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A fleur-de-lis tummy tuck is an abdominoplasty that removes excess skin in two directions: vertically, through an incision down the centre of the abdomen, and horizontally, through a low incision across the lower abdomen. When the two incisions are drawn together they resemble the fleur-de-lis emblem, which gives the operation its name. It is designed for people who have lost a large amount of weight and are left with loose skin that hangs down and also runs across the abdomen, creating a wide waist that a standard tummy tuck cannot correct.
After major weight loss, whether through diet, exercise or bariatric surgery, the skin has often been stretched beyond the point where it can recover. People who have achieved something remarkable in losing the weight are frequently frustrated that loose skin hides the change, causes rashes and discomfort, and makes clothes fit poorly. Removing that skin can complete the transformation both physically and emotionally.
Why a standard tummy tuck is sometimes not enough
A standard tummy tuck pulls the skin downwards and removes the excess at the bottom. It treats vertical laxity well. After major weight loss, however, there is often as much excess horizontally as vertically. If only the vertical excess is removed, the waist remains wide, with loose skin at the sides and folds across the upper abdomen.
The fleur-de-lis technique adds a vertical incision to remove a wedge of skin from the centre, tightening the abdomen from side to side as well. The result is a narrower waist and a flatter upper abdomen.
Who is a good candidate?
You may be a good candidate if you:
- have lost a large amount of weight, often after bariatric surgery
- have loose skin across the abdomen and waist as well as hanging below the navel
- have maintained a stable weight for at least six months
- are well nourished, with normal protein, iron and vitamin levels
- are a non-smoker and in good health
- accept a vertical scar in exchange for a better contour
People who are still losing weight should wait, as further weight loss will create new loose skin.
Comparing the options
| Standard tummy tuck | Fleur-de-lis tummy tuck | |
|---|---|---|
| Direction of skin removal | Vertical (downwards) | Vertical and horizontal |
| Scars | Low horizontal scar, around the navel | Low horizontal scar plus vertical midline scar |
| Effect on the waist | Moderate narrowing | Marked narrowing |
| Typical patient | After pregnancy or moderate weight change | After massive weight loss |
| Operating time | 2–4 hours | 3–5 hours |
How the operation is performed
The operation takes three to five hours under general anaesthesia.
- Marking. Markings are made with you standing, measuring the vertical and horizontal excess precisely. This is the most important step, because the amount of skin removed must be enough to tighten the abdomen but not so much that the closure is under excessive tension.
- Horizontal incision. A low incision is made across the lower abdomen, as in a standard tummy tuck.
- Vertical incision. A vertical wedge of skin and fat is removed from the midline, from below the breastbone to the horizontal incision.
- Muscle repair. Separated abdominal muscles are tightened if needed.
- Belly button. The navel is repositioned and reshaped.
- Closure. The incisions are closed in layers, and drains are usually placed.
Liposuction of the flanks is used cautiously in this operation, because the skin flaps need a good blood supply to heal.
Preparing for surgery
Preparation is especially important after weight loss. Blood tests check your protein, iron, vitamin B12, vitamin D and other markers of nutrition, and supplements are prescribed if needed. Stop smoking and all nicotine products at least six weeks before and after surgery. Stop hormonal contraception if advised, as it increases the risk of blood clots. Arrange help at home for at least two to three weeks.
Recovery
- Days 1–3: hospital stay; walking starts early, slightly bent; drains in place
- Days 4–10: recovery in a hotel or home; drains removed; dressings checked
- Weeks 2–4: gradual return to upright posture and light activity; desk work from about three to four weeks
- Weeks 6–8: gradual return to exercise and lifting
- Month 12: scars fade and flatten; final contour visible
A compression garment is worn for six to eight weeks. The skin of the abdomen will feel numb for months, and some permanent reduction in sensation is common.
Risks
The main risks are similar to those of a standard tummy tuck, including bleeding, infection, seroma, delayed healing, visible scars and blood clots. The point where the vertical and horizontal scars meet is under the most tension and has the least blood supply, so it is the area most prone to slow healing. Patients after bariatric surgery can also have lower nutrient reserves, which increases the risk of wound problems if deficiencies are not corrected beforehand.
Other procedures after weight loss
Loose skin after major weight loss rarely affects the abdomen alone. The upper arms, thighs, breasts, back and buttocks are often involved too. Common procedures include an arm lift, a thigh lift, a breast lift and, in men, gynecomastia surgery for loose chest skin. Trying to do everything at once makes the operation too long and raises the risk of complications. A staged plan, usually starting with the abdomen, with three to six months between operations, is safer and allows each area to heal well. The order is decided according to which area affects you most.
Caring for the scars
The fleur-de-lis leaves two scars: a low horizontal one and a vertical one along the midline. Both are red and firm for the first few months before gradually becoming paler and flatter over twelve to eighteen months. Silicone gel or sheets, started once the wounds have healed, can help the scars mature well. Protecting them from the sun for the first year prevents darkening. If a scar becomes raised or thickened, treatments such as steroid injections can help. Most patients find the scars become much less noticeable than they expected, especially compared with the loose skin they replaced.
Life after surgery
Most patients describe a real change in how they move and dress. Rashes and hygiene problems in skin folds usually disappear. Exercise can become more comfortable. Maintaining a stable weight is essential to keep the result, and the scars need time and care, including sun protection and scar management, to fade well over the first year.
Fleur-de-lis tummy tuck in Istanbul
International patients should plan twelve to fourteen days in Istanbul. This allows for the operation, the hospital stay, drain removal and wound checks before the flight home. Long flights increase the risk of blood clots after abdominal surgery. Compression stockings, regular walking in the cabin and staying hydrated are important.
Dr. Mehmet Özdemir is a plastic, reconstructive and aesthetic surgeon holding the EBOPRAS qualification, with body contouring and reconstructive surgery among his main areas of work. He trained in Germany, Poland and Brazil and practises in Bakırköy, Istanbul, where he consults in Turkish, Kurdish, English and German.
