Operation Guide: What Happens During a Fleur-de-lis Tummy Tuck Surgery?

If you’ve lost massive weight through surgery or exercise, a standard tummy tuck may not be enough to remove excess skin on your abdomen. When you have a lot of loose skin on your midsection, Dr Bernard Beldholm may recommend a fleur-de-lis tummy tuck.

This article explains what happens during the fleur-de-lis operation. By reading this article, you will know exactly what to expect on surgery day. He explains his surgical technique in detail and answers many questions about how a fleur-de-lis operation works. You’ll also learn what to expect in recovery and what the scars look like.


What is a fleur-de-lis tummy tuck?

A tummy tuck removes excess skin and fat on the abdomen. There are many types of tummy tucks. Fleur-de-lis abdominoplasty is one of them.

Named after the shape of a water lily, the fleur-de-lis surgery has an incision on the mid and lower abdomen that leaves a T-shaped scar.

During the fleur-de-lis procedure, Doctor Bernard may also reduce fat with lipo and repair the abdominal muscles if needed. He regularly does this as part of all the tummy tuck procedures he offers.

Who is a candidate?

A fleur-de-lis tummy tuck is for patients who have extensive loose skin after weight loss that can’t be removed with a standard tummy tuck. The fleur-de-lis operation tightens skin in both the vertical and horizontal directions, unlike a tummy tuck which only improves one direction of excess skin.

To be eligible for surgery, you will need to reach a normal body mass index (BMI) and maintain a stable weight for six months. You can calculate your BMI here.

Some medical conditions may disqualify a patient from having cosmetic surgery. To find out more, email or call Dr Bernard Beldholm to book a consult. The consultation is purely informative. There is no obligation to have surgery.

Fleur-de-lis vs tummy tuck: What is the difference?

Many post-massive-weight-loss patients have a large amount of loose skin on their middle and sides. In these cases, a standard tummy tuck would leave too much loose skin behind, especially high on the abdomen and on the sides. By addressing both the lower and middle part of the tummy, these patients can finally have a flat abdomen and freedom from all that loose skin.

The difference between the fleur-de-lis and standard tummy tuck is that Doctor Bernard makes a vertical cut in the middle of your abdomen and then brings the sides in. After that, he finishes the fleur-de-lis procedure by performing a standard tummy tuck on the patient.

The fleur-de-lis removes excess skin in two directions due to the T-shaped scar. A tummy tuck only removes skin in one direction, leaving one scar on the lower abdomen.

What are the benefits of fleur-de-lis abdominoplasty?

Some of the benefits may include:

  • A tighter, flatter tummy
  • Narrower waist and hips
  • Less abdominal fat
  • Repair of ab muscle separation
  • Clothes that fit better
  • Improved mobility
  • More self confidence
  • Elimination of chronic skin conditions from excess skin

What are the drawbacks?

A standard tummy tuck leaves a horizontal scar on the lower abdomen. That scar is usually hidden in the underwear line. In contrast, the fleur-de-lis has a vertical scar on the mid abdomen and a horizontal scar on the lower abdomen.

This scar is only hidden when you are fully clothed. It can be seen in two-piece swimmers and undergarments. Nonsurgical scar revision options such as lasers and injectables may be used to reduce the look of scars after surgery.

While the scars are significant, many patients with lax skin are happy to trade the scars for a tight, flat tummy.

I’m not sure if I need a fleur-de-lis or regular tummy tuck…Help!

It can be difficult to know what kind of tummy tuck you need without coming in for a consultation. During your consult, Doctor Bernard will examine your excess skin and let you know what procedure will give you the best result.

Factors such as amount of weight lost, skin quality, and location of the excess skin will all be taken into consideration. Based on this, he will design a treatment plan customised to your body.

In addition to full tummy tucks and extended tummy tucks, he also offers the fleur-de-lis tummy tuck and body lift, and many other body contouring surgeries that tighten skin and remove fat.

