Decision Guide

Which abdominal procedure is right for me?

Panniculectomy, abdominoplasty, and fleur-de-lys abdominoplasty each solve a different problem. This guide compares what each removes, where the incision sits, and who tends to be the best candidate — so your consultation starts from an informed place.

Panniculectomy

Removes the overhanging pannus (excess skin and fat) low on the abdomen. Does not tighten abdominal muscles.

Low horizontal incision, scar typically hidden under the underwear line
Ideal for overhanging skin/fat causing discomfort or hygiene issues
Does not address muscle laxity

Most Common

Abdominoplasty

Removes excess skin and fat — roughly twice as much as a panniculectomy — and tightens weakened or separated abdominal muscles. The belly button is repositioned upward.

Low horizontal incision, scar typically hidden under the underwear line
Ideal for loose skin and weakened muscles, often after pregnancy or weight loss
Improves core support and abdominal contour

Fleur-de-Lys Abdominoplasty

Removes excess skin and fat both horizontally and vertically, and tightens muscle. Addresses more skin in both the upper and lower abdomen than a standard abdominoplasty.

Combines a low horizontal incision with a vertical incision (inverted “T” scar)
Ideal for excess skin/fat above and below the belly button
Addresses vertical laxity, common after major weight loss

Criteria	Panniculectomy	Abdominoplasty	Fleur-de-Lys Abdominoplasty
Incision	Low horizontal	Low horizontal	Horizontal + vertical (“inverted T”)
Muscle repair	No	Yes	Yes
Skin/fat removed	Baseline amount	~2x panniculectomy	Most — both directions
Area addressed	Lower abdomen only	Above & below navel	Above & below navel, plus midline
Belly button	Not repositioned	Repositioned upward	Repositioned
Best for	Overhanging skin causing hygiene/comfort issues	Loose skin + weakened muscles (pregnancy/weight loss)	Major weight loss with excess skin in both directions

Results vary based on individual healing, weight stability, and body goals. This comparison is educational — your specific anatomy determines the best option.

How Dr. Borsuk thinks about this

A larger operation isn’t automatically a better one — the right choice solves your specific problem with the least trade-off.
Where the loose skin sits (below the navel, above it, or both) is usually the first deciding factor.
Muscle separation (diastasis) affects core strength and often changes which option makes sense.
Scar length and placement are a real trade-off worth weighing against the correction achieved.
Every recommendation starts with your anatomy and goals — not a default procedure.

Note: this guide covers front-of-abdomen (anterior) options only. If you also have excess skin at your flanks or back, see Anterior Surgery vs. Adding a Back Lift →

Still not sure which fits?

That’s exactly what a consultation is for. We’ll look at your anatomy together and talk through the honest trade-offs.

Schedule a Consultation