Question 1

What is a panniculectomy?

Accepted Answer

A panniculectomy is a surgical procedure that removes the panniculus, an “apron” of loose skin and fat that hangs from the lower stomach after significant weight loss.

Colloquially, this procedure is sometimes called FUPA removal surgery. (FUPA stands for “fatty upper pubic area,” and the acronym is a slang term for the abdominal pannus.)

While diet, exercise, and weight loss surgery can decrease excess fat, surgical pannus removal is the only way to get rid of the excess skin that often remains behind after significant weight loss.

Overhanging skin can cause discomfort and limit your physical activity (as well as your confidence and wardrobe choices), but it’s not unsolvable.

“A responsible plastic surgeon will go over all the options with you, including removal of the skin and fat alone (panniculectomy) and a tummy tuck (abdominoplasty), where the deep layer of fascia is tightened as well, often with tightening of the upper abdominal skin,” explains Beverly Hills plastic surgeon Dr. Brent Moelleken.

Stomach skin removal via plastic surgery may even be covered by your health insurance, if it's deemed medically necessary.

Some people also choose to combine this procedure with:

Body contouring procedures like liposuction, to remove excess fat and sculpt the midsection.
A full lower-body lift, to remove excess skin below the waist.
A pubic lift (monsplasty), to contour the mons pubis.
Hernia repair. “Make sure your provider is properly trained to do hernia surgery, if one should be discovered at the time of surgery,” Dr. Moelleken cautions.

Question 2

What are the pros and cons of a panniculectomy?

Accepted Answer

Pros

The procedure can safely remove the abdominal pannus (or “apron belly”) that’s often left after massive weight loss.
Abdominal skin removal can improve your health and quality of life by resolving rashes, irritation, body odor, neck and back pain, and even ulcers that can occur when skin hangs below your belly.
FUPA surgery helps clothing fit better and delivers a major self-esteem boost. That's a key reason type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el of RealSelf members who had the procedure say their panniculectomy was “Worth It.”
It's easier to lead an active lifestyle after excess skin is removed, so this procedure can lead to additional weight loss.
In cases where pannus removal is deemed medically necessary, the cost of the procedure may be at least partially covered by health insurance.
It can be combined with other body-contouring procedures, including liposuction, or other elective surgeries, such as a thigh lift or breast lift.

Cons

This is a major surgery with a lengthy recovery: at least two weeks of downtime and several months to fully heal.
The procedure only removes excess skin. It won’t tighten the abdominal muscles or restore a flat abdomen like a tummy tuck can.
The procedure often leaves a prominent panniculectomy scar from hip to hip, across the lower midsection—or even longer, if the abdominal pannus (loose skin) hangs down on the sides as well as the front. “In many patients, a full body lift may be necessary if the loose skin also goes around to the back,” says Dr. Moelleken.
Even when FUPA removal surgery is covered by insurance, out-of-pocket expenses can add up.

RealSelf Tip: If you have a bit of an apron belly due to excess fat, rather than overhanging skin, it may be possible to get rid of it with body contouring treatments, such as VASER liposuction. An experienced doctor will be able to evaluate your skin elasticity to determine whether fat removal alone will help—or whether you might be left with sagging skin.

Question 3

How much does a panniculectomy cost?

Accepted Answer

The price you pay will depend on your surgeon’s level of experience, their practice location, the extent of your procedure, whether your health insurance covers any portion of this loose skin stomach surgery, and a few other factors.

You can finance your treatment with CareCredit.

See our complete guide to panniculectomy costs

Question 4

Panniculectomy before and after pictures

Accepted Answer

The panniculectomy photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 5

Who is a good candidate for a panniculectomy?

Accepted Answer

Good candidates for panniculectomy surgery have overhanging excess skin in the lower abdominal area and pubis, typically after losing a significant amount of weight. Often these patients have had bariatric surgery, like gastric bypass, which can result in massive weight loss.

