Front and back are different problems
An abdominoplasty (standard or fleur-de-lys) is an anterior procedure — it removes excess skin and tightens muscle across the front of the abdomen. It does not address the flanks (the sides, sometimes called “love handles”), the back, or the buttocks. If excess skin or fullness wraps around to those areas, anterior surgery alone will leave it untouched, even after an otherwise excellent result in front.
Posterior options are split by exactly what they address: a bra line back lift addresses the upper/mid back only. A lower back lift & buttock lift addresses lower back rolls and — because of how the incision and tissue elevation work — can also lift and reposition buttocks that have flattened or begun to sag after significant weight loss. A full circumferential body lift combines anterior and posterior work in one continuous incision around the entire torso. Knowing which of these actually applies to you is exactly what this guide and a consultation are for.
Signs anterior surgery alone may be enough
- Excess skin and laxity are concentrated in front, below and around the navel
- Flanks and back have reasonably good skin tone and elasticity
- No significant buttock flattening or sagging
- Weight loss was moderate, or concentrated in the abdomen specifically
Signs a back lift is worth adding
- Persistent fullness or excess skin at the flanks that wraps around from front to back
- Visible rolls of skin at the bra line or across the mid-back
- Buttocks that have noticeably flattened or begun to sag
- Weight loss was extensive and circumferential, not isolated to the abdomen
One surgery or two?
| Combined (Anterior + Back Lift) | Staged (Two Separate Surgeries) | |
|---|---|---|
| What it covers | Front and back in one surgery — essentially a body lift | Abdominal surgery first, back lift later (or vice versa) |
| Recovery | One longer, more demanding recovery | Two separate, individually shorter recoveries |
| Total cost | Generally lower than two separate procedures | Generally higher (separate facility/anesthesia fees each time) |
| Surgical risk per session | Higher, given longer combined surgery time | Lower per individual session |
| Best for | Patients in good health who can commit to one longer recovery | Patients who prefer shorter individual recoveries, or for whom combined surgery carries more risk |
A fully combined anterior-and-posterior procedure in one surgery is essentially what a body lift is — see our Body Lift page for full detail on that option.
This is an anatomical assessment, not a preference
Whether you need anterior surgery alone or should add a back lift depends on where your excess skin actually is — not on which sounds simpler. A physical examination is the only reliable way to determine this, which is exactly what a consultation covers.
Frequently asked questions
Can a fleur-de-lys abdominoplasty address my flanks too?
No — a fleur-de-lys addresses excess skin above and below the navel through a vertical and horizontal incision, but it’s still an anterior procedure. It does not reach around to the flanks or back.
Will a back lift fix a flat or sagging buttock on its own?
A back lift can meaningfully improve buttock position by lifting tissue upward as part of the procedure, but it’s not a substitute for a dedicated buttock augmentation if significant volume is also needed. This is worth discussing directly if buttock volume, not just position, is a concern.
How do I know if my case needs staging instead of combining?
This depends on your overall health, the extent of excess skin, and how long a combined surgery would realistically take. Dr. Borsuk will give you a direct recommendation during consultation based on your specific anatomy.