Fleur-de-Lis Abdominoplasty

1. What Is Fleur de Lis Abdominoplasty?

Fleur de Lis abdominoplasty is a special tummy tuck technique preferred particularly in patients who, after significant weight loss, have marked excess skin in both the vertical and horizontal directions in the abdominal area.

In this method:

• A horizontal incision is made along the bikini line, as in a classic tummy tuck,
• In addition, a vertical incision is made along the midline extending upwards towards the rib cage.

The resulting scar resembles a floral motif, which is why the technique is called “Fleur de Lis” (lily flower). The aim is to remove excess skin and tissue in three dimensions by tightening the abdomen not only from bottom to top, but also from side to side.

2. How Does It Differ from Classic Tummy Tuck?

Classic abdominoplasty:

• Is performed using only a horizontally oriented incision,
• Tightens excess skin by pulling it downward,
• Can only modestly reduce sideways (width-wise) enlargement of the abdomen.

Fleur de Lis abdominoplasty:

• Includes a vertical incision in addition to the horizontal one,
• Thus tightens the skin not only downward but also from right to left,
• Can provide better narrowing of the waist and abdomen especially in patients whose abdomen has widened significantly in the transverse direction.

As a result, the Fleur de Lis technique is considered in patients where classic tummy tuck is insufficient because there is sagging “both lengthwise and widthwise.”

3. In Which Situations Is Fleur de Lis Abdominoplasty Preferred?

Fleur de Lis abdominoplasty is generally preferred in:

• Patients who have lost a large amount of weight after bariatric surgery (such as gastric sleeve, bypass, etc.) or diet and exercise,
• Cases where the abdomen shows not only downward sagging but also widespread sideways expansion and excess skin,
• Situations where there is such a broad transverse excess of skin that a classic tummy tuck would not adequately slim the waist and abdomen,
• Patients with an apron-like skin fold at the front abdominal wall that hangs both downward and to the sides,
• Cases where the patient has been fully informed about the vertical scar and accepts it.

In short: if the abdomen has become significantly enlarged and then sagged not only downward but also widthwise, the Fleur de Lis technique can provide more effective tightening.

4. Who Is a Suitable Candidate for Fleur de Lis Abdominoplasty?

Suitable candidates are those who:

• Have lost a significant amount of weight and whose weight has now become relatively stable,
• Have meaningful excess skin in both vertical and horizontal directions in the abdominal area,
• Are in a general state of health suitable for surgery,
• Understand that both vertical and horizontal scars will be permanent and have realistic expectations about scarring,
• Can comply with postoperative compression, activity and follow-up instructions.

Because the scars in Fleur de Lis are more noticeable and visible than in classic abdominoplasty, candidates often prioritise resolving the functional and aesthetic problems caused by the excess skin.

5. Preoperative Evaluation and Planning

Before surgery:

• The patient’s medical history, previous weight loss process, bariatric surgery history (if any), chronic illnesses, medications and allergies are evaluated in detail.
• The abdomen is examined while standing to assess:
  1. Amount and direction of excess skin,
  2. Location of stretch marks,
  3. Fat distribution,
  4. Skin quality.
• If there is a separation between the abdominal muscles (diastasis), it is planned whether this will be repaired during surgery.
• The course of the vertical and horizontal incisions is explained in detail using drawings or sample photos, including:
  1. Bikini line,
  2. Areas below and above the navel,
  3. The point where the midline incision extends towards the rib cage.
• Necessary blood tests, anaesthesia assessment and additional investigations are performed.
• Recommendations are given regarding stopping or reducing smoking, blood-thinning medications and certain herbal products before surgery.

At this stage, the aim is to prepare a safe surgical background and to provide a clear framework about scars, results and recovery.

6. How Is Fleur de Lis Abdominoplasty Performed?

(Vertical and Horizontal Incision Principle)

Fleur de Lis abdominoplasty is performed under general anaesthesia.

In summary:

Incision planning

• A horizontal incision is made along the bikini line, similar to a classic tummy tuck.
• In addition, a vertical incision is planned along the midline of the abdomen, starting below the navel and extending above it towards the rib cage.
• When viewed from above, these two incisions create an “inverted T / fleur de lis” appearance.

Lifting the skin and muscle repair

• The abdominal skin is lifted up towards the rib cage.
• If there is separation between the abdominal muscles (diastasis), the muscles are brought together and sutured, strengthening the abdominal wall.

Removal of excess skin

• With the horizontal incision, vertical excess is removed in the up–down direction,
• With the vertical incision, excess skin in the right–left direction is removed; thus the abdomen is narrowed not only by pulling downward, but also by tightening from the sides.

Navel and closure

• The navel is repositioned at an appropriate point on the newly tightened abdominal skin.
• The vertical and horizontal incisions are closed using aesthetic suturing techniques.
• In most patients, drains are placed in the abdominal area.
• At the end of surgery, a compression garment supporting the abdominal area is applied.

The result is a flatter abdomen and waist, reduced in both length and width, at the cost of vertical plus horizontal scars.

