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Background:  Contouring of the abdomen through tummy tuck surgery is one of the most common body contouring procedures. It is a widely recognized operation that has a long history of proven effectiveness. There is no substitute for excising loose tissues about the waistline to create a flattening effect.

While the tummy tuck is a well recognized operation it is not as well known that there are numerous variations to it based on the amount of tissue excised, the location of the resultant scars and whether liposuction is also used. One of these variants is the fleur-de-lis which means it is a combined horizontal and vertical excisions of abdominal skin and fat creating the inverted T-shaped scar pattern when closed.

Because the fleur-de-lis tummy tuck incorporates the additional vertical excision it removes tissue from an additional dimension. For this reason I call it the ‘3D Tummy Tuck’ as it is the only variant of tummy tuck surgery to do so. By removing a midline vertical tissue segment this provides a hormonal waistline tightening that does not exist in the more traditional ‘2D tummy tuck’. Whether the additional midline scar is a worthy tradeoff  for that benefit depends on how much loose abdominal tissue is present. It is almost an unequivocal decision if a midline abdominal scar already exists.

Case Study:  This young female had a history of multiple pregnancies as well as a prior abdominal surgery with a midline scar between the umbilicus and the sternum. Her central abdomen had radiating stretch marks around the umbilicus which indicates that she had a lot of tissue expansion from her pregnancies.

Under general anesthesia an inverted T-shaped excision pattern was done on the frontal abdomen. A large wedge of tissue was removed with the horizontal piece being bigger than the vertical excision.  A midline fascial plication was also done. The umbilicus stayed in the same location but with a new circumferential scar.

The traditional value of a tummy tuck, even though it involves a long scar, is that the scar stays low and relatively hidden in underwear clothing. The introduction of a vertical component to the tummy tuck changes the scar aesthetics. The benefits of the waistline narrowing effect must justify that tradeoff.

Case Highlights:

1) The traditional tummy tuck is a 2D procedure with an horizontal elliptical excision pattern.

2) The combined horizontal and vertical excisions pattern, the fleur-de-lis, is a 3D tummy tuck.

3) The decision for a 3D tummy tuck is easy if an existing midline abdominal scar already exists.

Dr. Barry Eppley

Indianapolis, Indiana

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