Following weight loss, either from dieting or following one of the many bariatric procedures designed to help people lose weight, there is often a gross excess of skin over the entire abdominal area. In many cases, these patients are best managed with a standard abdominoplasty. In others, there is simply too much excess skin, especially around the circumference of the abdomen. In order to remove enough skin in the horizontal direction (around the patient as opposed to vertically), a fleurs-de-lys type abdominoplasty is sometimes required. It is very similar to the standard abdominoplasty except that the excess skin in the upper abdomen is removed, leaving a vertical scar in the midline of the abdomen. Because of this additional scar, this procedure is reserved for selected patients only.
A fleurs-de-lys abdominoplasty is performed under a light general anesthetic and usually takes from 3 to 4 hours. Patients remain in the clinic over night for monitoring only. As mentioned, the operative procedure is similar to the standard abdominoplasty. After the underlying muscles are tightened, the excess skin in the upper abdomen is removed and the skin closed with a vertical incision in the midline of the abdomen. The length of this incision will vary and does not extend up the rib cage or breast bone in most cases. The excess skin in the lower abdomen is then removed and the incision closed. One or two drains are usually required. A dry dressing and a compression garment are then fitted.
The incisions for a fleurs-de-lys-abdominplasty are similar to the standard procedure with the added incision in the midline of the abdomen. The shaded area illustrates where the tissue is undermined to allow the muscles to be tightened if necessary and the excess skin to be removed. This procedure is designed to rejuvenate the entire abdominal area mainly in patients following massive weight loss.