Board Certified PS with extensive in post Bariatric reconstruction 

Hello and thank you for your
question. Based on your photographs, I recommend a belt lipectomy instead of a fleur de lis.  This can avoid the vertical scar of a fleur de lis and still give you a contoured hourglass shape.    Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.  I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Dear M,     Thanks for posting your pictures. From observing your front and side view picture you are an excellent candidate for a standard  tummy tuck. There is no need for Fleor de Lis, which results in  more scarring and is associated with  more  complications.  I have never used it in my over 31 years of practice and well over 1000 tummy tuck surgery, because I did not find it necessary.    From observing your back and side view , you are a good candidate for butt lift and lower back skin roll  excision. I would recommend not to combine the 2 surgeries, because of difficult post operative recovery and increase rate of severe complications.    You have to realize that not all results are the same, because experience, technical skills and aesthetic eye are critical for good outcome. So, do your due diligence carefully and choose your surgeon wisely.   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly,check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with flat stomach, tight and youthful skin, nice belly button, improved body posture and low scar.                   Best of luck,                                    Dr Widder    

Dear mkibbey,it is hard to tell for sure without an examination. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. 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

I recommend a belt
lipectomy.  I do not believe you need the
vertical incision of the Fleur de Lis to pull your abdominal skin horizontally.  If you are not planning future pregnancies, I
recommend mesh reinforcement.  The mesh
creates a more hourglass figure by compressing the abdominal wall resulting in
early satiety and helps maintain a reduced weight.  Best Wishes,Gary Horndeski, M.D.

Thanks for your question and the photos. Congratulations on your weight loss. From your pictures you are certainly on the right track. You appear to have both vertical laxity font and back, as well as side to side laxity. In a situation such as yours I generally recommend a fleur de lis first followed by a staged lower back excision essentially completing a belt lipectomy.  Why stage it you may ask?  If you are pulling on the front and the back at the same time you are fighting yourself. You may not get as much  loose skin out of either.  In general I prefer to do the tummy first. (in your case likely fleur de Lis) removing as much skin as possible and going as far back as possible. Once the patient has healed and can lay flat the lower back and flanks will be able to have more tissue removed than a combined procedure.The extra skin under the arms is a different situation. In a weight loss patient such as yourself liposuction which removes fat will make the skin even looser. A better solution in my opinion  is a bra strap excision which removes both skin and fat in the upper back region. I hope this makes sense, Best wishes, I have included a link to some thinking about surgeries in the massive weight loss patient below as well.

For some of my patients that have had massive weight loss, they often times want to focus on their abdominal area first and then their lower body. The abdomen is usually the area that bothers them most. The fleur de Lis removes tissue in a horizontal and vertical direction for maximal improvement but it does some with a vertical scar. Most patients don't mind the scar because the contour and shape is so lovely. I recently had a patient give me a big hug after this surgery because she is so happy and pleased with the result. Her abdomen is flat and she now has a waist. It is best to see a board certified plastic surgeon with experience in this area.

Dear Mkibbey,
I would high caution against a flier de lys procedure.  There is a much higher wound complication rate at the inverted "T" where all the incisions come together. Hope this helps and good luck!