A FDL tummy tuck, short for fleur-de-lis abdominoplasty, is a body contouring surgery that uses both a horizontal and vertical incision to remove excess skin from the abdomen. It’s designed for people with significant skin laxity in multiple directions, most commonly after massive weight loss, where a standard tummy tuck wouldn’t remove enough tissue to produce a smooth result.
How It Differs From a Standard Tummy Tuck
A traditional tummy tuck uses a single horizontal incision along the lower abdomen, running hip to hip. This works well for removing a horizontal band of loose skin, but it can only tighten in one direction: up and down. For someone who has lost a large amount of weight, there’s often just as much excess tissue side to side, particularly around the belly button and upper abdomen. A horizontal-only approach can leave columns of bunched skin on either side of the midline.
The FDL procedure adds a vertical incision that runs from the lower horizontal cut up toward the breastbone. The two incisions meet in a T-shape, and the resulting scar pattern resembles the fleur-de-lis, the stylized lily used in French heraldry. The vertical component is typically marked as an inverted triangle or U-shape, allowing the surgeon to pull tissue inward from both sides and dramatically narrow the waist. This dual-direction approach removes skin excess in both the horizontal and vertical planes simultaneously.
Who Is a Good Candidate
The primary candidates are people who have undergone massive weight loss, whether through bariatric surgery or lifestyle changes. Traditional abdominoplasty techniques often fail to adequately correct the complex contour changes these patients experience. The key physical sign that points toward a FDL rather than a standard tummy tuck is upper abdominal skin laxity, meaning loose, hanging skin above the belly button that won’t be addressed by a low horizontal cut alone.
If you can grab handfuls of loose skin on either side of your midline, or if your surgeon notes that a transverse-only excision won’t produce an adequate aesthetic result, the FDL pattern becomes the better option. It’s also sometimes used in patients who haven’t had massive weight loss but have significant tissue laxity from aging, pregnancy, or genetics that extends well above the waistline.
What the Surgery Involves
The procedure typically takes 3 to 5 hours under general anesthesia. After the incision pattern is marked on the skin, the surgeon removes the excess skin and fat within both the horizontal and vertical outlines. The skin flaps are then pulled together and closed, creating the T-shaped junction at the center of the lower abdomen.
In most cases, the surgeon also repairs separated abdominal muscles, a condition called diastasis recti that’s common after weight fluctuations or pregnancy. This involves stitching the two halves of the abdominal wall back together along the midline, running from the pubic bone up toward the ribcage. The muscle repair restores core support and flattens the abdominal profile from the inside. Surgical drains are typically placed beneath the skin to prevent fluid buildup and are removed within 3 to 7 days after surgery.
Results and Body Contouring
The vertical resection is what sets the FDL apart in terms of results. By removing tissue in the horizontal direction, the waist narrows significantly more than it would with a standard tummy tuck. A notable case study involving identical twins illustrated this clearly: one twin received a traditional transverse abdominoplasty while the other received the fleur-de-lis approach. The twin who had the FDL achieved a waist-to-hip ratio of 0.7, which is considered ideal for a feminine silhouette. The twin with the standard procedure ended up with a waist-to-hip ratio close to 1, with visible residual skin excess and a vertical midline groove.
The FDL approach is particularly powerful at creating defined waist-to-hip curvature and eliminating the periumbilical skin excess (the loose tissue flanking the belly button) that standard techniques tend to leave behind. For massive weight loss patients with both upper and lower abdominal laxity, the contouring difference can be substantial.
Recovery Timeline
The first 24 hours involve rest with no bending, lifting, or straining. You’ll be walking in a hunched posture to avoid tension on the incisions, and you’ll wear a compression garment continuously. Most surgeons schedule a follow-up within the first week to check the incisions and remove drains.
Light activities, like short walks and basic household tasks, become possible around 2 to 3 weeks post-surgery, though this varies. At the one-month mark, most patients can start gentle exercise but should still avoid anything that heavily engages the core, including heavy lifting, crunches, and intense bending. Full clearance for strenuous activity comes later, and most surgeons advise wearing the compression garment for at least four weeks. Lymphatic drainage massage, starting around day 5, can help reduce swelling during the first few weeks.
Because the FDL has more incision length than a standard tummy tuck, the overall healing process tends to be slightly longer. The vertical scar in particular takes time to mature and flatten, often continuing to improve for 12 to 18 months.
Risks and Complications
The T-junction where the horizontal and vertical incisions meet is the most vulnerable point for healing problems. Blood supply is reduced at that intersection, which can lead to delayed wound healing or, in some cases, skin necrosis. The incidence of skin necrosis in abdominoplasty ranges from about 3% to 4.4% when surgeons use limited dissection techniques that preserve blood flow. When necrosis does occur, healing can take weeks or months depending on the size of the affected area.
Other risks include the same ones associated with any abdominoplasty: infection, fluid collection (seroma), blood clots, and scarring that heals wider or more prominently than expected. The additional vertical scar is the most significant trade-off of this procedure. It runs up the center of the abdomen and, while it fades over time, it remains permanently visible. For most FDL candidates, the improved contour outweighs the extra scar, but it’s a trade-off worth understanding clearly before committing.
Cost
The average surgeon’s fee for a standard tummy tuck is $8,174, according to the American Society of Plastic Surgeons. A fleur-de-lis abdominoplasty generally costs more because of the additional operating time and complexity. That average figure also doesn’t include anesthesia fees, operating room costs, medical tests, compression garments, or prescriptions, all of which add to the total. Final out-of-pocket costs vary significantly by region and surgeon.
Insurance coverage is uncommon for cosmetic abdominoplasty, but some insurers will cover part of the procedure when it’s performed to address medical issues like chronic skin infections or rashes beneath hanging skin folds after massive weight loss. Documentation from your primary care provider and a letter of medical necessity from your surgeon can strengthen a coverage request.