18 years ago, I had a RNY. I lost 124 lbs. I kept most of it off until the last 3 years when I gained about 45 pounds. I have been successful in losing weight that additional weight and am back with 5 pounds of my lowest weight!

I did not have plastic surgery 18 years ago and it's my biggest regret. Now that I am stable in weight, I'm looking at plastic surgery.

I've talked to 2 Docs. And I'm confused and torn.

Doc#1 says Fleur. He says that I don't have much back skin/fat. He can pull the skin forward and tighten it. I have a pronounced belly that hangs quite low and I get heat rashes/yeast infections frequently. Doc#1 says that Fleur should be a great solution. He said it will also take care of my sagging mons. (Which I really want gone!) He will also tighten my abs after nearly 50 years of weight gain and loss.

Doc#2 says to do a panniculectomy and lipo around the sides. She feels this is the best option as my frame is not necessarily curvy and she could not be sure of getting a flatter tummy.

Let's assume, this is all out of pocket cost. I like both Docs. Which would you choose and why?

I could use some insight and advice!

Thanks

2 hours ago, Huckdoodle said:

18 years ago, I had a RNY. I lost 124 lbs. I kept most of it off until the last 3 years when I gained about 45 pounds. I have been successful in losing weight that additional weight and am back with 5 pounds of my lowest weight!

I did not have plastic surgery 18 years ago and it's my biggest regret. Now that I am stable in weight, I'm looking at plastic surgery.

I've talked to 2 Docs. And I'm confused and torn.

Doc#1 says Fleur. He says that I don't have much back skin/fat. He can pull the skin forward and tighten it. I have a pronounced belly that hangs quite low and I get heat rashes/yeast infections frequently. Doc#1 says that Fleur should be a great solution. He said it will also take care of my sagging mons. (Which I really want gone!) He will also tighten my abs after nearly 50 years of weight gain and loss.

Doc#2 says to do a panniculectomy and Lipo around the sides. She feels this is the best option as my frame is not necessarily curvy and she could not be sure of getting a flatter tummy.

Let's assume, this is all out of pocket cost. I like both Docs. Which would you choose and why?

I could use some insight and advice!

Thanks

This is what my PS told me when I first consulted with her and she's really good at what she does, she's also professor of PS at the local university, so I trusted her advice... she said most women that have lost a lot of weight, like over 100 lbs, usually have saggy skin above the belly button also, so they need a Fleur. If you go with just a "regular" tummy tuck that they do for like a mommy makeover, you will have a tightened lower abdomen, and still be left with saggy skin above the belly button. It will look out of proportion. So she did a Fleur on me. And I'm happy that she did.

Also Panni's don't involve tightening the musculature. So if you have had kids, and or lost 100+ pounds, chances are you also have a diastasis recti, it just happens with morbid obesity and pregnancy. So in order to get a flat tummy, usually that diastasis recti has to be repaired. Hence why Fleur's are so common for post wls patients.

Thanks. I greatly appreciate your perspective. I thought I knew what I needed to do (FDL) but my second opinion had me very confused.

You're quite welcome!

18 years ago, I had a RNY. I lost 124 lbs. I kept most of it off until the last 3 years when I gained about 45 pounds. I have been successful in losing weight that additional weight and am back with 5 pounds of my lowest weight!
I did not have plastic surgery 18 years ago and it's my biggest regret. Now that I am stable in weight, I'm looking at plastic surgery.
I've talked to 2 Docs. And I'm confused and torn.
Doc#1 says Fleur. He says that I don't have much back skin/fat. He can pull the skin forward and tighten it. I have a pronounced belly that hangs quite low and I get heat rashes/yeast infections frequently. Doc#1 says that Fleur should be a great solution. He said it will also take care of my sagging mons. (Which I really want gone!) He will also tighten my abs after nearly 50 years of weight gain and loss.
Doc#2 says to do a panniculectomy and Lipo around the sides. She feels this is the best option as my frame is not necessarily curvy and she could not be sure of getting a flatter tummy.
Let's assume, this is all out of pocket cost. I like both Docs. Which would you choose and why?
I could use some insight and advice!
Thanks

I had the pannicolopy

Are you happy with the panniculectomy results?

panni just removes excess skin and doesn't necessarily have the goal of making everything attractive or even natural. In fact, some people lose their belly buttons, from what i understand

lower body lift does front and back plus mons lift. Lipo and muscle tightening are usually included. There is an attempt to make everything look natural This is what most people get.

Fleur de lis is the lower body lift with the addition of a vertical incision going all the way up your front - up to right under the ribs. It's usually done if you have a lot of excess skin high up where it's hard to reach with a normal lower body lift. It's not very common, but it does really pull everything tight.

I don't think I'd bother with a plain panni unless you have financial restrictions. The full lower body lift is going to look a lot better. If you have a ton of excess skin, esp up near your ribs, you may want the FDL cut added in as well. I was kind of borderline, but we decided to do the standard lower body lift first, and then if I felt like I still had too much excess skin, he'd add a FDL cut later. I ended up not bothering with it. I do still have a little excess skin up near my ribs, but no one can see it other than me, and it's honestly not that bad unless I bunch it up with my hands (which - when are you going to do that??). It pretty much came down to which would I rather live with - a little excess skin high on my torso, or a big scar going up my middle? Six of one, half dozen of the other, was my opinion. So I just kept what I had (a standard LBL (lower body lift)). The FDL cut would have been additional money, too, since it would have been done in a separate surgery.

Thank you!!!! I wish the 2 Docs could have given me as clear as explanation as this!

When I went through this choice of a normal tummy tuck or a Fleur I was torn - My partner at the time said 'It won't be any more painful but the results will be better' For once he spoke sense lol... They said I would look 'boxy' if I had normal tummy tuck... I didn't wanna look like a box, lol

I don't know if Fleur de lis is anythign about a Lower Body lift type thing its just an upside down T shape that brings everythign in from different directions and re-sites it in a much better way to rid you of all the excess, leaving a more natural shape. The Dr said he did a 'mons lift' at the same time though which is a little bit of lower body...

I remember when the surgeon had gone down to prepare.. I got them to bring him back up to 're-line' me - I leant forward and the lines he had first put would have still left me with sagging excess so he got out his biro and drew more lines on me. I really did not wanna have to do it again... ?

I am very very glad I had the fleur de lis!!! I had it in 2010 And I am as happy today as I was then. Though I do have scars - I am still so so so happy with the result, not that I have thought of taking a picture in a longggggggg time...

My before and afters are pictures are on this thread..

https://www.bariatricpal.com/topic/418611-tummy-tuck-without-muscle-reconstruction/?tab=comments#comment-4727014

Just took you a today pic... lol

Edited April 15, 20224 yr by Scamp

Thanks! That's all been similar to my thoughts. I'm glad you like your results. You look great.

The scar doesn't bother me since I have one from my full RNY. I joke that with the hip to hip scar, I'll have a smiley face with my breaststroke as the eyes.

I've booked the Fleur-de-lis for June 10! Eek!

You could ask about a panneculectomy and add on abdominplasty. That would address upper abdomen skin with out the vertical scar….