A standard abdominoplasty (tummy tuck) removes skin from top to bottom. After major weight loss, the abdomen is often just as loose from side to side, and a horizontal incision alone cannot correct that. The fleur-de-lis abdominoplasty was developed for exactly this problem.
In short: A fleur-de-lis abdominoplasty combines the usual low horizontal incision with a vertical incision up the middle of the abdomen, so loose skin can be removed in both directions. It suits patients after major weight loss whose skin hangs horizontally as well as vertically, and it can restore a narrower waist that a standard tummy tuck cannot. The trade-off is a vertical scar in addition to the horizontal one. A Medicare rebate under item 30177 may apply where the criteria are met.
- Why a standard tummy tuck may not be enough
- Who it suits
- Fleur-de-lis compared
- The operation
- Recovery
- The vertical scar
- Cost and Medicare
- Questions
Why a standard tummy tuck may not be enough after weight loss
In a standard abdominoplasty the skin of the upper abdomen is pulled down and the excess is removed along a low horizontal line. That works well when the looseness is mainly vertical, as it often is after pregnancy.
After major weight loss the skin has usually been stretched in every direction. When only the vertical excess is removed, the horizontal excess remains: the waist stays wide, loose skin gathers at the sides, and vertical folds may persist above the belly button. The fleur-de-lis pattern removes a vertical wedge of skin from the midline as well, which tightens the abdomen from side to side and narrows the waist.
Many people who have had open bariatric surgery or other abdominal operations already have a vertical scar in the upper abdomen. In that situation the fleur-de-lis incision can often incorporate and replace the old scar, which makes the added vertical scar a smaller trade-off.
Who a fleur-de-lis abdominoplasty suits
- your weight has been stable for at least six months, ideally twelve
- when you pinch the skin side to side above the belly button, a large fold gathers
- your waist remains wide or shapeless despite weight loss
- you have vertical folds or creases above the belly button
- you already have an upper midline scar from previous surgery
- you accept a vertical scar in exchange for a better shaped abdomen
- you are free of all nicotine, or able to stop completely at least eight weeks before surgery and stay off it for eight weeks after
The operation is not the right choice for everyone. If most of the looseness is vertical, a standard abdominoplasty gives a good result without the extra scar. If the priority is simply removing a hanging apron, a panniculectomy is a shorter operation. If the looseness extends around the flanks and back, a body lift may be the better operation. Working out which applies is the main purpose of the consultation.
Find out which abdominal operation fits you
Dr Kumar assesses the direction and amount of loose skin, the muscle layer and any existing scars, then explains the options and their trade-offs. A GP referral is required.
Fleur-de-lis compared with other abdominal operations
| Standard abdominoplasty | Fleur-de-lis abdominoplasty | Lower body lift | |
|---|---|---|---|
| Loose skin removed | Top to bottom | Top to bottom and side to side | Top to bottom, all the way around |
| Effect on the waist | Limited | Narrows the waist from the front | Tightens flanks, back and buttocks as well |
| Scar | Low horizontal | Low horizontal plus vertical midline | Circumferential, around the body |
| Hospital stay | 3 nights | 3 nights | 3 to 4 nights |
| Possible Medicare item | 30177 | 30177 | 30179 |
More detail is on the abdominoplasty (tummy tuck) and body lift pages.
What the operation involves
Markings are made with you standing, and the vertical excess is measured by pinching the skin together in the midline. Under general anaesthetic, the lower abdominal skin is removed through the horizontal incision and the vertical wedge is removed through the midline incision.
Where the abdominal muscles have separated (rectus diastasis), they are repaired with sutures, which firms the abdominal wall and improves the waist. The belly button stays attached to the abdominal wall and is brought out through the new skin in its natural position. The skin is closed in layers. Drains are used and are removed by Dr Kumar’s nurses once the drainage has settled.
If the pubic area is heavy or has descended, a monsplasty is often performed at the same time through the same horizontal incision.
Combining with other operations
A fleur-de-lis abdominoplasty can be combined with a monsplasty, and in selected patients with liposuction of the flanks. Where the back and buttocks also need lifting, the fleur-de-lis pattern can be combined with a circumferential body lift, but that is a long operation and is often better staged.
Arms, thighs and breasts are usually addressed at separate operations, a few months apart. Keeping each operation within a safe length reduces the risks of anaesthesia, blood loss and wound complications, which matters more after weight loss than in routine cosmetic surgery.
Recovery, week by week
| When | What to expect |
|---|---|
| In hospital | Three nights at Westmead Private Hospital. You will be walking, slightly bent at the waist, from the first day, with compression stockings and measures to reduce the risk of clots. A compression garment is fitted. |
| Weeks 1 to 2 | Time off work. Tightness across the abdomen and swelling. Short walks several times a day, sleeping with the upper body raised and knees bent; standing gradually straightens. Drains are removed by Dr Kumar’s nurses once the drainage has settled. First review with Dr Kumar and his nurses at about one week. |
| Weeks 2 to 6 | Most patients return to work from about two weeks, then gradually resume most everyday activities over the next four weeks. How quickly depends on how physical the activity is and the area operated on. No heavy lifting or straining, and drive only once you can do so comfortably and safely. The Prineo and Micropore dressings come off at six weeks, and the compression garment is worn for six weeks. |
| Weeks 6 to 12 | After your six-week review, exercise and more physical work are built up progressively. Most patients are cleared for full activity at the 12-week review. |
| 3 to 12 months | Swelling settles and the scars mature. Reviews at 6 months and 12 months. |
Dressings, garments and scar care are managed by Dr Kumar’s nurses, who also work on the wards at Westmead Private Hospital. The nurses who prepare you for surgery are the same ones who look after you at every post-operative review.
