Dr. Amir Ghaznavi is a double board certified plastic surgeon (American Board of Plastic Surgery, American Board of Surgery) who specializes in body contouring for massive weight loss patients, including the fleur-de-lis (FDL) tummy tuck. He published peer-reviewed research on post-bariatric body recontouring and maintained weight loss outcomes in Plastic and Reconstructive Surgery (2014) and presented this research at the American Society for Aesthetic Plastic Surgery (The Aesthetic Society) meeting in Montreal (2015). His published data demonstrated that body contouring surgery helps post weight loss patients maintain their results long-term, a finding that directly shapes how he counsels every FDL candidate at AMG Plastic Surgery.
Dr. Ghaznavi trained in plastic surgery at Henry Ford Medical Center and completed a microsurgery fellowship at Cleveland Clinic, one of the most competitive microsurgery programs in the country. He spent six years as an Assistant Professor of Surgery at Case Western Reserve University and Cleveland Clinic, where he managed complex abdominal wall reconstruction and post-bariatric contouring cases. He also published research on abdominal wall reconstruction using free tissue transfer (JPRAS, 2016), giving him a reconstructive foundation that most cosmetic-only surgeons do not have. This matters for FDL patients because the fleur-de-lis technique involves managing blood supply to large skin flaps, repairing separated or weakened abdominal muscles, and making surgical decisions that protect tissue viability while maximizing cosmetic outcome.
What Is a Fleur-de-Lis Tummy Tuck (FDL)?
A fleur-de-lis tummy tuck, also called FDL abdominoplasty, is a specialized tummy tuck procedure designed for patients who have significant extra skin in both the vertical (up-and-down) and horizontal (side to side) directions across the abdominal area. The name comes from the fleur-de-lis symbol, the French lily, because the unique incision pattern resembles its shape.
A standard tummy tuck uses a single horizontal incision from hip to hip across the lower abdomen. This works well for patients with moderate skin excess concentrated below the belly
button. But many patients, especially massive weight loss patients who have lost 80-150+ pounds through bariatric surgery, GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound), or natural weight loss, have excess abdominal skin that extends across the upper abdomen, wraps around the sides, and hangs in skin folds that a horizontal incision alone cannot address.
The fleur-de-lis technique solves this by using two incisions: the standard horizontal incision across the lower abdomen, plus a vertical incision that runs from the breastbone down to the pubic area. These two incisions create an inverted-T or anchor-shaped incision pattern that allows Dr. Ghaznavi to remove skin from both horizontal directions (side to side tightening) and vertical directions (top to bottom tightening). The result is comprehensive contouring of the entire abdominal area, from the ribcage to the pubic area, that a standard abdominoplasty cannot achieve.
FDL Tummy Tuck vs. Standard Tummy Tuck: Which Do You Need?
This is the most important decision for post weight loss patients considering abdominal contouring. Choosing the wrong procedure leads to incomplete results.
Choose a standard tummy tuck if:
Your excess skin is concentrated in the lower abdomen below the belly button. Your upper abdomen has adequate skin quality and elasticity. You need skin removal in the horizontal direction only (side to side). You have moderate, not massive, weight loss (typically under 50-60 pounds lost). A standard tummy tuck uses a horizontal incision only and does not leave a vertical scar.
Choose a fleur-de-lis tummy tuck if:
You have experienced major weight loss (typically 80+ pounds) through bariatric surgery, GLP-1 medications, or sustained lifestyle changes. Your extra skin extends across both the upper abdomen and lower abdomen. You have hanging skin folds that wrap around your sides and back. Your abdominal skin has lost elasticity in both vertical and horizontal directions, meaning the skin will not retract with a horizontal incision alone. You are willing to accept an additional vertical scar in exchange for significantly better contouring.
Choose a body lift if:
Your excess skin extends beyond the abdominal area to the flanks, lower back, and buttocks. A body lift (circumferential lipectomy) wraps the incision around the full circumference of the torso. Many patients find that a body lift combined with the fleur-de-lis technique produces the most comprehensive result after massive weight loss.
Dr. Ghaznavi evaluates every post weight loss patient individually and recommends the procedure, or combination of other procedures, that will produce the best contour for their specific anatomy.
