Fleur de Lis Abdominoplasty

Conveniently located to serve the areas of Houston and Katy, TX

The Fleur de Lis Abdominoplasty, also known as a vertical abdominoplasty,  is a tummy tuck procedure designed for patients in need of extensive soft tissue removal in the abdomen. Commonly used in patients who have experienced massive weight loss, it differs from a standard abdominoplasty procedure in that it also involves an additional vertical incision in the abdomen. This extra incision allows the surgeon to remove a significant amount of excess skin to comprehensively recontour the midsection.

Taking its name from the european heraldry symbol of a stylized lily, this technique can achieve more precise contouring in bariatric patients compared to the standard abdominoplasty.  

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If you have undergone a gastric bypass or gastric sleeve procedure, a fleur de lis abdominoplasty may be a better cosmetic surgery option compared to a traditional abdominoplasty.  Arrange a personal consultation with a board certified cosmetic surgeon, Ricardo Bonnor M.D., F.A.C.S.. Call Texas Surgical Arts at (281) 579-5638  

Abdominoplasty for Bariatric Patients

As the largest organ of the human body, our skin is a versatile and vital layer of outer protection.  But when significant fat deposits deplete quickly, the skin cannot simply “snap back” into an aesthetically pleasing body contour. There is no question that bariatric intervention helps thousands of people achieve long-term, lasting weight loss.  However, for many people who previously fell into the morbidly obese weight range, rapid weight loss can leave troublesome skin sagging that can bring with it frustration and discomfort. 

Research indicates that as many as 70% of post-bariatric patients request abdominoplasty. These patients had lost a significant amount of their body mass, but experienced multiple uncomfortable skin-related symptoms that seriously impacted their quality of life. (1)

Problems with Post-Bariatric Excess Skin

One study conducted in Sweden provides some insight into post-bariatric patient’s experience with excess skin. Their questionnaire revealed some startlingly consistent results in male and female patients. 

  • 91% of male and 67% of female respondents felt they had an unattractive body (due to excess skin).
  • 91% of women had excess skin in their arms, while 78% of men reported excess abdominal skin.
  • In both women and men, excess skin on the abdomen caused the most discomfort.
  • Female respondents had significantly more discomfort, and amount of excess skin compared to men. 
  • The amount of excess skin had a positive correlation to the degree of discomfort in all body parts. (2)

Common Problems in Post-Bariatric Patients

In practical terms, having a significant amount of residual skin in the abdomen causes problems. These can include the following.

  • Persistent skin irritation/rash
  • Discomfort from chaffing/rubbing
  • Unpleasant odors, hygiene difficulties 
  • Skin texture and pigmentation changes
  • Prominent stretch marks
  • Frequent skin infections
  • Distorted/displaced umbilicus (navel)
  • Waistband “overhang” 

Additionally, the body shape that remains following bariatric surgery can affect mental health. Body image can be severely impacted despite the absence of fat, and some patients express that their abdomen is “just as ugly” as before.  This, in turn, can lead to lowered self-esteem, depression, sexual intimacy difficulties, and body shame. (3)

When is the Right Time for a Fleur de Lis?

For the safest, most efficient abdominoplasty surgery, patients follow strict instructions before and after their surgery. Cosmetic surgeons also explain to each candidate the timeline for post-bariatric procedures. One of the most important things for post-bariatric patients to consider is choosing the right time for abdominoplasty. Here, the expert consensus is clear. Body contouring procedures should not commence until:

  • The patient’s weight loss is complete
  • Weight has been stable for at least 6 months
  • Usually takes place 9 to 12  months after bariatric surgery (4)

Dr. Bonnor will assess your weight loss and discuss the timeline of your abdominoplasty at your personal consultation.

The Fleur de Lis Technique

The fleur de lis technique expands upon the traditional tummy tuck for a more effective way to contour the post-bariatric body. Dr. Bonnor makes two incisions in the abdomen that allow a larger amount of redundant skin to be removed from the middle of the abdomen. (5) He places a horizontal incision from hip to hip, just above the pubic line. (6) The second incision is placed vertically and intersects the first incision at the midline (the center of the abdomen). This shape resembles the fleur de lis. He then removes the necessary amount of skin before suturing the incisions shut.


Candidates for the fleur de lis abdominoplasty are usually people who have experienced massive weight loss from a bariatric procedure such as a gastric bypass, gastric sleeve, or lap band. It is one of the best-suited techniques for the removal of large amounts of excess skin. Abdominoplasty may not be right for patients with certain medical conditions. These include but are not limited to the following.

