I'm 268 pounds, 5' 7" with a BMI of 42, would I be a panniculectomy candidate? (Photos)

Hello,
Thank you for your question and congratulations on your tremendous weight loss! It is challenging in situations such as yours to determine optimal timing for skin removal. Insurance generally covers panniculectomy for patients like you, when the pannus falls to the level of the pubis (pubic bone) and rashes are difficult to manage even with topical treatments (i.e. creams). 
You do not mention how long it has been since your weight loss surgery. It’s important that you weight be stable prior to a panniculectomy or tummy tuck. Typical this occurs 12-18 months after surgery. The pros and cons of a panniculectomy alone vs panniculectomy with tummy tuck should be discussed at length. Oftentimes my patients will undergo combined panniculectomy and tummy tuck, covering the out of pocket portion not covered by insurance. 
As a combined bariatric (obesity) and cosmetic surgeon, performing skin removal and body lifts that allow my patients to strengthen and maintain their healthy lifestyle changes is one of the most rewarding aspects of my job.
Video or in-person consultation with a cosmetic surgeon will give you a better understanding of the surgical options and best timing for your needs.
Best wishes,
Dr. Moein

Thank you for your question and for sharing your photos and history. Based on your photos and your history of weight loss, you seem like an excellent candidate for a panniculectomy or, even better, a tummy tuck.

A panniculectomy would remove the excess skin and fat (the "apron") that’s causing rashes and hygiene issues. This would help improve your comfort and ability to perform daily activities. However, a panniculectomy is primarily focused on functional improvements and doesn’t include muscle repair or provide the same degree of body contouring.

A tummy tuck (abdominoplasty), on the other hand, would not only remove the excess skin but also tighten the abdominal muscles and improve the overall shape of your midsection. This would give you better long-term results both functionally and aesthetically. Since you’ve already had weight loss surgery and lost a significant amount of weight, a tummy tuck could help you feel even more confident and comfortable in your body.

I recommend discussing both options with your plastic surgeon, especially since the rashes and hygiene issues could help qualify you for insurance coverage of a panniculectomy.

Sincerely,
Dr. Katzen

With a current BMI of 42, you would benefit from discussing an exercise and diet program with your PCP.  Your PCP could also prescribe something for your rashes.  Once you reach a BMI of about 30, you would be a good candidate for a TT, which because it is a cosmetic procedure, would not be covered by your medical insurance.  A panniculectomy only involves removal of the hanging tissue to address hygiene issues, rashes/infections, etc.  It does not involve the extent of tissue undermining, tissue removal or plication needed after 3 C-sections or umbilical transposition.Check with your medical insurance provider to determine if you meet specific criteria for them to cover the panniculectomy.