I’m very happy and pleased with the quality of care and treatment I received at AMG Plastic Surgery. Dr Ghaznavi was very thorough, attentive and caring before, during and after my surgery and continues to be. From the moment I walked in the office, Pam greeted me and helped calm my nerves and has been supportive throughout the entire process and continues to be. I highly recommend this practice for any plastic surgery you need. You will be well taken care of.
How the Fleur-de-Lis Tummy Tuck Procedure Works
Consultation and Surgical Planning
Dr. Ghaznavi sees every FDL consultation patient personally. He evaluates your abdominal skin quality, the extent and distribution of extra skin and excess fat, the integrity of your abdominal wall muscles, your overall health, and your weight loss history. Patients should be at a stable weight for at least 6-12 months before scheduling FDL surgery. If you are still actively losing weight, the surgery should wait.
Dr. Ghaznavi discusses the incision pattern, explains where the resulting scars will be, shows before-and-after photos of FDL patients with similar body types, and helps you set realistic expectations for the outcome.
The Incision Pattern
The fleur-de-lis technique uses a unique incision pattern that distinguishes it from every other tummy tuck procedure:
Horizontal incision:
Runs from hip to hip across the lower abdomen, positioned low in the bikini line or at the level of the pubic area. This is the same incision used in a traditional abdominoplasty.
Vertical incision:
Runs from the lower chest (xiphoid area) down to meet the horizontal incision at the pubic area. This vertical component is what allows the surgeon to remove skin in the up-and-down direction, tightening the abdominal skin from side to side.
The two incisions together create an inverted T-shape. The excess skin between these two incisions is removed, and the remaining abdominal skin is pulled inward from both directions and closed.
Muscle Repair
Most FDL patients have weakened or separated abdominal muscles (diastasis recti) from pregnancy, weight gain, or the mechanical stretch of carrying significant excess weight. During the FDL procedure, Dr. Ghaznavi performs muscle repair by plicating (suturing together) the separated rectus muscles, restoring core strength and creating a flatter abdominal profile.
Belly Button Repositioning
In a complete fleur-de-lis tummy tuck, the belly button is detached from the surrounding skin, preserved on its stalk, and brought through a new opening in the repositioned skin (umbilicoplasty). The belly button is sutured into a natural-appearing position.
Skin and Fat Removal
The volume of skin removed in an FDL procedure is significantly greater than in a standard tummy tuck. Many patients have multiple pounds of excess skin and underlying excess fat removed. Dr. Ghaznavi removes this tissue while carefully preserving the blood supply to the remaining skin flaps. Protecting blood supply is critical in FDL surgery because the larger the area of skin elevation, the higher the risk of wound healing complications.
Managing Blood Supply
This is where the reconstructive training matters. The vertical incision in the fleur-de-lis technique disrupts blood supply pathways that a standard tummy tuck preserves. Dr. Ghaznavi’s microsurgery fellowship at Cleveland Clinic trained him in precise tissue handling and blood supply management across large surgical fields. His published research on abdominal wall reconstruction using free tissue transfer (JPRAS, 2016) demonstrates his command of the vascular anatomy that governs outcomes in FDL surgery.
Who Is a Good Candidate for FDL Abdominoplasty?
FDL surgery is designed for a specific patient population. Good candidates:
- Have experienced massive weight loss (80+ pounds) through bariatric surgery (gastric bypass, gastric sleeve), GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound), or sustained lifestyle changes including proper diet and exercise
- Have significant extra skin in both the upper and lower abdomen that hangs in skin folds
- Are at a stable weight for at least 6-12 months before surgery
- Are in good overall health and medically cleared for a major surgical procedure
- Are nonsmokers or have stopped smoking at least 4-6 weeks before surgery
- Understand that the FDL technique produces a vertical scar in addition to the horizontal scar, and accept this tradeoff for superior contouring
- Do not plan future pregnancies, which would stretch the repaired muscles and skin
- Have realistic expectations about the outcome, the recovery process, and the permanence of scars
- Patients who are still losing weight, who have uncontrolled diabetes, who smoke, or who have a BMI above 35-40 should delay surgery until these factors are addressed. Dr. Ghaznavi discusses all candidacy criteria during the consultation.