Other contributing factors to stomach skin removal surgery include:

Aging
Pregnancy
Prior surgery (like liposuction) that left sagging skin

For health reasons and to ensure optimal results, it’s best to be at a BMI of less than 30 or within 10 pounds of your goal weight, and to be stable at that weight for six months prior to surgery, says Dr. Jaime Schwartz, a plastic surgeon in Beverly Hills, California.

This allows your surgeon to accurately gauge how much skin they should remove and helps ensure that you’ll be able to maintain your results over time. “Most doctors would agree that it’s best to lose the weight first, then perform the skin removal procedure once the patient's weight has stabilized,” explains Dr. Moelleken.

However, in rare cases, FUPA surgery can be performed at the same time as weight-loss surgery. A retrospective study of 325 morbidly obese patients indicated that combining procedures improved quality of life during the weight-loss period, prevented the development of more overhanging skin, and helped avoid dangerous and disabling complications, including lymphedema (swelling) of the abdominal wall.

Another researcher’s comment on the study notes that while the aesthetic result may not be as satisfactory, the same functional goals are achieved—and patients are often pleased to avoid a second surgery.

If you plan to undergo bariatric surgery, talk to your doctor about how you can best plan for future body contouring procedures.

Question 6

Panniculectomy vs. tummy tuck: What's the difference?

Accepted Answer

A panniculectomy and a tummy tuck are performed for different reasons, and the outcomes are very different, too. “The panniculectomy is an operation to treat a medical problem, with no regard for the visual or aesthetic outcome,” adds Dr. Dallas Buchanan, a plastic surgeon in Tampa, Florida. “The tummy tuck is an operation that is meant to improve the aesthetic appearance of the abdomen.”

If you’re weighing the two, consider these key points.

A panniculectomy can give you a flatter abdomen, more mobility, and relief from rashes and skin irritations.
However, it can’t tighten your abdominal muscles and give you the flat tummy that abdominoplasty (aka a tummy tuck) can. If you want a taut and trim midsection, a tummy tuck will probably be your best bet.
A panniculectomy strictly removes hanging skin from the lower abdomen: it doesn’t touch the area above the belly button. “Most people who have a panniculus also have large upper stomach folds, and they would much rather have all the skin redraped, which is what a tummy tuck does,” says Dr. Adam Oppenheimer, a plastic surgeon in Orlando, Florida. “A panniculectomy addresses only the lower folds—it leaves all the upper folds of loose skin there.”
A tummy tuck can also reposition the belly button and may involve liposuction, to fully contour the flanks and even the back.

“If you’re going to undergo the procedure and deal with the recovery time, I would recommend getting the benefit of the tummy tuck for core strength and appearance,” says plastic surgeon Dr. Michelle Place, who practices in San Ramon, California. However, “If you are interested only in improving rashes or skin breakdown and wearing clothes better, then the panniculectomy is a good choice.”

In weighing an abdominoplasty vs. a panniculectomy, Dr. Moelleken notes that you’ll also need to take your general health into account. “In some patients, their health isn’t sufficiently good that they can safely have an abdominoplasty, so a panniculectomy is a good second choice,” he explains.

Question 7

How much weight can you lose with a panniculectomy?

Accepted Answer

Some people lose several pounds with FUPA surgery—typically 5 to 10, depending on the extent of their previous weight loss. In some extreme cases, more than 20 pounds of tissue is removed during FUPA surgery.

Many patients also find that they lose more weight once they recover from a pannus removal procedure, simply because it’s much easier to be active once the extra skin is gone, explains Dr. Lewis Andres, a plastic surgeon in Scottsdale, Arizona.

Question 8

What happens during a panniculectomy? How long does surgery take?

Accepted Answer

Panniculectomy surgery takes several hours and is usually performed under general anesthesia.

If you have underlying health issues, like diabetes or high blood pressure, your abdominal pannus removal procedure may be performed in a hospital operating room. If not, it may take place in a surgery center or the surgeon’s private facility, which typically has lower facility fees.

