125 pound weight loss - Is it possible to get a flatter upper abdomen with no Fleur De Lis? (Photos)

I agree with 2 stages for the abdominoplasty and reverse abdominoplasty. You’ll be fine without the fleur de lys. It’s nit worth scar and potential wound healing problems

Unfortunately, after massive weight loss, your skin and tissues don’t alway shrink down. Many MWL patients will require several stages.

In my experience, these upper abdomen rolls respond poorly to liposuction during traditional tummy tuck- although, some patients accept the improvement because they don’t want additional scars.

Best results have been with fleur de lis tummy tuck since this addresses both vertical and horizontal skin excess.

Pulling down with a traditional tummy tuck and then pulling up with a reverse will not narrow your waist/torso side to side.

We have been able to best improve the belly overall with a fleur de lis. This is more than just T tummy tuck, and not all surgeons are comfortable with it. it aggressively removes a lot of skin, rolls with one operation. The extra scar is a trade off usually accepted by our patients for the results.

An exam and consultation with a plastic surgeon who performs these procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

Reserved 16595,

Thank you for your pictures. Congratulations on your hard work and weight loss. I understand your concern with a Fleur-De-Lis, abdominoplasty due to its incision pattern. In my nearly 2 decades of experience with your current excess skin, it is going to be the best option to achieve the best aesthetic result. A reverse tummy tuck to help the upper is going to be a potential issue because the scar will start off in the crease of your breast, but due to normal healing and relaxation of the skin it's going to migrate down and be seen like a mustache on your upper abdomen. Again, not aesthetically pleasing, and you still end up with an incision of your upper abdomen. It's best to have a controlled incision pattern that gives you the best chance to have a very faint healed surgical incisions with an outstanding aesthetic result.

Best wishes,

ESJ

#TruthAndTransformation

This is a great question and indeed a challenging case. Since there is excess skin in both the horizontal and vertical dimensions, a Fleur-de-lis tummy tuck (abdominoplasty) would address the excess skin the best, leading to the best possible contour. If you prefer to avoid a vertical incision from the FDL, performing a traditional tummy tuck with a staged reverse tummy tuck can help remove the upper rolls and extra skin, however it will not take away the extra skin horizontally. Liposuction around the rib cage can be an effective tool to help with the overall contour and figure, but since you have extra skin and rolls in your upper abdomen, the liposuction will not effectively address the skin laxity and may not be the best option for you.
Deciding which procedure is right for you is an personal decision that should be discussed with your surgeon to come up with what is best for you and your goals.

First of all, congratulations on the amazing weight loss! I think its important to understand why you want to avoid the Fleur-de-lis. When done well, the scar line can heal very well and is a wonderful way to tighten your trunk in both horizontal and vertical directions. It is extremely powerful in its ability to give you the flat abdomen you deserve. It would also certainly make the addressing your back rolls much easer when it comes to the midback lift by removing redundant tissue and tightening your trunk overall. To stage a reverse tummy tuck is certainly an option but again you're subjecting yourself to a similarly long scar, if hidden under the breasts. As always, speak with your board certified plastic surgeon and explore their post-op results from Fleur-de-lis, and I think you'll be surprised at how great they can look.

Dear Reserved165995,

Congratulations on your remarkable weight loss achievement! Based on your photos and your goals, I believe you are an excellent candidate for a comprehensive body contouring approach that doesn't necessarily include the vertical cut associated with a Fleur De Lis tummy tuck.

For your case, a 360 lower body lift would be highly beneficial. This procedure addresses excess skin and fat around the entire circumference of your abdomen, waist, and back, effectively lifting and tightening these areas. It provides a significant transformation, particularly for patients with substantial weight loss, by removing the "belt" of excess skin and improving body contour.

In addition to the lower body lift, a breast augmentation with lift will rejuvenate and enhance your breast shape and size, complementing the lower body lift and creating a harmonious overall appearance.

Given your concern about the upper abdominal roll, a second-stage procedure, known as a horizontal torsoplasty, can be particularly effective. This involves an incision made along the bra line to specifically address and reduce back rolls. This stage may also include liposuction to further refine and contour your silhouette, focusing on achieving the most aesthetically pleasing result.

The advantage of staging these procedures is that it allows for targeted, precise corrections with a more manageable recovery process, and potentially minimizes complications associated with extensive single-session surgeries.

Your journey is unique, and choosing a plastic surgeon experienced in post-weight loss body contouring is crucial. Look for a surgeon with an extensive portfolio of before-and-after photos of patients with similar backgrounds and goals. This will give you a better understanding of their skill level and the potential outcomes you can achieve.

By opting for a 360 lower body lift followed by a horizontal torsoplasty and breast work, you're likely to achieve a beautifully contoured figure that reflects your weight loss journey and goals. Remember, the key is to work closely with a plastic surgeon who understands your vision and has the expertise to make it a reality.

Sincerely,

Dr. Katzen
Plastic Surgeon

Hello and thank you for your question. I agree that the way that your skin is draped in the upper and mid abdomen does present challenges that should only be addressed by a board certified plastic surgeon experienced in skin removal surgery after major weight loss.

If you have researched how the scar of a fleur-de-lis abdominoplasty heals and are wanting to avoid that, I would suggest a reverse abdominoplasty and an extended abdominoplasty. The incision should extend beyond the skin folds in the posterior portion to fully remove that excess skin. The surgeon may discuss a belt lipectomy, or truncal body lift, to fully tighten this skin.

A discussion with your surgeon on how to stage these procedures and the risks/benefits would be necessary.

Best of luck to you!

Congratulations on your weight loss! If you want to get rid of the upper abdominal rolls, you will need more scar than you would get with a simple abdominoplasty. You would either need fleur d'lis, reverse abdominoplasty (least favorable outcome), or direct excision of the extra rolls at a second surgery. I would suggest going to a surgeon with a lot of experience in body contouring after weight loss so you can get an idea of the expected outcome with each procedure in your situation on your body. If you have a tummy tuck first, then it may allow you to have an easier time deciding which procedure you want to do secondarily. Best of luck!

Thanks for your question! For optimal improvement, you should consider a fleur de lis and then some sort of back lift. If you just want improvement and are okay with some laxity, an extended tummy tuck (just to address the front) would be sufficient. Good luck!

What CAN be done and what SHOULD be done are often different. Removal of loose hanging skin and fat may be accomplished by a variety of approaches. You have accomplished tremendous benefit for yourself by weight loss and your hourglass body shape is obscured by those horizontal draping folds. After a well done fleur-de-lis helps restore your waist, if the scar is objectionable, revise it, tattoo it, or camouflage it as needed with cosmetics. Other approaches will not produce as nice an overall outcome for you.