Consult today - can't do LBL or TT alone, recommends fleur-di-lys - I'm having trouble finding...

I flew down from WI to have a consult at the Baylor Medical Surgical residency program today & to make a long story short, I ended up having it with Dr. Bullocks, who is a board certified PS & Director of the aesthetics portion of their residency training program.

I had an open DS & have a horizontal scar across the midline of my stomach, about 3 - 4 inches above my belly button.  I always had 2 rolls of fat - one large lower abd and one smaller one above my belly button.  My DS surgeon made the incision at the bottom of this upper, smaller one.  This now creates an insurmountable stumbling block for doing PS to achieve a flat abdomen. 

I cannot do a LBL or even just a TT to get a flat abd because he cannot lift the skin between this DS incision & my belly button.  He told me that the blood flow runs laterally downwards in an arc from the outside of my stomach/upper sides towards the midline of the body down my stomach.  The existing midline incision already disrupts this natural flow of blood downwards, which is why he can't lift the portion of skin b/w it & my belly button.  He told me that I don't have enough excess skin above the incision to have that be the incision that he uses as part of a TT or LBL bc there's just not enough to pull all the way down. 

If he tried the regular incisions of a TT or LBL, chances are VERY VERY high that the skin b/w the existing incision & above my belly button would not get enough blood flow & simply die/ rot.  He strongly encouraged me to get multiple opinions on how to proceed, but told me he would be shocked if anyone would actually do it bc the known risk is so high with the horizontal incision that I have - which is a good 8 inches across.

He said this type of incision is HIGHLY unusual, which I knew.  I always thought it would be a good thing, that instead of a long vertical scar left, it would be something akin to a cesarian type scar once I had a TT or LBL.  I'm so very disappointed right now.

We discussed several options & based on my own preferences & legitimate/safe possibilities, a fleur-di-lys is probably my best option.  He told me he could do a LBL, but he could only address the excess skin (lift it/ interrupts blood flow) by making the high point of he incision along the lateral line that would run across the very upper portion of my belly button & below.  That would leave me with a significant midline roll with stretch marks & excess/ loose unsightly skin.  ONLY in a second operation could he then remove the excess skin from my upper roll, so essentially like a TT on my upper roll.  This would leave me with an 8 inch horizontal scar EXACTLY where a short top would end/ right above my jeans.  I don't like that thought.  Wearing a shorter top or tankini that exposes a couple of inches of skin every now & then is one of the goals, you know?  Much less going through TWO operations & still having an 8 inch scar - all of which is completely visible.

A TT alone is not a good option for a couple of reasons.  First, I have the same problem that I've just described with the LBL.  Second, I have too much excess skin around the lateral & back portions of my hips - it would create a decidedly puckered or "dog eared" look at both hips at the sides & I would still have the excess skin on the back portion - 3 small folds, not hugely bad, but it's nowhere near a stone's throw of aesthetically pleasing, either.

Sooooo . . . another option would be to do the first operation that I described where the horizontal LBL scar line would bisect with my upper belly button.  Then have another operation that would essentially be a TT of the upper roll in the reverse direction - literally pulling the skin upwards, which would give me a running scar along the undersides of my breasts AND run right along b/w my breasts.  The advantage would be that the scar would then be about 3 inches below my breasts & then I would have that flat, scarless midsection that I wanted.  That's still TWO operations with TWO big scars & frankly, it's not that much that would be scarless between the tops of my jeans & the upper scar.  A shorter top like a halter type top (not bikini, halter) would still show it.

Soooo . . . . that leaves me with another option of a fleur-di-lys.  I have an email into the coordinator to confirm I understand this correctly (I was feeling WAY overwhelmed by all of this & trying to remember as much as I could afterwards, pls understand!), but I believe that the fleur-di-lys is a vertical scar along the length of my entire abdomen that pulls the skin inwards from the sides ALONG WITH a traditionally placed TT of the lower abdomen.  IS THAT RIGHT???

The advantages of this is that it would excise the horizontal existing scar entirely (yes, there's that much skin available) so that it would drastically reduce the risk of wound healing problems due to vascularization of lower tissue.  It would still be a small risk, but really very low - I confirmed that one - otherwise he wouldn't do it.  It would work bc he would be removing all the scar tissue that would hinder my blood flow in a traditional TT alone or LBL.   We pulled the skin togther & checked out my hips - lateral & back - NO issues in excess puckering skin or excess skin being left.  It would actually be sufficient to entirely address my lateral & back excess skin issues, again bc they're not THAT bad. 

How do I feel about this last option?  Given the other options for two surgeries & scar placements vs my goal of having a relatively nice looking flat abdomen without an 8 inch horizontal scar . . . I think it's the best option & he rather liked that one also.  I would rather have one vertical scar visible if I wanted to expose my stomach than an 8 inch horizontal scar.

Comments, feedback?  I do have the fleur-di-lys method right, yes?  It's a vertical incision pulling together AND a TT?

Lisey, I also didn't really have enough extra skin on my backside to warrant an LBL. My surgeon was very aggressive with my Fluer-di-lis tummy tuck. He extended my horizontal scar pretty far into my hip area. He basically cut me to the table without having to turn me over during surgery. I thought about having my upper vertical scar revised but have decided not to. I don't think I'll be in bikini in public. I do wear them in my own backyard!  Here is a picture I just took of my scars and I'm 16 months out from surgery. Not bad for an old lady...LOL

Thanks, Renee.  Your tummy looks very nice!  I'm just dissappointed bc this whole time since the DS I've been looking forward to having my midline 8" scar become much, much lower . . . & secretly hoped it could be excised completely, though knew that probably wouldn't happen - not enough excess skin above it for that one.  I'm adjusting to the idea still, but I realize it's not a bad deal.  It's actually a lot cheaper & hopefully won't be quite as rough of a recovery.

Just wanted to say I can completely undestand why u were overwhelmed. Dr. Bullock is a awesome surgeon and safety is his defining factor. I have chosen him to do all of my plastics in two stages. The first being Dec 1. LBL/ with auto auhmetation of the buttocks and BL. I also have 2 friends that hve decided on him also. I truely believe that uwill get the results u are looking for with Dr. Bullock.

While I was very disappointed by the information, he also really struck me as a caring person & excellent surgeon.  I'm sure you will love your results!

I can imagine that the fleur de lis would work.  I had that done yesterday, and the area he marked took off a LOT of skin on my middle section.  I had a large roll there with stretch marks (probably similar to your horizontal scar in length) and it is all gone.  And it defined my waist and pulled up my back/hip skin too (which wasn't bad enough for a LBL either).

I haven't seen it all yet - still in the binder.  But I figured that one scar wouldn't be a big deal.  Especially if it got rid of all the stretch marks (which wouldn't with a traditional TT).  If I look like Rene by next year, I'll be happy!

I hope things have been going well for you since surgery!  I also wanted to say that I'm really glad that you had posted in a prior post about eating at least 135gm protein.  I had never heard of that before.  I also asked Dr. Bullocks about it & he confirmed it.  Glad I'm finding out now.

I'm doing well - posted some pics in a different thread.  I'm glad I started the protien first - it is SURELY hard to get it in now (I'm not even close).  Can't hardly eat at all.

Years ago I had surgery and I had a vertical scar just above the pubis area.  When I had my TT the surgeon used that scar for the lower portion and then recut me along the horizontal scar from my open DS to do my hernia repair and to pull in the upper.  I have been very pleased with my results and now a little over two years out from surgery my scars are very faint.  I can see how all of that info would be a little overwhelming.  My head is swimming just reading it!  

Red