You've lost over 100 pounds after bariatric surgery Now what do you do with all that loose, hanging skin?

If you've lost 75, 100 pounds or more through weight-loss surgery—or through diet and exercise alone—congratulations! Losing all that excess weight can transform your life in many ways.

At last, you're wearing smaller clothes sizes, becoming more active and enjoying life more. So what's the problem?

You can lose fat, but you can't lose skin

As you've probably discovered, your skin simply can't shrink as much as the rest of you. Many of the 100,000 Americans who undergo gastric bypass or lap-band surgery each year find that the weight melts away—but the excess skin stays behind.

If you've had a massive weight loss, you may be left with loose, hanging skin on your belly, arms, legs, breasts—even your eyelids and face. Exercise can build muscle tone, but it can't improve your skin tone. Fortunately, there's a solution.

Body contouring surgery finishes your transformation

Skin reduction or body contouring surgery can get rid of pounds of uncomfortable, embarrassing loose skin after massive weight loss, and help you achieve the look you desire.

The day you had bariatric surgery or started on your weight-loss regimen, you began a transformation. Body contouring surgery can complete that process of creating a whole new you.

What is body contouring surgery?

Skin reduction surgery is plastic surgery to remove loose, baggy skin and excess fat deposits following massive weight loss. There are several types of these body-contouring procedures:

  • A panniculectomy (see below) removes the apron of loose skin, tissue and fat from the lower abdomen.
  • An arm lift or brachioplasty gets rid of “bat wings” caused by loose, hanging skin in the upper arm.
  • A facelift or rhytidectomy removes excess fat, tightens underlying muscles and redrapes the skin of the face and neck.
  • Eyelid surgery or blepharoplasty removes fat, excess skin and muscle from the eyelids. An upper-lid blepharoplasty corrects drooping upper eyelids. A lower-lid blepharoplasty gets rid of puffy bags under your eyes.

Panniculectomy is the most commonly performed plastic surgery for people who have lost 50 pounds or more.

What is a panniculectomy?

A panniculectomy is a plastic surgery procedure that removes the apron of loose skin, tissue and fat—known as the pannus—that occurs in the lower portion of the abdominal wall after massive weight loss or sometimes after pregnancy.

See our photo gallery for examples.

Who is a candidate for a panniculectomy?

A panniculectomy may be right for you if you:

  • Have lost at least 50 pounds
  • Are in relatively good physical condition
  • Have excess skin folds without significant fat deposits
  • Have stabilized your weight
  • Are following a proper diet and exercise plan
  • Have realistic expectations of the surgery's outcome
  • Are physically, mentally and emotionally ready to undergo the procedure and the recovery process

When is the right time for a panniculectomy?

  • At least one year after weight-loss surgery. A study by the American Society of Plastic Surgeons shows that patients who wait a year after bariatric surgery have significantly fewer complications than those who have a panniculectomy sooner. Patients who wait are healthier going into the surgery. Their weight loss often results in getting their diabetes under control, lowering their blood pressure and reducing the stress on their heart.
  • When your weight has stabilized for at least six months. If you have a panniculectomy sooner and then lose more weight, you may need a second operation later.

How big can a pannus get?

A pannus can weigh as little as five pounds or as much as 120 pounds, depending on the amount of weight a person has lost. There is a grading system based on how far the pannus apron reaches:

Grade 1:Pannus extends to the pubic hairline and mons pubis, but not the genitals
Grade 2:Pannus covers the genitals in line with the upper-thigh crease
Grade 3:Pannus extends to the upper thigh
Grade 4:Pannus reaches the mid-thigh
Grade 5:Pannus covers the knees or beyond

What kinds of physical problems can a pannus cause?

A pannus can create difficulties in:

  • Getting in and out of bed
  • Standing and walking straight
  • Tying your shoes
  • Crossing your legs
  • Finding clothes that fit appropriately

Can a pannus also cause medical problems?

Yes. The pannus often traps perspiration under the hanging folds of skin, which can lead to:

  • Recurrent skin rashes
  • Skin infections
  • Foul odors
  • Non-healing skin ulcers

A pannus can also cause back pain. In the most extreme cases, a person can even develop gangrene if the blood supply to the pannus is insufficient.

Does insurance cover a panniculectomy?

Some insurance companies will pay for a panniculectomy if it is considered medically necessary. To receive insurance benefits, you will need to submit documented proof of medical necessity and have it approved by your insurance company before you undergo surgery.

If you do not qualify for medical benefits for a panniculectomy, financing is available.

When is a panniculectomy considered medically necessary?

Each insurance plan has its own requirements, but many insurers will cover a panniculectomy if:

  • The pannus is Grade 2 or greater;
  • You have lost 100 pounds or more and have been at a stable weight for at least six months;
  • If you have had weight-loss surgery, the operation was at least 18 months ago;
  • You have a documented history of recurrent rashes or non-healing skin ulcers for at least three months; and
  • The pannus causes demonstrated difficulty with walking, sitting or standing, or interferes with the activities of daily living.

Check your insurance policy to see what benefits you may qualify for if you are considering a panniculectomy.

How is a panniculectomy performed?

A panniculectomy is done on an inpatient basis. The surgery takes three to five hours—or longer if combined with other procedures such as hernia repair. The incision runs horizontally from hip to hip, curving downward in the middle.

After Dr. Parungao makes the incision, he frees up the skin surrounding the navel and removes the excess skin. He then repairs any hernias and closes the incision in layers.

How fast is the healing process?

