Fleur de lis Abdominoplasty After Bariatric Surgery, Raleigh, NC*

Massive weight loss after bariatric surgery will lead to major skin excess in several locations primary of which is the abdominal area. The large excess amount of skin is known as a pannus. The skin excess can be considered horizontal meaning across the lower abdomen but also vertical or central meaning in the midline. To ideally address this area, a fleur-de-lis type abdominoplasty is often ideal at treating all of these areas of excess. It does result in a midline scar which may be objectionable to some patients however the consequences of not doing it is persistent central skin excess and laxity. This 56-year-old woman had lost 165 pounds after a bariatric procedure done almost 10 years ago. She remained obese but not morbidly obese and had chronic infections. She had a previous midline scar which made the decision for a fleur-de-lis easier since she already had a scar present there. The patient had over 13 pounds of skin excess fat removed during the procedure. She did have some wound breakdown in the lower abdominal incision which took about 4-6 weeks to totally heal. This was treated with topical wound care with dressing changes done daily but eventually healed. It is not unusual to have minor wound breakdown with this procedure- however outcome is usually not affected.