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Hello, As you gain weight, fat accumulates around the stomach (omentum) and under the skin. This accumulation causes the abdomen to become distended. Because of gravity, the fat pushes on the lower abdomen. The skin around the lower abdomen is weak and very elastic. Pressure from the underlying fat pushes the skin out. This appears as an "apron". The medical term for this apron of excess skin and fat is "pannus".The surgical removal of this apron (or pannus) is called a panniculectomy. The incision goes from hip to hip. This procedure may be covered by insurance. If the abdominal wall muscles (rectus abdominus) and upper abdominal skin above the belly button needs to be removed, then the better procedure may be an abdominoplasty. This incision goes from hip to hip. There is also a very small incision around the belly button. If you have excess skin and fat that extends around your hips and to the top of your buttocks, you may need a 360 circumferential lower bodylift. The incision goes from the front all the way around the back. Like the abdominoplasty, there is an incision around the belly button. If you are considering these procedures, please seek an experienced, board certfied plastic surgeon.