What is the defining factor in performing a vertical panniculectomy? (Photos)

Thank you for your question on what to do with your abdomen after massive weight loss.  I must clarify a few things. There is no such thing as a vertical panniculectomy. There is only (horizontal) panniculectomy. There is the Fleur-de-Lis, however, the Fleur-de-Lis is not a panniculectomy; the Fleur-de-Lis is an inverted-T abdominoplasty.  During a panniculectomy, the abdominal pannus is removed. The abdominal pannus is the area that hangs over the pubic region. The panniculectomy does not cover any area above the pannus or belt line. Therefore, any area above the belt line is not technically the pannus. The area above the pannus is not covered by insurance. The insurance company rules the area above the pannus to be cosmetic. Plastic surgeons did not create these rules.  These rules and decisions were created by insurance agents.  In your case, I would suggest an abdominoplasty or extended tummy tuck. This would get rid of the lower abdominal skin and fat as well of some of the vertical abdominal skin. A panniculectomy will not get rid of the upper abdominal skin. Also, having the rectus abdominis muscles repaired does not mean you cannot have children. Either way, please seek a board-certified plastic surgeon. Sometimes a panniculectomy is covered by insurance, but again this is just the pannus, not the upper abdomen. Most insurance companies rule a tummy tuck as a cosmetic surgery and will not cover a tummy tuck portion.  I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the panniculectomy, tummy tuck, extended tummy tuck, high lateral tension tummy tuck, abdominoplasty, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or extended tummy tuck are big procedures, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or extended tummy tuck. Do your research.  Make sure they have performed at least 100 panniculectomies or extended tummy tuck surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, panniculectomy or extended tummy tuck surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Dear Cute922189,You need an in person exam to determine if a FdL incision is necessary. I would check with your insurer because a FdL incision is usually NOT covered by most insurers. What insurers will cover is an panniculectomy that removes the skim below the belly button or sometimes removes the belly button.  Consult with a board certified plastic surgeon to learn more about the differences between a panniculectomy and a tummy tuck.Good luck,Nirmal R. Nathan, M.D.

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgeons

A panniculectomy is a functional procedure for the lower abdomen that focuses on excising the abdominal apron.  If there is usually a significant amount of excess tissue, a vertical incision may also be performed. It leaves a scar that cannot be hidden so my patients prefer the horizontal scar. 

Dear Cute822189,
it is hard to tell for sure without an examination. Based on your photos, it looks like you would benefit from a panniculectomy. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery