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Adam G. Tattlebaum M.D.

Fleur De Lis Tummy Tuck: Anatomy of a Procedure

A fleur de lis tummy tuck is a type of plastic surgery you may never have heard of. It may be something you will never need, but for a large percentage of my patients, particularly patients who have lost a great deal of weight, it is at least something that they should be made aware of.

The usual tummy tuck pulls lax abdominal skin downwards. This is fine for the average postpartum mom who has gone up and down in weight with pregnancy.

But we are lucky that this works for most patients because it is not how weight loss works. When weight fluctuates up and down, it is a 360-degree event around the body – not just top to bottom. As such, patients with significant weight loss have loose skin from side to side as well. 

This is where fleur de lis tummy tucks can help.

Here’s an example from my practice. A few years ago, I saw a woman who had lost over 100 pounds through diet and exercise. She was, without a doubt, ready to get rid of all the loose skin hanging from her lower belly. Another doctor recommended liposuction and a standard tummy tuck procedure, but because of the significant skin laxity around her entire lower torso, I asked if she had considered a fleur de lis tummy tuck.

She looked at me as though I were crazy, not because she didn’t want the tummy tuck, but because she had never even heard of the procedure.

So, What Is A Fleur De Lis Tummy Tuck?

In a fleur de lis tummy tuck, a central, vertical incision is made from the upper abdomen downwards. Here, the incision connects with a second, horizontal incision from hip to hip.

This allows the surgeon to remove excess, sagging skin in both directions – creating a tighter, flatter abdomen both top to bottom and side to side.

The two incisions result in a vertical and horizontal scar in the shape of an upside-down “T”.

The name, fleur de lis, comes from the pattern drawn on the abdomen before surgery, which is similar to a French decorative symbol. It means flower of the lily.

Fleur De Lis Tummy Tuck Vs Regular

So how does a fleur de lis tummy tuck compare to a traditional tummy tuck?

The average tummy tuck patient, often a postpartum mother or someone who has lost 30-40 pounds, has a vertical laxity of the tummy. Sit in a chair, grab your lower belly and if you’re like me, you may feel a roll of excess skin and fat that you’d prefer not to have.

If you remove that roll from hip to hip, the remaining skin on the upper tummy can be pulled down like a window shade – tight and flat. That’s a standard tummy tuck, which tightens vertical laxity.

For reference, a mini tummy tuck is very similar, but the procedure only removes skin from below the belly button, making it more suitable for those requiring minor adjustments.

The issue is that neither properly addresses the needs of massive weight loss patients. Such patients not only have a lower roll of excess skin and fat (the vertical laxity), but they are also loose from side to side (around the flanks).

If you think you may be one of those people, put your hands on your flanks and push toward the middle. If there is a big roll of skin in the middle where you pushed in, you are demonstrating horizontal laxity.

If you then grab the lower abdomen and pull it tight, you’ll see a standard tummy tuck does not address horizontal laxity. For most of my weight loss patients, a light bulb goes off when they figure out the difference between horizontal and vertical laxity.

A fleur de lis can address horizontal laxity because an incision is made down the middle of the abdomen, allowing plastic surgeons to remove excess skin and tighten the abdomen from side to side, along with top to bottom. 

For ease, here are the key differences summed up:

  • A standard tummy tuck has one, horizontal incision across the pubic bone, whereas a fleur de lis incision creates a connected horizontal and vertical scar in a ‘T’ shape.
  • A standard tummy tuck address vertical skin laxity, whereas a fleur de lis tummy tuck addresses both vertical and horizontal laxity
  • A standard tummy tuck is commonly performed on postpartum mothers and minor weight loss patients, whereas patients who have lost a significant amount of weight are good candidates for a fleur de lis.

What if a patient doesn’t want a fleur de lis tummy tuck?

Even if a weight loss patient does not want a fleur de lis procedure (usually due to the midline scar), it is important that they know it’s an option. With a standard tummy tuck, they will still have horizontal laxity, which is ok, as long as they understand why. The consult is always easier when the patient has at least heard of it ahead of time.

If a patient has horizontal laxity, but doesn’t like the sound of the fleur de lis technique, they must also understand that this may limit the amount of muscle tightening I can accomplish.

Muscle tightening, for most, flattens the abdominal wall, but it also pulls excess skin into the middle of the abdomen. In a patient who already has severe horizontal excess skin, I may have to limit the degree of tightening, or in some cases, avoid it so that we don’t wind up with a bulky wad of skin in the midline.

That issue goes away with a fleur de lis because I can literally remove and throw away that excess skin.

Summary

Many plastic surgeons don’t offer a fleur de lis tummy tuck, and because of that, many will not even discuss it with weight loss patients. I find that disappointing. Patients should at least know about it as an option.

In many ways, I find it easier than a standard tummy tuck because I am not working inside a tunnel. The exposure for tightening the abdominal muscles is unparalleled. While there is an additional incision to close, the surgery is not much longer in duration than a standard tummy tuck.

And what happened to the patient who thought I was crazy?

She did extensive research, as most of my patients do, and decided to proceed with a fleur de lis abdominoplasty. She was thrilled with the results.

For those considering a tummy tuck, scheduling an appointment is easy. Reach out to me online or give our office a call at 301-656-6398.

November 23, 2020 8:15 am
Categories: Blog, Tummy Tuck

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