Losing a significant amount of weight through bariatric surgery, sustained lifestyle change, or other means transforms health, mobility, and self-confidence — but often leaves behind a by-product patients did not anticipate: stretched, redundant skin that no amount of additional training or dieting can reduce. The abdomen is the most common location where this excess skin accumulates, sometimes in amounts that a standard horizontal tummy tuck incision cannot adequately address. For patients with substantial loose skin extending both horizontally across the lower abdomen AND vertically up the midline, the Fleur-De-Lis (FDL) abdominoplasty uses a second vertical incision to access and remove the additional skin that a standard approach leaves behind. For the right candidate, FDL delivers a flat, contoured abdomen when no less-extensive technique can.

Dr. John Anastasatos performs Fleur-De-Lis abdominoplasty at his Beverly Hills practice with the reconstructive body contouring training this extensive operation requires. Dr. Anastasatos served as Chief Resident in Plastic Surgery at the University of Alabama at Birmingham — training that covered the full reconstructive spectrum including complex body contouring after massive weight loss — and has published a book chapter on full abdominoplasty in Aesthetic Surgery of the Abdominal Wall. Board certified by the American Board of Plastic Surgery, a Fellow of the American College of Surgeons (FACS), and named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World.

Fleur-De-Lis vs. Standard Tummy Tuck

A standard tummy tuck is performed through a horizontal incision that extends across the lower abdomen, just above the pelvic bones. This single incision provides adequate access to remove excess skin and tighten the abdominal muscles in the lower abdomen — and for most patients with moderate skin laxity, this is the right operation.

But for patients with substantial loose skin that extends both horizontally AND vertically — particularly after massive weight loss — a single horizontal incision does not give the surgeon enough access to address the upper abdomen. The skin in the upper portion of the abdomen cannot be adequately tightened through a lower incision alone. The Fleur-De-Lis abdominoplasty adds a second, vertical incision running from the lower horizontal incision up toward the breastbone, creating the fleur-de-lis pattern that gives the technique its name.

This vertical incision allows the surgeon to remove the excess skin that extends up the midline, tighten the upper abdominal muscles, and produce a far more dramatic contour than a standard tummy tuck alone could achieve. The trade-off is a larger scar — the vertical component remains visible after healing. For patients whose skin laxity is substantial enough to require FDL, the improvement in contour is typically well worth the scar, which most patients describe as a meaningful upgrade from the post-weight-loss appearance that motivated them to seek surgery.

“The Fleur-De-Lis is the right operation for a specific patient: someone who has completed a major weight-loss transformation and has loose skin that extends vertically up the midline, not just horizontally across the lower abdomen. A standard tummy tuck in this patient would produce an inadequate result. The vertical incision is the only way to address what’s actually there. Patients are almost always thrilled with the outcome — the contour improvement is dramatic, and the scar is a reasonable trade for the result.” — Dr. John Anastasatos

Who Is a Good Candidate for Fleur-De-Lis Abdominoplasty

FDL abdominoplasty is a specialized operation for patients whose anatomy specifically calls for it — not a universal alternative to standard tummy tuck. Ideal candidates typically include:

• Post-Bariatric Surgery Patients: Men and women who have undergone gastric bypass, sleeve gastrectomy, or similar procedures and have achieved stable weight loss.
• Massive Weight Loss Through Other Means: Patients who have lost significant weight through sustained lifestyle change and have stabilized at their target weight.
• Substantial Horizontal and Vertical Skin Laxity: Loose skin that cannot be adequately addressed through a single horizontal incision — particularly excess skin extending up the midline.
• Stable Weight for 12+ Months: Weight stability ensures the surgical result will not be distorted by subsequent fluctuations.
• Prior Abdominal Surgeries: Patients who have existing vertical scars (including previous abdominal surgery) may be particularly suited for FDL, since the vertical component can be incorporated into the existing scar.
• Acceptance of the Scar Trade-Off: Understanding that the vertical incision produces a visible scar and agreeing that the contour improvement justifies it.
• Good Overall Health: General medical health sufficient to support a more extensive operation and recovery.

What the Fleur-De-Lis Procedure Addresses

Because FDL uses both a horizontal and vertical incision, the procedure can address aspects of abdominal anatomy that standard tummy tuck cannot:

• Lower Abdominal Skin: Removed through the horizontal incision just as in a standard tummy tuck.
• Upper Abdominal Skin: Removed through the vertical incision — the defining advantage of the FDL approach.
• Vertical Midline Laxity: Addressed directly by the vertical incision, producing a tighter, more defined midline.
• Lower and Upper Abdominal Muscles: Both portions of the rectus abdominis muscle can be repaired through the combined incision pattern.
• Existing Vertical Scars: Previous scars from abdominal surgery (including vertical C-section scars) can be incorporated into the FDL incision.
• Belly Button Repositioning: As with other forms of abdominoplasty, the belly button is relocated and may be reshaped.

