Dr. Cat Begovic, MD, FACS, board-certified plastic surgeon, Beverly Hills
Key Takeaways
- A fleur de lis tummy tuck uses both a horizontal hip-to-hip incision and a vertical midline incision to remove skin in two directions
- Best suited for patients after massive weight loss (typically 100+ pounds) with significant horizontal skin laxity
- Recovery takes 6 to 8 weeks for normal activities, with surgical drains usually in place for 1 to 2 weeks
- The procedure leaves an anchor-shaped scar but addresses loose skin a standard tummy tuck cannot correct
- Average cost ranges from $12,000 to $20,000 depending on surgeon, geography, and whether paired with other procedures
- Candidates should be at a stable weight for at least 6 months and finished having children
What Makes a Fleur de Lis Tummy Tuck Different
A fleur de lis tummy tuck, also called a fleur de lis abdominoplasty, is a specialized body contouring procedure designed for patients with substantial skin laxity in both the horizontal and vertical directions. Unlike a standard tummy tuck that only removes skin below the belly button through a single hip-to-hip incision, the fleur de lis approach adds a second vertical incision running from the breastbone down to the pubic area.
This combined approach creates the anchor-shaped or inverted-T scar pattern the procedure is named for. This is almost exclusively a post-massive-weight-loss procedure. After losing 100 pounds or more, or after bariatric surgery, the skin often has laxity in every direction, not just downward, and a single horizontal incision simply cannot remove enough tissue to create a defined waist and flat abdomen.
Fleur de Lis Tummy Tuck vs. Regular Tummy Tuck
The difference comes down to the direction and amount of skin being removed. A standard abdominoplasty works well for patients with moderate lower-abdominal laxity, usually after pregnancy or modest weight loss, and leaves one horizontal scar hidden by most underwear.
A fleur de lis adds the vertical component because horizontal-only tightening cannot eliminate the side-to-side excess that massive weight loss creates. If you pinch your skin inward at the waist and see significant loose folds, a standard procedure will likely leave you with dog-ears or a wide, boxy waist shape. The fleur de lis trades a more visible scar for a dramatically better contour in these cases.
Pros and Cons of a Fleur de Lis Tummy Tuck
Pros: removes far more skin than a standard tummy tuck, narrows the waist meaningfully, eliminates midline skin redundancy, and often produces far better contour for weight-loss patients.
Cons: the vertical scar runs up the center of the abdomen and is visible in swimwear, healing takes longer, and there is a slightly higher risk of wound healing issues where the two incisions meet.
For the right candidate, most patients tell us the tradeoff is worth it.
"The scar conversation is one I have with every fleur de lis patient, and I always say the same thing: the scar is real, but so is what's on the other side of it. I've never had a patient who was the right candidate for this procedure come back at a year and say they wish they hadn't done it because of the scar. What they say is that they can finally wear a belt."
Dr. Cat Begovic, MD, FACS
Who Is a Good Candidate
The ideal candidate has lost a significant amount of weight, typically 100 pounds or more, and has maintained a stable weight for at least 6 months. Bariatric surgery patients make up a large portion of fleur de lis cases.
The pinch test tells the story: if loose skin at your flanks meets in the middle when pulled inward, the vertical excision is justified. You should also be a non-smoker (or willing to quit for at least 6 weeks before and after surgery), at a healthy BMI (usually under 32 to 35 for elective cases), and finished having children. Pregnancy after any abdominoplasty can stretch the repair and compromise results.
Patients should also be in good overall health with no uncontrolled conditions that impair healing, such as uncontrolled diabetes. A thorough preoperative evaluation reviews medical history, medications, and baseline labs to confirm surgical readiness.
Massive weight loss rarely loosens the abdomen alone. When the inner thighs have loosened too, a thigh lift can be planned as a second stage once the abdomen has healed.
Recovery, Results, and What to Expect
Fleur de lis recovery time runs longer than a standard abdominoplasty because of the additional incision and greater skin undermining. Most patients spend the first night in a surgical facility or with a post-op caregiver. Drains are placed to prevent fluid buildup and usually stay in for 1 to 2 weeks; caring for drains is a daily task during this window, and every patient is walked through it before surgery.
Expect 2 to 3 weeks off work for a desk job, longer for physical labor. Walking hunched forward is normal for the first 7 to 10 days to protect the repair. Compression garments are worn around the clock for 4 to 6 weeks. Light exercise resumes at 4 weeks; strenuous activity waits until 6 to 8 weeks.
Scars and Before and After Expectations
Fleur de lis before and after photos show the dramatic contour change: a cinched waist, flat abdomen, and removal of the apron of skin that frustrates so many weight-loss patients. The anchor-shaped scar is real and permanent, but it flattens and lightens significantly with proper care: silicone sheeting starting at 3 weeks, sun protection, and scar massage. The scars continue to fade and flatten through 18 months post-op.
According to the American Society of Plastic Surgeons, body contouring procedures after major weight loss, including fleur de lis abdominoplasty, are among the fastest-growing categories in reconstructive and aesthetic surgery as bariatric surgery rates continue to rise.
"I show every fleur de lis patient before-and-after photos at their consultation, not to sell them on anything, but because realistic expectations are everything. This isn't a procedure where the scar disappears. But when patients see what the abdomen looks like at 12 months with proper scar care, the scar stops being the thing they're focused on. The shape takes center stage."
Dr. Cat Begovic, MD, FACS