If you have a lot of excess skin on your mid and lower abdomen, you could be a candidate for a fleur-de-lis tummy tuck. This article explains how the surgery works.

Operation Guide: Fleur-de-lis tummy tuck

Learn how Dr Bernard Beldholm, FRACS performs a fleur-de-lis tummy tuck with lipo after massive weight loss.

PHASE 1: SURGERY PREPARATION

Markings

Before heading into surgery, Doctor Bernard will meet you in the anesthetic bay to go over any last-minute questions. He will draw a T-shaped marking on your abdomen to plan the incisions.

The markings are similar to a full tummy tuck, except there is an additional vertical marking on your abdomen. Around this, he will place two more lines in the shape of a triangle on your abdomen.

While the vertical scar can’t be hidden unless you’re fully clothed, he will make every effort to hide the lower abdominal scar as best as possible.

Body positioning on the operating table

Now that your skin is marked, you will lie on your back on the operating table.

Anaesthesia

A fleur-de-lis tummy tuck is performed under general anaesthesia through an IV. After you are sedated, you will have a tube placed to help you breathe. A licensed anaesthetist will oversee you the whole time and monitor your vitals. You will have no memory or sensation of surgery.

PHASE 2: VASER LIPOSCULPTURE

Not all patients need lipo to remove abdominal fat after weight loss, but many do. Doctor Bernard uses a newer type of lipo called VASER. Many surgeons consider VASER the gold standard in surgical fat reduction. It melts fat so your tummy will look more trim and toned. This can be safely done during a fleur-de-lis tummy tuck.

VASER lipo does more than remove fat. It has many other benefits. It reduces bleeding during the operation, which may make your surgery safer. It also helps free the excess skin so it can be removed easier.

VASER fat reduction takes approximately one hour.

Applying the wetting solution

Doctor Bernard will make tiny incisions at the site of fat removal. A cannula (thin hollow tube) will be inserted into your skin. Through the cannula, a fluid made of lignocaine and adrenaline is applied to the tissues. Dr Beldholm prefers to use a large amount of wetting solution as he finds it gives the best results.

Protecting your skin

Before he inserts the VASER wand into your skin, Doctor Bernard will place protective ports in your skin at the point of insertion. This protects your skin from heat burns since the VASER gets hot as it oscillates.

Fat melting

Doctor Bernard will insert the VASER wand into the target fat. He will move it in a back and forth motion until all the fat is melted. VASER melts fat with ultrasound energy. The energy rapidly forms bubbles in the wetting solution to dislodge and emulsify the fat cells.

Because VASER selectively targets fat, it won’t damage nearby blood vessels and nerves as much as traditional liposuction. When the fat reaches the consistency of hot butter, it is time to remove it.

Fat removal

A machine will suck the fat out through a cannula. Since the fat is now a liquid consistency, all that is needed to remove it is low-power suction. For this reason, VASER is considered gentler on your tissues than ordinary lipo, which uses aggressive suction. Once the fat is removed, your tummy and sides will look slimmer and empty.

PHASE 3: VERTICAL INCISION

The vertical incision will remove the excess skin on your midsection.

Belly button incision

Your belly button acts like a button on a tufted cushion. It tethers your abdominal tissues in place. Since a fleur-de-lis removes a lot of skin, it is necessary to free the belly button. This allows Doctor Bernard to make your tummy skin as tight as possible.

Doctor Bernard will make a small incision around your belly button. Next, he will stitch a small plastic bit to the umbilical stalk. That makes it easier to feel where your belly button is located later in the surgery when your excess skin is pulled down over it.

Vertical incision

It is time to get rid of the excess skin. Following the markings, Doctor Bernard will make an upside-down V on your abdomen with the scalpel. He will seal any blood vessels that open with diathermy to reduce bleeding. He will free the excess skin from the underlying tissues.