7. Combination with Liposuction and Shaping the Abdominal Contour

Fleur de Lis abdominoplasty is often combined with liposuction:

• Liposuction may be applied to the abdomen, flanks and, if necessary, the area just in front of the back, allowing:
  1. Thinning of fat tissue,
  2. Better definition of the waistline,
  3. Softer and more balanced contour after skin removal.

The liposuction technique (classic, Vaser, etc.) is planned according to the patient’s skin quality, fat volume and the surgeon’s experience. The goal is not only to remove excess skin and fat, but to align the body lines with the patient’s overall silhouette.

8. The First Postoperative Days: Pain, Drains and Hospital Stay

After surgery:

• The patient wakes up with a compression garment supporting the abdomen and dressings protecting the incision lines.
• Tightness, pulling and pain along both the horizontal and vertical incision lines in the front abdominal wall are normal.
• Most patients will have one or more drains in the abdominal area; these help remove fluid that may accumulate in the first days.

In the first 24–48 hours:

• Changing position in bed,
• Standing up for the first time and taking short walks are done slowly and under the supervision of the medical team.

Pain is managed with the medications prescribed by the surgeon.

Usually, a hospital stay of 1–2 nights is preferred for comfort and safe monitoring.

9. Staying in Istanbul, Follow Ups and Returning Home

For patients travelling from abroad or another city:

• It is generally recommended to stay in Istanbul for 7–10 days in order to:
  1. Remove drains (if used),
  2. Perform the first checks of the stitches and incision lines,
  3. Clarify compression and activity instructions,
  4. Closely monitor the early healing process.

During this period, the patient receives detailed information on:

• How to perform wound care and dressings,
• Showering and hygiene,
• Positions for lying, getting up and sitting,
• In which situations they should contact the clinic.

If long-haul flights are planned, the flight date and in-flight recommendations (movement, fluid intake, leg exercises) are planned with the surgeon, taking into account clot risk and prolonged sitting.

10. Compression Garment Use, Positioning, Swelling and Daily Life

Compression garment

After Fleur de Lis abdominoplasty, the garment is important for:

• Controlling swelling,
• Helping the skin adapt to the underlying tissues,
• Supporting the abdominal wall.

In most patients it is used:

• For 4–6 weeks,
• For most of the day in the early weeks,
• Then gradually reduced over time.

Positioning

• In the first days, walking slightly bent forward is normal; this reduces tension on the incision lines.
• When lying down, a position with slightly bent knees and an elevated upper body is usually recommended.
• Over the days, the patient gradually transitions to a more upright posture; movement restrictions are reassessed at follow up visits.

Swelling and bruising

• Swelling and tenderness in the abdominal area are significant in the first 1–2 weeks.
• Swelling largely decreases over 3–4 weeks.
• Achieving the final contour and maturation of scars is a process that extends over several months.

11. Returning to Social Life, Work and Sports

Home activities

• Having help at home in the first days is valuable.
• Activities such as carrying children, tasks that require bending and heavy lifting should be reintroduced gradually.

Return to work

• For desk-based jobs, most patients can return to work after about 10–14 days.
• For jobs involving physical effort, a 3–4 week plan is usually made depending on the job demands.

Return to sports

• Light walking is encouraged from the early weeks, within the limits permitted by your surgeon.
• Exercises that heavily strain the abdominal muscles, weight training and high-intensity sports generally require a waiting period of 6–8 weeks.

Exact timing and intensity are determined individually at follow up visits.

12. Possible Risks and Complications in Fleur de Lis Abdominoplasty

Because this technique includes a longer incision line than classic tummy tuck, the risk profile is similar but somewhat broader:

• Bleeding, infection
• Delayed wound healing, particularly wound breakdown at the upper and lower ends of the vertical incision
• Fluid accumulation (seroma)
• Wound problems due to decreased circulation at the skin edges
• Asymmetry or contour irregularities
• Temporary or more prolonged changes in sensation (e.g. numbness in the abdominal skin)
• Vertical and horizontal scars that are more prominent than expected
• General surgical risks such as blood clots (deep vein thrombosis) and pulmonary embolism

These risks are minimised as much as possible through appropriate patient selection, proper preoperative preparation, an experienced surgeon and strict adherence to postoperative instructions. All potential situations are discussed transparently with the patient before surgery.

13. Results and Expectation Management

With Fleur de Lis abdominoplasty, the goals are to:

• Narrow the abdomen both lengthwise and widthwise,
• Remove as much excess skin and stretch marks as possible,
• Make the waist–abdomen line tighter, more compact and better proportioned.

In the first weeks, due to swelling and tightness, the results may look different from the final outcome.

• The abdominal shape becomes largely evident within 6–8 weeks.
• Maturation and lightening of the vertical and horizontal scars, and adaptation of the body to the new shape, require a 6–12 month process.

The most satisfying results are obtained in patients who:

• Maintain stable weight,
• Reduce or stop smoking,
• Attend follow up appointments regularly,
• Carefully follow compression and movement recommendations,
• And have realistic expectations regarding scars.