Here’s what happens once you are unconscious from the anesthesia.

Your surgeon will make a horizontal incision across your pubic area, from hip bone to hip bone.
They will trim off the panniculus and bring the remaining tissue together.
Your incisions will be closed with sutures or surgical glue and tape.
Surgical drains may temporarily be placed at the incision site, to prevent fluid buildup during recovery, though surgeons are increasingly relying on progressive tension sutures instead.
FUPA removal surgery is usually an outpatient procedure, so you should be able to go home the same day, once the anesthesia has worn off (usually within an hour or two). However, some hospitals prefer to have patients stay overnight (or longer) for monitoring, particularly if the procedure is extensive or the patient has other medical conditions.
When you do go home, you’ll need to have someone you trust accompany you and stay with you for the first day or two of your recovery.

Question 9

Will you still have a belly button after a panniculectomy?

Accepted Answer

Yes, the belly button (umbilicus) is usually preserved.

However, there are some circumstances where its preservation is too risky or not possible, due to poor blood supply. This may be due to previous scars around the belly button, or because a very large abdominal pannus has been removed. A new belly button can be surgically reconstructed later, at an additional charge.

A true panniculectomy removes only the apron of skin and fat below the belly button, without repositioning it, so it may end up lower on the abdomen since the skin is pulled down.

However, “Normally it’s preferable to move the belly button to improve the overall contour and result, which moves it into the gray zone of abdominoplasty [tummy tuck],” during which the original belly button and umbilical stalk remained attached to the abdominal wall and a new opening is created for them in the repositioned abdominal skin, explains Dr. Jeffrey Sweat, a plastic surgeon in Sacramento, California. “With a panniculectomy, insurance companies often don’t reimburse for the extra work involved.”

If you’re paying privately for the entire procedure, seek out a plastic surgeon who believes that a well-positioned belly button is a normal part of an attractive abdomen and will save it if possible, without additional charges.

If insurance is covering your pannus removal procedure, clarify with your surgeon what exactly is to be covered, just to make sure there are no surprises.

Question 10

What is the recovery time for a panniculectomy?

Accepted Answer

Plan for 10 to 14 days of recovery time after a panniculectomy.

You should be able to return to work about 2 weeks after this stomach skin removal procedure, unless your job requires a lot of movement or heavy lifting. Avoid strenuous activity (including working out) for 6 weeks post-op, to avoid putting tension on your incisions as they heal.

Most people experience pain, swelling, and bruising in the midsection after surgery, so your provider may recommend prescription or over-the-counter painkillers, to help you stay comfortable during the first few days of your recovery.

You may be instructed to wear a compression garment called an abdominal binder, to support the tissue around your incision as it heals and reduce swelling. If you do, you'll wear it for about a week, taking it off only to shower.

Depending on which kind of stitches your surgeon uses, they will either be removed by your surgeon about a week after your procedure or dissolve on their own within two weeks.

If you have surgical drains, they will be removed in the doctor’s office a week or so after your FUPA removal surgery.

Stay in touch with your surgeon if you notice any unusual changes during your recovery.

Question 11

When will you see panniculectomy results?

Accepted Answer

You will see a difference immediately after abdominal skin removal, but it will take up to 3 months for most of the swelling (and possibly bruising) to resolve and up to 2 years to see your final results.

If your primary concern is skin irritation and infections from the panniculus, “a panniculectomy procedure gives almost immediate relief from these issues,” says Dr. Andres.

In time, you’ll see a flatter belly where the apron of loose skin used to be.

Question 12

How long do panniculectomy results last?

Accepted Answer

Results are considered permanent, so long as you maintain a stable weight. “For many patients, abdominal-wall panniculectomy is a life-changing experience and results in dramatic changes in self-esteem, self-confidence, and self-image,” says Dr. Richard Bruneteau, a plastic surgeon in Omaha, Nebraska.

Once you recover, your lower midsection should remain flatter, without the need for more procedures.

