Fleur-de-Lis Tummy Tuck: When a Vertical Scar Is Worth It

The name comes from a shape. A fleur-de-lis tummy tuck is drawn with a horizontal limb and an upright limb, so the piece of skin removed looks a little like that outline before it is closed. You do not need the heraldry. You need to know that the upright limb becomes a scar you can see when you look down.

Everything else on this page follows from that drawing. More skin can come out. The scar pattern is heavier than a standard tummy tuck. People arrive here after major weight loss¹, which is one of the settings the abdominoplasty chapter gives for skin that has lost its recoil. The chapter describes the traditional operation. The fleur-de-lis pattern is the variation used when looseness runs across the abdomen as well as down it.

What it is

A standard abdominoplasty removes excess skin and subcutaneous fat and, when indicated, tightens the underlying muscle¹. The traditional incision is horizontal, and the umbilicus is transposed¹. A fleur-de-lis tummy tuck keeps that horizontal plan and adds a vertical incision from the lower scar up toward the breastbone, usually stopping short of it. The vertical opening is how skin from the right and left is brought to the middle and the excess is cut away.

Think of two pulls. Downward pull, through the horizontal scar, takes the skin that hangs from the upper abdomen. Sideways pull, through the vertical scar, takes the skin that folds from flank toward flank. If you only need the first pull, you do not need the second scar. If both pulls are needed, a horizontal scar alone leaves a side-to-side redundancy that the downward pull cannot erase.

The belly button is usually brought out through the redraped skin, as in a traditional tummy tuck, because the front flap is being moved. This is not a mini. A mini uses a shorter lower incision and does not reposition the umbilicus¹. Fleur-de-lis is at the other end of the scar spectrum.

This page does not describe a minute-by-minute theatre routine. Incision length and how far the vertical limb runs vary with the skin in front of the surgeon. A diagram would only repeat the two directions already named. There is no patient photograph here.

Who it is for

The operation is for people whose abdominal skin is loose vertically and horizontally. That pattern is common after major weight loss¹, including after bariatric surgery, when a large volume has gone and the skin has stayed. Pregnancy can leave looseness too, but a fleur-de-lis plan is less often the first suggestion unless the side-to-side excess is obvious.

It is not the operation for a small pocket under the belly button. That is the mini description: excess below, little excess above. It is also not automatically the operation just because someone has lost weight. If the looseness is a hanging apron without a need to tighten the sides toward the midline, an apronectomy or a horizontal abdominoplasty may be the closer match. Those are different pages: apronectomy and what a tummy tuck is.

Weight should be stable before skin is cut to a pattern, because further loss or gain changes the fit. This page does not set a number of months or a BMI. Skin quality, scars from older operations, and hernias change the plan as well. None of that can be settled from a keyword.

The trade-off: more skin removed, more scar

The honest version is short. You can remove more skin if you accept more scar. The horizontal scar of a full tummy tuck is already permanent. The vertical scar is an additional permanent line on the midline, where clothes and a bare abdomen show it. People who have lived with a heavy apron often prefer that line. People who have a modest fold often do not, once they understand the line does not fade away.

There is no score on this page for when the trade is worth it. Worth is the balance between skin you can see in the mirror and a scar you can also see. A surgeon can say what each incision would remove. The preference is yours. Marketing that calls the vertical scar barely noticeable is not a medical description.

More scar also means more wound. Where the vertical and horizontal lines meet, the corner is a place surgeons watch. This page does not quote a breakdown rate for that corner. What can be cited is a single-surgeon series of people who had lost at least 50 pounds: 499 patients, 154 of them with a vertical fleur-de-lis component.

In that group the overall abdominal complication rate was 26.3%, and the major-complication rate was 5.0%². Transverse-only and fleur-de-lis operations had similar rates, apart from a higher rate of wound infection when the vertical cut was added². Those figures are from a massive-weight-loss practice in the United States. They are not an NHS rate, and they are not the chance of a problem at the scar corner specifically. The same paper describes the pattern as suited to upper abdominal skin laxity that a transverse cut alone may not correct².