The vertical scar, and sensation
The vertical scar is the main reason patients hesitate over a fleur-de-lis abdominoplasty, and it deserves a straight answer. It runs from below the breastbone to the horizontal scar and is visible in swimwear that exposes the midriff. In exchange, the abdomen is tightened side to side and the waist is narrower, something a horizontal scar alone cannot achieve when the skin is loose in both directions.
The point where the two scars meet, the T-junction, is under the most tension and is the area most likely to heal slowly. Scars are red and firm for several months and usually fade and flatten over 12 to 18 months, though scar maturation varies between people. Numbness of the abdominal skin is expected, and sensation usually improves over months, though some change can be permanent.
Risks and complications
All surgery carries risk, and wound problems are more common after major weight loss, with a higher BMI, with diabetes and with any nicotine use. Risks include:
- slow healing or wound separation, particularly at the T-junction
- seroma, a collection of fluid that may need draining
- infection
- bleeding or haematoma
- problems with healing of the belly button
- fat necrosis
- blood clots in the legs or lungs
- asymmetry, dog ears or thickened scars
- the need for further surgery
Dr Kumar will go through your own risk profile at consultation. You can read more about the risks of surgery.
Cost and Medicare
Dr Kumar’s initial consultation fee is $400, with a Medicare rebate of approximately $88. A referral from your GP is required to see Dr Kumar. Surgical fees are quoted individually after consultation, once the operation and any staging are settled. The practice does not publish package prices for body surgery.
A fleur-de-lis abdominoplasty after weight loss may attract a Medicare rebate under item 30177, which covers excision of redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty, with or without muscle repair and repositioning of the belly button. All three of the following must be met: intertrigo or another skin condition that risks loss of skin integrity and has failed three months of conventional treatment; the redundant skin and fat interferes with the activities of daily living; and weight has been stable for at least six months after significant weight loss. Significant weight loss means a reduction of at least five BMI units. Medicare benefits are not available for surgery performed for cosmetic reasons.
When a Medicare item applies, your private health fund may also cover hospital costs, depending on your level of cover. The hospital runs a fund check before issuing its quote, so your itemised quote shows what your fund covers. The guide to Medicare rebates and plastic surgery explains how the system works, and costs and payment sets out what the quote includes and how the in-house payment plan works.
Results
Surgical photographs are restricted to viewers aged 18 and over. The outcomes shown in any photograph are relevant only to the patient pictured, and individual results will vary. You can view the abdominoplasty gallery and the body contouring after weight loss gallery.
Where Dr Kumar operates
Consultations are held at Westmead, Penrith and Orange. If you live a long way from Sydney, you can send photos to Dr Kumar’s team before your first appointment.
Fleur-de-lis abdominoplasty is performed at Westmead Private Hospital, an accredited Ramsay Health Care hospital with an inpatient ward set up for body contouring after weight loss. It is one of a group of operations covered on the body contouring after weight loss page.
Common questions
What is the difference between a fleur-de-lis and a standard tummy tuck?
A standard tummy tuck removes loose skin from top to bottom through a low horizontal incision. A fleur-de-lis abdominoplasty adds a vertical incision in the midline so that skin can also be removed from side to side, which narrows the waist. It suits skin that is loose in both directions, which is common after major weight loss.
Is the vertical scar worth it?
That depends on how loose the skin is from side to side and how you feel about scars. When the horizontal excess is significant, a standard tummy tuck leaves the waist wide and loose skin at the sides. Dr Kumar will show you what each approach can and cannot achieve for your abdomen so you can decide.
Does Medicare cover a fleur-de-lis abdominoplasty?
It can, under item 30177, when all three criteria are met: a skin condition such as intertrigo that has failed three months of treatment, interference with daily activities, and weight stable for at least six months after losing at least five BMI units. Eligibility is assessed at consultation, and a GP referral is required.
Can my existing bariatric surgery scar be used?
Often, yes. If you have a vertical scar in the upper abdomen from previous surgery, the fleur-de-lis incision can usually include and replace it.
Are the abdominal muscles repaired?
Usually, where they have separated. Repairing the muscles firms the abdominal wall and helps the waist.
How long will I be in hospital?
Three nights at Westmead Private Hospital is typical.
When can I go back to work and exercise?
Most people take about two weeks off work, then gradually return to most activities over the following four weeks. Exercise and heavier work are built up after the six-week review, particularly after muscle repair, and most patients are cleared for full activity at 12 weeks.
Is a fleur-de-lis abdominoplasty suitable for men?
Yes. Men often carry loose skin around the waist after weight loss, and the vertical component can improve the flanks and waist. Men are well represented among Dr Kumar’s post-weight-loss patients.
Can it be combined with a body lift?
In selected patients, yes, but it makes for a long operation, so staging is often safer. The plan depends on your health and the areas to be treated.
Talk it through with Dr Kumar
If your abdomen is loose from side to side as well as top to bottom, a consultation will establish whether a fleur-de-lis abdominoplasty, a standard abdominoplasty or a body lift fits best. Dr Kumar consults in Westmead, Penrith and Orange, and a GP referral is required. You can also download the post-weight-loss surgery guide first.
This page is intended as general information and is not a substitute for individual medical advice. All surgery carries risk, and individual results will vary. Surgical photographs on this website are intended for viewers aged 18 and over. Read more about the risks of surgery here.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