Removing the loose skin

Doctor Bernard will test the incision before cutting any skin. He uses sutures to gather the excess skin at the midline to make sure the exact right amount of skin is removed — no more, no less. He will mark the excess skin and then remove it using the markings as a guide.

Closing the incision

He will close the incision in layers. A deep permanent suture and absorbing sutures are used. He works from the deeper abdominal layers up toward the skin surface.

Doctor Bernard will also use ARTISS tissue glue. This glue comes in a spray bottle. As he sutures the layers closed, he will spray the glue to make sure there are no empty spaces in the tissues. Research shows surgical glue lowers the risk of post-operative seroma, or fluid buildup, that would need to be drained.

Seroma is a common complication after surgery. While it is usually a minor problem, any efforts to reduce the chance of seroma are worth it, in Doctor Bernard’s medical opinion. He has been using ARTISS glue during his tummy tuck surgeries for many years with good results.

PHASE 4: HORIZONTAL INCISION

Next, he will perform a standard tummy tuck to remove the remaining excess skin on your lower abdomen.

Horizontal incision

Doctor Bernard will make an incision from hip to hip. Again, he will seal any blood vessels that open to reduce bleeding. He will free the skin and work his way up from the incision toward your belly button. He will dissect the abdominal tissues to just below a tough layer known as the scarpa’s fascia, but no further. It is easy to see the scarpa’s fascia because it is white.

Doctor Bernard will not dissect below the scarpa’s fascia. He finds this eliminates the need to wear drains to remove fluid after surgery. Drains can be uncomfortable and a source of infection. By performing a drainless tummy tuck, he makes your recovery easier and safer.

Creating the epigastric tunnel

Many tummy tuck patients have ab muscle separation due to past obesity or pregnancy. A tummy tuck allows Doctor Bernard to stitch the muscles back together. In order to do this, he will create a tunnel to access the muscles instead of opening up your whole abdomen. The tunnel allows him to fix the muscles without dissecting the tissues more than they need to be. Less dissection has been shown to preserve blood flow, lymphatics, and nerves.

Muscle repair

He will suture the abdominal muscles at the midline. He uses special barbed sutures. These sutures gently hook into the tissues, so he will not need to tie knots like a regular suture.

Eliminating the knots means you won’t feel the sutures under your skin. The muscles are close to your skin surface, so that is important. It also saves time in the operating room since tying knots can be time consuming. That means you will spend less time under anaesthesia. While anesthesia is considered safe for healthy people, most people do not want to be sedated for a long time.

Removing the loose skin

Doctor Bernard will place the operating table on a tilt of approximately 15 degrees. He will carefully remove the remaining loose skin on your abdomen. Since he already removed the fat with VASER, the skin is easy to remove.

Belly button repositioning

Once the excess skin and fat is gone, your belly button will need to be moved. Doctor Bernard will make a small incision and pull your umbilical stalk through it. The goal is to place your belly button so it looks natural on your tummy, not sitting too high or low.

He will then artistically shape your belly button with ARTISS tissue glue and four sutures, making efforts to bury the sutures so the resulting belly button scar is not obvious. Each belly button is unique; Your individual preferences play a role in the belly button reshaping process.

To make your belly button look as natural as possible, he may remove a small bit of fat from behind it with liposuction. This creates a small depression around your belly button, which is a classic feature seen on fitness and swimwear models.

Closing the incision

Doctor Bernard will apply a permanent suture to the scarpa’s fascia. This layer of your abdomen can withstand a lot of tension for the tightest closure possible. He will also apply barbed sutures to close the overlying layers as well as ARTISS tissue glue. The initial incision is closed with absorbing sutures. Due to Doctor Bernard’s surgical technique, you won’t have to wear drains to remove fluid from the wound site in early recovery.