Scar healing

Both limbs of the scar go through the same long maturation as any abdominal scar. Early on the lines are firm and pink. Over many months they usually flatten and pale. This page does not print a month when the colour is final, because that figure is not in the source used here. Raised or stretched scars happen. They are not a personal failure.

The vertical scar cannot be tucked into the underwear line. That is the point of the trade-off section. Sun protection and the scar care you were given are reasonable. A product that promises to delete the line is not. How abdominal scars are looked after, including the fleur-de-lis vertical limb, is covered in scar healing after a tummy tuck.

Infection, a wound that opens, or a scar that becomes suddenly painful is a reason to contact the operating team or your GP. NHS 111 is the out-of-hours route. Call 999 for chest pain, sudden breathlessness, or a collapse. This site cannot see the wound.

Recovery

Recovery follows the size of the operation. Two incisions mean a larger wound than a horizontal tummy tuck alone, and the tightness can run both down the abdomen and across it. Standing fully straight may take time. Swelling above and beside the scars can last longer than people expect from a weekend story. This page does not publish a day-by-day calendar or a hospital stay, because those figures are not in the source used here.

Drains are part of ordinary abdominoplasty care. StatPearls calls one or two drains typical, and not mandatory¹. A fleur-de-lis plan may use them. Ask, rather than assuming the pattern of the scar dictates the drain. A garment, short walks, and a ban on heavy lifting are the usual early rules. The shared outline is on recovery.

Fleur-de-lis vs extended

An extended tummy tuck keeps a single low scar and runs it further out, so the flanks are included. A fleur-de-lis tummy tuck puts the extra scar on the front, vertically. Choose between them by where the loose skin is. Skin that rolls around the sides points toward the longer horizontal scar. Skin that folds from hip to hip across the front points toward the upright scar. Some people have both problems. That is a surgical planning question, not a reason to collect operation names.

Neither pattern is a 360, which continues around the back. The back is a different scar again. Start from the types hub if the names are still overlapping, and from after major weight loss if the loose skin is not only on the abdomen.

Cost

A fleur-de-lis fee is not stated on this page. The only explanation is the fee guide, which does not print a separate price for this scar pattern.

FAQ

• What is a fleur-de-lis tummy tuck?

  A fleur-de-lis tummy tuck is an abdominoplasty with two scar directions. A low horizontal scar removes skin from above, as in a full tummy tuck. An upright scar in the midline removes skin from side to side. It is discussed when weight loss has left looseness in both directions. The umbilicus is usually repositioned, because the front of the abdomen is redraped. It is not a short-scar mini operation.

• Why the vertical scar?

  The vertical scar is there so skin can be taken from the sides toward the middle. A horizontal scar alone pulls skin downward. It does less for a wide, loose apron that hangs sideways as well as down. After large weight loss that side-to-side laxity is common. The upright line is the price of removing it. Hiding the line is not something this operation offers.

• Is it worth the extra scar?

  It is worth considering when the extra skin from side to side bothers you more than an upright scar would. It is a poor trade if the looseness is only up and down, because a horizontal operation may be enough. No one on this page can score that trade for you. Look at where your loose skin actually sits, and treat the vertical line as permanent.

• Who needs one?

  People who have lost a large amount of weight and still have skin that is loose from side to side, as well as from the ribs toward the pubis, are the group this pattern is built for. A small lower fold does not need an upright scar. The operation is not a reward for weight loss and not a punishment for it. It is one way of removing skin that will not shrink on its own.

• How does a fleur-de-lis tummy tuck differ from an extended one?

  An extended tummy tuck lengthens the horizontal scar toward the flanks so the sides are included. A fleur-de-lis tummy tuck adds an upright scar on the front so skin can be pulled toward the midline. Both can be discussed after weight loss. They are not two names for one drawing. One spreads the scar sideways. The other adds a scar you will see on the front of the abdomen.

• Where is the fleur-de-lis fee explained?

  Not on this page. This site does not print a separate fleur-de-lis price, and it does not invent a higher figure because the scar is longer. The cost guide is the only fee page. A written quote should say whether the plan is fleur-de-lis, extended, or a circumferential operation, because those are different incisions.