The Vertical Scar: What Patients Need to Know
The vertical scar is the primary reason some patients hesitate about the fleur-de-lis technique. Here is the honest assessment.
The FDL procedure leaves two scars: a horizontal scar across the lower abdomen (similar to a standard tummy tuck, hidden in the bikini line) and a vertical scar running from the chest down to the horizontal incision. The vertical scar is visible and cannot be hidden by all clothing choices. It is visible in a bikini and in many two-piece swimsuits.
However, many patients who have lived with massive weight loss skin excess are far more bothered by the hanging skin folds, skin irritation, rashes, and the limitations on clothing choices and physical activity than they are by a surgical scar. The decision to accept the vertical scar comes down to this: would you rather have a scar on a flat, contoured abdomen, or no scar on an abdomen with significant hanging skin?
Dr. Ghaznavi places the vertical incision carefully to minimize scarring and uses layered closure techniques. The scar is initially red and raised, then gradually flattens and fades over 12-18 months. Scar management with silicone sheets and topical treatments further improves the final appearance.
Many patients find that the life changing improvement in their body contour, comfort, and ability to wear normal clothing far outweighs the presence of the vertical scar.
Recovery Process After FDL Tummy Tuck
FDL abdominoplasty is a more extensive procedure than a standard tummy tuck, and the recovery process reflects that.
First Two Weeks
Plan to take at least two weeks off from work and daily responsibilities. Walking (upright, with a slight bend) begins the day of surgery to prevent blood clots. Swelling, bruising, and tightness are significant. Pain is managed with prescribed medication. Dr. Ghaznavi’s enhanced recovery protocols, informed by his published pain management research, reduce the need for narcotic medication.
Compression garments must be worn 24 hours a day for the first 3-4 weeks to reduce swelling, support the repaired abdominal wall, and help the skin conform to the new contour. Drains are commonly placed during FDL surgery to reduce fluid buildup beneath the skin flaps. They typically remain in place for 1 to 2 weeks and are removed when fluid output drops below a safe threshold.
No heavy lifting (nothing over 10 pounds), no bending at the waist, and no driving during this period.
Weeks3-6
Swelling decreases noticeably. Most patients return to desk-based work by week 3. Walking increases. Compression garments transition to 12 hours per day. No exercise or strenuous activity.
Weeks 6-12
Dr. Ghaznavi clears patients to gradually resume exercise, starting with walking and light cardio and progressing to core engagement. The scars begin to mature and flatten. Follow-up visits continue at 8 weeks, 3.5 months, and 6 months.
Full Recovery
Full recovery, including scar maturation and final contouring, takes 6-12 months. Many patients report that the improvement in physical comfort, mobility, and clothing fit is noticeable within the first month, even before the final result is visible.
Risks and Complications
FDL tummy tuck is a major surgical procedure with a longer recovery and higher complication profile than a standard abdominoplasty. Understanding the risks helps patients make an informed decision.
- Wound healing complications: The most common concern with the fleur-de-lis technique. The T-junction where the vertical and horizontal incisions meet is under the most tension and has the highest risk of delayed healing or wound separation. Minor separations at the T-junction are among the most common healing events after FDL surgery and are typically managed with in-office dressing changes rather than a return to the operating room. Dr. Ghaznavi’s tissue handling technique and layered closure minimize this risk.
- Fluid buildup (seroma): Collection of fluid under the skin flaps. Managed with compression garments and drains when indicated.
- Skin irritation and numbness: Temporary loss of sensation in the abdominal skin is common. Skin irritation at the incision lines resolves as healing progresses.
- Blood clots: Risk is present with any major surgery requiring extended immobility. Early ambulation and compression devices during surgery reduce this risk.
- Infection: Rare with appropriate surgical technique and antibiotic protocols.
- Asymmetry or contour irregularities: Minimized by surgeon experience and pre-operative planning.
- Scar widening: The vertical scar is subject to tension from body movement and can widen over time. Scar management and avoiding heavy lifting during recovery reduce this risk.