What to Expect From Recovery

Fleur-De-Lis abdominoplasty is performed under general anesthesia and is typically a longer operation than standard tummy tuck — commonly four to six hours, depending on the extent of skin removed and whether the procedure is combined with other body contouring work. Many patients stay overnight for monitoring; others go home the same day.

A compression garment is worn continuously during the first several weeks and during waking hours for approximately six to eight weeks. Drains are placed during surgery and typically removed over the first one to two weeks. Patients typically move in a slightly bent-forward posture during the first one to two weeks and gradually straighten as healing progresses. Most patients return to desk-based work within two to three weeks. Strenuous activity, lifting, and core-intensive exercise are restricted for approximately six to eight weeks. Final refinement of the result and full scar maturation emerge over six to twelve months.

Frequently Asked Questions About Fleur-De-Lis Abdominoplasty

How visible is the vertical scar?

The vertical scar is more noticeable than a standard tummy tuck scar because it is not hidden below clothing in the same way. However, it fades significantly over time and typically becomes a fine line that is well-tolerated. For patients who need the FDL for adequate contour, the scar is a reasonable trade for the substantial improvement in abdominal shape.

Is FDL only for post-bariatric patients?

Not exclusively, but post-bariatric and massive-weight-loss patients are the most common candidates. Other patients with substantial horizontal and vertical skin laxity — from any cause — may also be appropriate candidates. Dr. Anastasatos assesses anatomy during consultation.

Can Fleur-De-Lis be combined with other body contouring?

Yes. FDL is often combined with other post-weight-loss procedures such as arm lift, thigh lift, breast surgery, or belt lipectomy. Because FDL is already an extensive operation, combinations are planned carefully with safety as the priority. Some patients benefit from a staged approach.

How long before I see final results?

Most of the improvement is visible within the first three months, though final refinement and full scar maturation continue for six to twelve months. Compression garments and proper scar care during the first year support the best long-term scar appearance.

Will insurance cover Fleur-De-Lis?

Coverage varies significantly by insurer. When there is documented medical necessity related to post-weight-loss skin issues — chronic rashes, hygiene problems, or other functional symptoms — partial coverage is sometimes available. Purely cosmetic components are generally not covered. Dr. Anastasatos’s office can help navigate these considerations.

What is the difference between FDL and belt lipectomy?

FDL addresses horizontal and vertical abdominal skin through two incisions on the front of the abdomen. Belt lipectomy addresses circumferential skin laxity around the entire lower torso — front, sides, and back — through an incision that runs around the body. Some patients need one; some need the other; some need both, typically in staged procedures.

Why Choose Dr. Anastasatos for Fleur-De-Lis Abdominoplasty

• UAB Plastic Surgery Chief Resident: Senior-level training at the University of Alabama at Birmingham covering the full reconstructive and aesthetic spectrum — including complex body contouring after massive weight loss.
• Published Book Chapter on Full Abdominoplasty: Author of a peer-reviewed chapter in Aesthetic Surgery of the Abdominal Wall — direct authority on the abdominoplasty techniques that underlie the FDL approach.
• Board-Certified and FACS: Certification by the American Board of Plastic Surgery and Fellowship in the American College of Surgeons reflect rigorous, verified training.
• Reconstructive and Aesthetic Dual Competency: The combined training to address both the structural reconstructive work and the refined aesthetic finishing that FDL requires.
• Full Spectrum of Abdominoplasty Options: Standard, endoscopic, lipo abdominoplasty, FDL, and belt lipectomy — allowing each operation to be matched precisely to the patient’s anatomy.
• Featured in Leading Media: Reuters, the Boston Globe, FOX News, Forbes, Vogue, Elle, and the plastic surgery series Nip/Tuck.
• Top 10 International Recognition: Named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World and recognized as a Castle Connolly and U.S. News Top Doctor.

Schedule Your Fleur-De-Lis Abdominoplasty Consultation in Beverly Hills

If significant weight loss has left you with substantial horizontal and vertical abdominal skin laxity that a standard tummy tuck cannot adequately address, the Fleur-De-Lis abdominoplasty may be the operation that finally delivers the contour your transformation deserves. Dr. John Anastasatos welcomes patients to the Beverly Hills office at 436 North Bedford Drive, Suite 202, Beverly Hills, CA 90210, for a private consultation covering your anatomy, the appropriate surgical plan, and realistic outcomes. Contact us at Los Angeles Plastic Surgery to arrange your appointment with Dr. Anastasatos.