  • Patients who cannot give up smoking
  • Patients taking anticoagulant medication
  • Patients who have prior surgical complications
  • Patients with other serious health conditions

Personal Consultation

Dr. Bonnor will speak with you to gather important information at your personal consultation. He will ask you to provide some details about your medical history, and the particulars of your bariatric surgery. Most importantly, he will ask you about how your weight loss has progressed since your procedure, and note your current body mass index (BMI). Once he has taken these details, he will examine the excess skin in your abdomen and discuss your eligibility for abdominoplasty. If a fleur de lis abdominoplasty is indicated, he will discuss how the procedure differs from a standard tummy tuck.

Corresponding & Complementary Procedures

Arm Lift

If an abdominoplasty is necessary for the abdomen, there may be other areas with excess skin following the loss of a substantial amount of weight. For many women especially, there can be more noticeable excess skin in the upper arms. To counter this, Dr. Bonnor offers arm lift surgery in two forms to suit the needs of the patient; mini-brachioplasty and liposuction-assisted brachioplasty. The mini brachioplasty is a less-invasive procedure for patients who wish to address skin sagging around the armpit, and does not involve skin removal toward the elbow. Liposuction-assisted brachioplasty involves the removal of remaining fat and skin, for a more streamlined arm silhouette.

Breast Lift (Mastopexy)

Many women experience significant tissue sagging in their breasts after weight gain or weight-loss. In particular, the nipple and areola are in a lower-than-desirable position. A mastopexy procedure repositions the breasts higher on the chest wall for better overall shape and projection. Dr. Bonnor will use either a short-scar incision for minimized scarring, or use BodyTite; a radiofrequency-assisted liposuction technique that does not involve long scars.

Thigh Lift

To slim the upper legs and trim excess skin following weight-loss surgery, Dr. Bonnor can perform a thigh lift procedure. To create a slimmer leg profile, he makes discreet incisions to tighten and reshape the area, to better reflect your overall weight loss throughout your body. Read more about post-bariatric body contouring on our website.

To speak with him about your desired procedure, or combination of procedures to remove excess skin, please schedule a personal consultation at Texas Surgical Arts. Call (281) 579-5638 or fill out a form online to get in touch with us.

Frequently Asked Questions (FAQ)

How is a fleur de lis tummy tuck different from a standard abdominoplasty?

The fleur de lis technique involves an extra vertical incision in the abdomen. This allows the surgeon to remove more excess skin than the standard abdominoplasty. It is particularly advantageous for bariatric patients to address large amounts of excess skin after massive weight-loss surgery.

Does a fleur de lis tummy tuck take longer than a standard tummy tuck?

The fleur de lis abdominoplasty takes longer than a standard tummy tuck. Where as standard abdominoplasty takes between 3 to 4 hours, a fleur de lis abdominoplasty can take 5 to 6 hours, depending on the patient’s individual circumstances.


  1. Elander, A., Biörserud, C., & Fagevik Olsén, M. (2021). Excess skin after weight loss following bariatric surgery: focus on the abdomen. Surgery for Obesity and Related Diseases. https://doi.org/10.1016/j.soard.2021.01.005 
  2. Staalesen, T., Fagevik Olsén, M., & Elander, A. (2013). Experience of Excess Skin and Desire for Body Contouring Surgery in Post-bariatric Patients. Obesity Surgery, 23(10), 1632–1644. https://doi.org/10.1007/s11695-013-0978-z
  3. Gilmartin, J. (2013). Body image concerns amongst massive weight loss patients. Journal of Clinical Nursing, 22(9-10), 1299–1309. https://doi.org/10.1111/jocn.12031
  4. Sadeghi, P., Duarte-Bateman, D., Ma, W., Khalaf, R., Fodor, R., Pieretti, G., … Cuomo, R. (2022). Post-Bariatric Plastic Surgery: Abdominoplasty, the State of the Art in Body Contouring. Journal of Clinical Medicine, 11(15), 4315. https://doi.org/10.3390/jcm11154315 
  5. Dinsmore, R. C., Pham, P. M., Lopez, J., & Palubicki, J. H. (2014). Safely Performing the Inferior-Medial Vector Fleur-de-Lis Abdominoplasty. Plastic and Reconstructive Surgery, 134(4S-1), 113. https://doi.org/10.1097/01.prs.0000455474.62431.e5 
  6. Bunting, H., Lu, K. B., Shang, Z., & Kenkel, J. (2020). Vertical Abdominoplasty Technique and the Impact of Preoperative Comorbidities on Outcomes. Aesthetic Surgery Journal Open Forum, 3(1). https://doi.org/10.1093/asjof/ojaa043