PHASE 5: FINALISING YOUR SURGERY

Wound dressings

He will apply sterile bandages to prevent contamination and support the wound as it heals. Many surgeons use ordinary sterile bandages. Doctor Bernard prefers to use an advanced PICO bandage.

This soft bandage is attached to a battery pack. When it’s powered on, it exerts gentle negative pressure on the wound to promote healing. It also reportedly lowers the risk of infection by trapping up to 99.9% of bacteria with AIRLOCK technology. Doctor Bernard has observed that most incisions heal beautifully after the PICO bandage is removed seven to ten days later.

Compression garments

You will wake in the recovery room already wearing a compression garment. Compression garments minimise swelling, which is a normal response to surgery. Compression may also lower the risk of seroma, or fluid buildup, after surgery. It is also thought to help the skin mould around your new body contours.

Results

The before and after results are dramatic. A huge amount of excess skin is removed during the fleur-de-lis operation. Paired with fat reduction from VASER and muscle repair, it can leave your abdomen much tighter, flatter and better defined.

The results are immediate since the loose skin and fat will no longer be present. However, it takes time to see the full results. Swelling dissipates and your tissues will relax in the next six to 12 months.

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Fleur-de-lis recovery

Generally speaking, this is what you can expect as you recover from surgery.

How much time will I need to spend in the hospital?

After fleur-de-lis surgery, you will most likely spend four to ten days in the hospital.

When can I shower after surgery?

You can shower 24 to 48 hours after surgery. Sponge baths may be easier in the first few days. Do not scrub or pick at the scar.

Is the fleur-de-lis tummy tuck painful?

Pain is moderate after the procedure, although each patient experiences a different level of discomfort. Pain medications will be prescribed to make your recovery more comfortable.

Doctor Bernard will have you stay in the hospital for a few days so nurses can assist you 24/7. In the hospital, pain medications are supplied through an IV so you may be more comfortable in the hospital than at home initially. When you go home, you may need help with household chores and shopping for a few weeks. Asking for assistance from family, friends or hired help are all options you might consider.

While recovery can be uncomfortable, it only lasts a few weeks. The results of surgery are long lasting.

How much time do I need to take off work, exercise and driving?

Most patients take two to four weeks off work and start driving again in three to four weeks. Heavy lifting and exercise are off limits for approximately six weeks.

What do the fleur-de-lis scars look like?

The fleur-de-lis operation leaves a T-shaped scar on the abdomen. Because the scar is significant, scar care is essential. You may be advised to use silicone scar sheets starting three to six weeks after surgery when the wound has healed and crusting is no longer present.

It can take a year or longer for scars to fade. While they will fade nicely in most cases, surgical scars never completely disappear. Laser scar treatments such as Laser Genesis are available to help lighten scars.

Do I need to wear a compression garment or binder after surgery?

Yes. You may be asked to wear the garment for approximately four to six weeks. You will be provided with instructions on how and when to wear the garment. For example, it can be removed to shower. In early recovery, you may be asked to sleep with it on and also wear it during the day.

What are the possible risks and complications?

No surgery comes without risk. A fleur-de-lis is considered safe for healthy individuals who have a normal body mass index (BMI). Possible side effects include, but are not limited to, infection, poor scarring, heavy bleeding, difficult recovery, nerve damage, bruising and seroma. Like all forms of surgery, rare but serious risks (such as death or blood clots) are possible.

The fleur-de-lis operation is complex. It requires a skilled surgeon. It is important to see a qualified surgeon who specialises in body contouring, such as Dr Bernard Beldholm, FRACS. A good surgeon can make your surgery as safe as possible, but they can’t eliminate all risks.

Summary

Dr Bernard Beldholm has performed tummy tucks of all kinds in the last 10+ years, including the fleur-de-lis operation. He aims to provide superior results in the safest manner possible. His surgical technique has several benefits. Less tissue dissection, sealing each blood vessel, using tissue glue and eliminating the need for you to wear drains are just as important as making sure you look great after surgery.