When do you need an abdominoplasty fleur de lis
I agree with others here that you do not seem to need a vertical component. Your pictures show a vertical excess, there doesn’t seem to be enough horizontal excess to warrant a pretty visible vertical scar.
Based on your pictures you look like an average tummy tuck patient who gets a very nice result using only a horizontal scar.
Although your pictures are not a replacement for a physical examination, looking at your thighs I wonder whether a thigh lift will make a big difference to your legs and is it worth the scar? (Martin Jugenburg, MD, Toronto Plastic Surgeon)
Abdominoplasty and thigh lift advice after weight loss
Your body after 140lb deflation is well above average, and it looks likely that your skin elasticity is maintained. I’m sure as you can be without actually examining you that you don’t need a fleur-de-lis incision pattern to achieve an excellent result.
The question is your back and flanks. They look as though the skin is reasonably elastic and not jelly like. It also looks like you have no buttock droop. Most patients with your degree of weight loss require a circumferential or almost circumferential skin excision for an optimal result.
It looks like you might not need that, and flank lipo alone will do a good job for your flanks as part of the tt. Check with your surgeon as to the intended management of your flanks. With respect to the thigh lift, as has been said below it depends upon the facility you’ll be going to and the level of postop care you have planned.
It is certainly possible to combine thigh lift and abdominoplasty together, but it increases the scale of the surgery and the blood loss, with all the potential consequences of that. In terms of medial thigh incision length, it’s actually hard to judge in you case from your pictures.
The abdominoplasty alone will elevate some of the inner thigh skin. In terms of advice for you though, the key to the inner thigh incision is less its overall length than the planning to make sure it’s completely medial, so not particularly visible from front or back. (Howard Webster, MBBS, FRACS, Melbourne Plastic Surgeon)
Abdominoplasty fleur de lis only for significant horizontal skin excess
You have accomplished a tremendous amount and have dramatically improved your health. Great job! Don’t just quit smoking for the surgery; quit for good. Although an exam is best for determining what procedure is best for you, based on your photographs, I would do a standard tummy tuck on you as I don’t feel that the vertical scar from a fleur-de-lis tummy tuck would be worth it.
If you have questions about whether or not you are doing the right thing, get a second opinion from a board certified plastic surgeon. (James McMahan, MD, Columbus Plastic Surgeon)
Feur-de-lis abdominoplasty or Almost the Same Results with a Regular Horizontal, Hip-to-hip Incision?
While nothing can actually replace an examination, from your photos, it appears that most of your excess tissues are in a vertical plane and not horizontal. If you had a significant amount of horizontal excess, then a fleur-de-lis pattern would be recommended but because your excess is mostly vertical, I believe you would obtain a very nice result with an extended abdominoplasty which will have a longer incision than a standard tummy tuck in order to control to loose tissues along your flanks/hips.
It is difficult to judge what form of thigh lift to recommend given the photos you included. If the laxity is just confined to the upper third of the thigh, then a limited thigh lift with the incision just along the thigh-groin junction would be recommended but if the laxity extends further down the thigh and has both vertical and horizontal tissue excess, then a medial thigh lift with an incision running down the inside of the thigh would be required. How far down the incision needs to go depends on the borders of the tissue laxity. Discuss your concerns again with your plastic surgeon before proceeding. It is better to have all of the questions and worries addressed before the OR, not afterwards. (Herluf G. Lund, Jr, MD, Saint Louis Plastic Surgeon)
Vertical incision probably not needed
The vertical incision of a fleur-de-lis tummy tuck is designed to reduce horizontal abdominal laxity. As you can see from your photos the majority of your laxity is vertically oriented. The amount of laxity that you have horizontally at the level of your belly button and above is much less and with your hip being wider than your abdomen above the belly button that amount of horizontal laxity will be taken up naturally.
I would go for the hip-to-hip incision tummy tuck. I cannot reliable comment on your inner thighs from the photos. If your laxity is located primarily in your upper one third of the thigh I would consider a crescent inner thigh lift. You will have to make sure that an experienced plastic surgeon performs this as performed in a wrong fashion can create some problems. (Remus Repta, MD, Scottsdale Plastic Surgeon)
Feur-de-lis TT
Tummy Tuck: With the amount of skin excess I see, I think you will have a better contour with a vertical incision to remove the horizontal skin excess. If you absolutely opposed a vertical scar, you would certainly get a lot of improvement with the standard abdominoplasty fleur de lis, but not as much. Thigh lift: I am not seeing good enough photos to evaluate the incision choice. One thing I would suggest is that you stand in front of a mirror and pull up on your abdominal skin rather snugly.
This simulates the TT, and note if you get much improvement on the inner thighs. Sometimes I see enough improvement with the TT that the patient in content with the thighs and avoids that procedure and its inherent scars. If there are other procedures that are planned, one of those might be better paired with the TT in case the thighs become less of an issue for you. Best wishes with your upcoming procedure. (Jourdan Gottlieb, MD, Seattle Plastic Surgeon)