Although everyone heals at a different rate, you can expect that your recovery will follow this general time line:

Within the first week

  • Surgical drainage tubes will be removed
  • Stitches will be removed (this may take 10 days)
  • Bruising and swelling will reach a peak

After several weeks

  • You will no longer need to wear a support garment
  • You may gradually increase your activity and exercise
  • You may return to non-strenuous work (typically within the first three weeks)
  • Bruising and swelling will continue to subside and you'll begin to see your results

After a few months

  • You'll see a truer picture of the final result of your surgery
  • Numbness or tightness will disappear
  • The reddish color of your incision line may begin to fade (full fading may take a year or more)

What results can you expect from a panniculectomy?

You will see a noticeable difference in the shape of your body quite soon after surgery. Your firmer, flatter abdomen will no doubt boost your confidence and make you feel more comfortable in clothing.

After a few months, your incision line will continually fade. But you should realize that that your scar will be permanently visible. Many patients view their scar as a small tradeoff for a firmer, sleeker appearance.

Panniculectomy produces long-lasting results. Unless you gain or lose a significant amount of weight after your surgery, you can expect to retain your new shape for many years. If you lose more weight in the future, Dr. Parungao may suggest additional treatment for restoring a sleeker abdominal contour.

Panniculectomy FAQ

Q. Isn't a panniculectomy just a tummy tuck?

A. No—there's an important distinction between the two. A panniculectomy simply removes the overhanging skin and fat from the lower abdomen.

A tummy tuck removes excess abdominal skin and fat as well—but unlike a panniculectomy, it also tightens the muscles of the abdominal wall and repositions the navel.

Q. What determines whether a panniculectomy or a tummy tuck is the right choice for me?

A. That all depends on your individual case. When I evaluate you during your consultation, I will explain my recommendations for you. Even for patients who need a panniculectomy, I sometimes do the full tummy tuck or abdominoplasty to get a more pleasing result.

Q. Will I have pain after my surgery?

A. Yes, you will experience some discomfort. The pain usually lasts up to seven days. We have “pain pumps” you can use to significantly decrease your pain following surgery.

Q. Is a panniculectomy considered cosmetic surgery or a reconstructive procedure?

A. The American Society of Plastic Surgeons considers a panniculectomy a reconstructive procedure when it is performed to correct or relieve structural defects of the abdominal wall and/or chronic back pain due to a functional weakness of the front abdominal wall.

Newsletters related to “Panniculectomy (after weight loss), Chicago, IL”

Diabetic mom gets a Mommy Makeover - March 2010 March 2010
Diabetic mom gets a Mommy Makeover - March 2010

News releases related to “Panniculectomy (after weight loss), Chicago, IL”

February 12, 2007—Noted Plastic Surgeon Sees Rising Trend in Body Contouring Surgery Among Weight-loss Surgery Patients

Oak Park, Ill. plastic surgeon and author Allan Parungao, MD FACS, notes the rising trend in body contouring or skin reduction surgery among people who have lost a massive amount of weight - a 22% increase from 2004 to 2005 alone. With more than 100,000 Americans undergoing gastric bypass and lap-band surgery each year, many are finding that their skin simply can't keep up with their rapid weight loss. Body contouring surgery frees these men and women of up to 100 pounds of loose, hanging skin and lets them enjoy a normal appearance.

Noted Plastic Surgeon Sees Rising Trend in Body Contouring Surgery Among Weight-loss Surgery PatientsPDF version of Noted Plastic Surgeon Sees Rising Trend in Body Contouring Surgery Among Weight-loss Surgery Patients

March 23, 2010—Plastic Surgery for Diabetics? Yes, It's Possible, Says Chicago-area Plastic Surgeon Allan Parungao, MD

According to the CDC, 23.6 million Americans have diabetes - a condition that can lead to slow wound healing and make a person unsuitable for plastic surgery. But it doesn't have to be that way. Chicago-area plastic surgeon and author Allan Parungao, MD, says diabetic patients with well-controlled blood sugar levels can have good results with plastic surgery.

Plastic Surgery for Diabetics? Yes, It's Possible, Says Chicago-area Plastic Surgeon Allan Parungao, MDPDF version of Plastic Surgery for Diabetics? Yes, It's Possible, Says Chicago-area Plastic Surgeon Allan Parungao, MD

Schedule a visit with Dr. Parungao today!

Before and afterPanniculectomy after bariatric surgery before and after photos
Weight loss:
Pannus Grade:

Amount removed:
Other procedures:
51, male
150 pounds

Persistent skin infections in the skin folds, back pain, abdominal hernia
6 pounds
Tightened abdominal wall in the course of repairing the hernia

> See more panniculectomy photos


We will be happy to answer your questions or schedule a consultation with Dr. Parungao.

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Considering body contouring surgery?
Schedule a consultation with Dr. Parungao

This information is merely an introduction to skin reduction surgery. Your next step is to schedule a personal consultation with Dr. Parungao, where he will listen to your personal goals for body contouring, evaluate you and advise you on how you can best achieve the outcome you desire.

Questions? Call our office at 312.671.9400

'My overhang was literally sitting on my lap'

Patient: Carmen, age 59

“After I had gastric bypass surgery and lost 75 pounds, everything was hanging—especially on my belly,” says Carmen. “My clothes wouldn't fit right and I was very uncomfortable. I even developed a rash under the folds of fat from the perspiration trapped there.”

Carmen had a panniculectomy and is very pleased with the results.

“Some people may think having plastic surgery is vanity,” Carmen admits, “but my children are grown and I want to look good! And I want clothes to be comfortable in.”

Carmen was so happy with her results that she had upper- and lower-eyelid surgery a few months later. “In my job, I have to face the public,” she explains. “People were always telling me I looked tired—even when I wasn't. Even my eye doctor commented on the droopiness in my eyelids.

“Now, after my eyelid surgery, I'm getting compliments every day!” she smiles. “When my co-workers look at me, they know there's something different, but they don't know what it is.”

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