Fleur-de-Lis Tummy Tuck: The Vertical Incision After Weight Loss

A fleur-de-lis tummy tuck adds a vertical incision to the standard horizontal one, creating an inverted-T or anchor scar, to remove width as well as height. It is used mainly after major weight loss, where there is excess skin side to side that a horizontal-only abdominoplasty cannot take in. The trade-off is a permanent vertical midline scar on top of the hip-to-hip scar.

This is the type I read about with the most caution, because the scar is the most visible decision in the whole field of tummy tucks. This guide, checked by a consultant plastic surgeon, explains who it is for and what it costs you in scarring. For the operation overall, see the tummy tuck pillar, and for how it sits among the alternatives, the types of tummy tuck.

What is a fleur-de-lis tummy tuck?

A fleur-de-lis tummy tuck combines a vertical midline incision with the standard low horizontal one, so the surgeon can remove loose skin both up and down and side to side. A standard abdominoplasty pulls skin downward toward a hip-to-hip incision, which removes height but not width. By adding the vertical incision, a fleur-de-lis also takes in the sides, tightening the waist where there is too much horizontal skin to remove any other way.

The operation otherwise resembles a full abdominoplasty: the muscle is usually repaired and the procedure is done under general anaesthetic, with a tummy tuck typically taking about 2 to 4 hours¹. The American Society of Plastic Surgeons describes the fleur-de-lis approach as reserved for cases with substantial horizontal as well as vertical excess².

Who needs a fleur-de-lis tummy tuck?

A fleur-de-lis tummy tuck is needed mainly after major weight loss, where loose skin hangs both downward and outward to the sides. After losing a large amount of weight, the skin envelope is often too big in every direction, and a horizontal-only incision cannot remove the width. The vertical incision solves that, at the cost of the midline scar.

The pattern of loose skin, not preference, drives the decision, and a plastic surgeon assesses it individually. If you have reached this through weight loss, read tummy tuck after weight loss, where the case for a fleur-de-lis comes up most often.

The fleur-de-lis scar

The defining feature of a fleur-de-lis tummy tuck is its scar: a vertical midline scar plus the long horizontal hip-to-hip scar, forming an inverted-T or anchor shape. Both scars are permanent. Like all tummy-tuck scars, they are usually raised and pink or red at first and fade and flatten over about 12 to 18 months, with the final appearance varying by skin type, genetics and aftercare. Scars are managed, not removed.

This is the honest trade-off. A standard abdominoplasty hides its single scar below the underwear line; a fleur-de-lis adds a vertical scar that runs up the centre of the abdomen and cannot be hidden the same way. For many people after major weight loss the result is still worth it, because no other incision removes that much skin, but it is a decision to make with clear eyes.

Recovery and muscle repair

Recovery from a fleur-de-lis tummy tuck broadly follows the full-abdominoplasty timeline, with muscle repair a key reason it feels like core surgery. A bent-forward posture for roughly the first 1 to 2 weeks is expected, time off work is about 2 to 6 weeks, and a compression garment is usually worn for about 6 weeks. Most people feel broadly back to normal by about 6 weeks, with full recovery taking around 3 months.

Because it usually includes plication of the separated muscle, the tightness across the core in the early weeks is significant. For what that repair involves and why it dominates early recovery, see muscle repair in a tummy tuck.

Cost and candidacy

A fleur-de-lis tummy tuck typically costs more than a standard one because it is a larger operation. In the UK private sector a full abdominoplasty is roughly £5,000 to £10,000, with a fleur-de-lis or combined procedure costing more; in the US the surgeon’s fee alone averages around $6,000 to $9,000, with the total cost commonly around $8,000 to $15,000 or more. It is usually not covered by insurance or the NHS when purely cosmetic.

As with every tummy tuck, it is best done once your weight is stable, and BAAPS stresses that it is a body-contouring operation rather than a way to lose weight³. Before committing, confirm you are a suitable candidate for a tummy tuck.