Can a Doctor Perform a Panniculectomy but Also Tighten Muscles?

Is it possible to remove extra skin at the bottom of the stomach, yet tighten the ab muscles all the way up the ribcage and leave the belly button alone? I'm average size (short torso) and have been told I need a panniculectomy by one doc and a full tummy tuck by another. (2 pregnancies) However, I don't feel I have 'excess' skin above my belly button, just muscle seperation in that area. And too much skin below the belly button.

Doctor Answers 16

Don't over-think and Micro-manage your plastic surgery

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Hi there-

I think you are thinking too much about this, and starting to fall into a trap I see too often- where a patient doesn't like what a surgeon told them, so they start looking for a surgeon who will tell them what they want to hear...

Nothing good will come of this...

It sound like you need a tummy tuck. There are many variations (I personally do 4 different types of tummy tucks), but the operation best for you will depend on many variables and a consultation would be necessary to make recommendations.

Your best bet is to find a surgeon certified by The American Board of Plastic Surgery that you like and trust and follow their recommendations.

If you wave a bit of money in the air, you will find someone to do what you want- but it's your body and safety we're talking about!

Here's some advice on how to find a surgeon you like and can trust:

Tummy tuck or panniculectomy depends on goals to be reached

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Panniculectomy refers to removal of a pannus or fold of skin from the lower abdomen after weight loss, often following gastric bypass. The intention is to remove the excess skin fold to improve function and posture, and in some occasions insurance coverage might be available. Muscle tightening in not part of the procedure, unless it is determined that a full tummy tuck is the goal to more fully improve the abdominal tone and contour. The full tummy tuck is the procedure of choice after pregnancy where a diastasis or separation of the sit-up muscles occurs. If your concern is laxity after pregnancy then the tummy tuck is for you. Skin laxity that is not apparent in the upper abdomen will provide enough give to cover the whole abdomen as the pannus or lax lower skin is removed and give the best result if this is your goal.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Panniculectomy Surgery

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Pregnancy can result in dramatic changes in a woman’s body. These changes are especially noticeable in the abdomen, where redundant saggy skin, weakened muscles, and stretch marks may occur. A large variety of surgical options are available for treating these problems. The procedure chosen for any particular patient is dependent upon their anatomic findings and aesthetic goals.

It’s important to realize that each patient’s situation is unique. The best results are obtained when correct analysis is performed and the best surgical option is applied. In most cases, patients will require a full abdominoplasty.

In your case, it’s virtually impossible to make a recommendation without pictures or a physical examination. It’s definitely possible to remove lower abdominal skin and tighten abdominal muscles without detaching the umbilicus. Whether or not this approach is appropriate for you is dependent upon a proper evaluation.

Under these circumstances, consultation with a board-certified plastic surgeon who has experience in this area is appropriate. This surgeon should be able to formulate a treatment plan that addresses your concerns. 

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A little tightening OR a lot of tightening - the choice is yours

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Although there is no way to know what you need without seeing you, I would guess that a full tummy tuck is an option if that surgeon knows what he is doing. The panniculectomy option may also be a valid one. But you have to understand that all surgeons have opinions, things they specialize in as well as often use different techniques.

The ultimate choice is yours. From the information you have given us, you can have a panniculectomy and only tighten the muscle below your belly button (which is all that MOST plastic surgeons will do with a panniculectomy), removing a small portion of skin.

OR, you can have a full tummytuck and have your muscles tightened all of the way from top to bottom and have much more skin removed. So...... a little tightening OR a lot of tightening. The choice is yours.

Don't be confused by semantics

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Based on your description, you have extra skin and fat on your abdomen, as well as some muscle separation. These should each be addressed to get your best result. Whether you call this an abdominoplasty (tummytuck) or a panniculectomy with some muscle repair is basically just semantics. In my practice I call this a tummytuck and I would tighten the muscles from the top- rib area- to the pubic area.

David Shuter, MD
Jupiter Plastic Surgeon

Panniculectomy and muscel repair

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Panniculectomy and limited undermining with full rectus abdomins muscle repair is possible but unusual and would most commonly requires surgery around the umbilicus to access the upper abdomen. This can be performed endoscopically as well.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Partial tummy tuck very seldom good idea.

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From your description, I think you need a full tummy tuck that will repair your muscles above and below the belly button, and remove all excess skin. I bet you do have some loose skin above belly button.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Tummy Tuck VS (Full) Tummy Tuck

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Regarding : is it ADVISABLE "to remove extra skin at the bottom of the stomach, yet tighten the ab muscles all the way up the ribcage and leave the belly button alone?" No. That would result in under-removal of loose tummy skin and the pulling of your belly button to an unnaturally low position close to your privates.

A PANNICULECTOMY (IE Apron removal) is meant to remove the skin/fat over-hang to allow people to clean themselves and keep the fold dry. It is not a procedure intended to flatten the tummy, correct muscle distention and separation, narrow the waist and pull up a sagging Mons pubis the way a Tummy tuck is.

Plastic surgeons daily interact with patients suffering with IOS (Internet Overflow Syndrome) many of whom also possess virtual Plastic Surgery training certificates from the prestigious Dr. 90210 University. While education is always a good thing, a lot of information, misinformation and misleading information leads to confusion and the making of bad decisions.

Choose a real Plastic surgeon ( and find out all your options.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Full tummy tuck vs panniculectomy

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A panniculectomy is done to remove the lower abdominal apron of extra skin in people who have lost weight usually after morbid obesity, not pregnancy.  It doesn't address any muscle tightening and certainly not the upper abdomen.  Without a photo. it sounds like what you need is a TT.  I wonder if the person who sggested a panniculectomy is even a plastic surgeon?

Tightening the Abdominal Muscles

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The best result would be achieved with a full abdominoplasty (tummy tuck) with rectus plication (tightening up the muscles). Without pictures or examening you, it is hard to give you specific advice. However, with panniculectomy only, the muscles can not be tighted adequately. I hope this is helpful.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.