Panniculectomy scars, spanning the lower abdomen from hip to hip, should be low enough to conceal easily with clothing. Like all scars, this one will be permanent but fade with time. If you’re concerned about scarring from pannus removal, ask your surgeon for scar treatment recommendations.

The best way to maintain FUPA surgery results is to embrace a healthy lifestyle and diet, to keep your weight stable.

It’s also important to remember that all skin eventually loses elasticity as part of the natural aging process, so you may develop some mild laxity over time. This can be treated with nonsurgical skin tightening procedures.

Question 13

Is panniculectomy surgery safe?

Accepted Answer

Panniculectomy procedures are considered safe, in the hands of a board-certified plastic surgeon.

Risks of abdominal pannus removal surgery are similar to those of most surgical procedures, the most serious ones being infection and blood clots (which can, in rare cases, lead to deep vein thrombosis).

Patients often have swelling and bruising, but more dangerous wound-healing complications can arise. Fluid-filled seromas are common and can be managed with surgical drains, or fluid aspiration by your doctor.

Blood accumulation (hematoma) can also be drained but may require surgery. “Patients can minimize their risk of a hematoma by having their blood pressure under good control and being monitored postoperatively in an aftercare facility or in the hospital,” says Dr. Moelleken.

Other concerns include wound separation and tissue necrosis.

Less serious risks include numbness around the incision sites (which usually resolves as the nerves recover over time) and asymmetry.

Follow your surgeon’s recovery instructions to encourage healthy healing. If you find your symptoms are more serious or last longer than expected, contact them as soon as you become concerned.

Question 14

Can you get pregnant after a panniculectomy?

Accepted Answer

This surgery will not impede pregnancy, but it’s much better to have it after you’re done having kids, to avoid the risk of ruining your results.

Dr. Hayley Brown, a plastic surgeon in Henderson, Nevada, notes that “If you get pregnant again, there’s always the chance that the skin will stretch out again.”

Question 15

Is panniculectomy revision possible?

Accepted Answer

If you’re unhappy with your results or hanging skin returns with weight fluctuations or aging, it’s usually possible to have revision surgery.

Keep in mind that this is not a cosmetic procedure, it’s about resolving a medical concern. A revision surgery to improve the appearance of your lower abdomen would probably be considered elective and, therefore, ineligible for insurance coverage.

“Dog ears”—excess tissue bunching at either end of the incision line—are one common concern following FUPA surgery. “Often, there is a balancing act between getting the loose skin off, weighed against how long the incision has to be,” explains Dr. Meolleken.

“Often, dog ears improve or go away with time,” adds Dr. Andres. “If they remain after several months, it is possible to excise the small amount of excess skin at the edge of the incision under local anesthesia, sometimes in the office, to give a flattened, improved appearance.”

Patients who want a tighter abdomen both above and below the belly button may want to consider a tummy tuck. If you don’t have loose skin, nonsurgical treatment options like Emsculpt Neo (which tones muscle and reduces fat) are also worth considering.

Question 16

Sources & studies

Accepted Answer

Colabianchi, Vincenzo, et al. “Panniculectomy Combined with Bariatric Surgery by Laparotomy: An Analysis of 325 Cases.” Surgery Research and Practice, vol. 2015, Nov. 2015.

Janis, Jeffrey, et al. “Panniculectomy: Practical Pearls and Pitfalls.” Plastic and Reconstructive Surgery - Global Open: August 2020.

Sachs, Darren, and John Murray. Panniculectomy. Stat Pearls, 2020.

Vilallonga, R. “Comment on ‘Panniculectomy Combined with Bariatric Surgery by Laparotomy: An Analysis of 325 Cases.’” Surgery Research and Practice, vol. 2016, Jan. 2016.

PANNICULECTOMY

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PANNICULECTOMY QUESTIONS

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100 pound weight loss, plan on loosing another 100 pounds. Will I need multiple skin removal procedures over time? (Photos)

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