How far does my belly have to hang to qualify for panniculectomy? (Photos)

Thank you for your question about what to do with your abdomen in the presence of a c-section scar and how far does your belly have to hang to qualify for panniculectomy. Insurance companies are VERY vague in how far your pannus needs to hang for the panniculectomy to be covered by insurance. In California and Nevada, insurance companies require the pannus to completely cover the pubis. The pubis is the top portion of the pelvic bone, where the pelvic bone fuses to itself. The pubis is the hard, vertical structure in the middle of the pelvic region in men and women.  The pubis is not the entire pubic region.  Often, patients have a little tummy hanging cover the pubis.  Sometimes, their panniculectomy is approved because their pannus covers their pubis. However, other insurance companies mandate that the pannus entirely cover the pubic region, not just the upper portion of the pubic region or pubis. These companies require that the pubic region is completely covered when you are standing in front of a mirror. Also, for insurance companies to approve a panniculectomy, it is important to document rashes and chronic skin irritation underneath the pannus.  Therefore, unfortunately, this is confusing for plastic surgeons and patients alike. Therefore, I would suggest you seek an experienced, board-certified plastic surgeon who has been working with insurance companies for years and knows the criteria and language to mention and discuss in your letter of medical necessity to your insurance company when seeking authorization of a panniculectomy. I hope that I have answered your question regarding what to do with your abdomen in the presence of a c-section scar and how far does your belly have to hang to qualify for panniculectomy.  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.)

Thank you for your question and photos.  Your expectations will dictate the best procedure(s) for you.  I suggest a consultation with a board certified plastic surgeon to go over the options that best address your goals.  Best of luck!
Dr Dhaval Patel
Double Board Certified
Plastic Surgeon
Chicago
Hoffman Estates 
Oakbrook 
Orland Park

Hello, 

Thank you for your question and photos. To be covered for panniculectomy, most insurance plans require evidence of chronic skin rashes not responsive to topical medications such as steroids and/or recurrent skin infections; conditions that are more common in a pannus that goes beyond the pubic bone and may extend to the genitals. 
Since your concern includes weak abdominal musculature, a more appropriate procedure is the tummy tuck which allows tightening of the abdominal musculature and correction of diastasis recti secondary to pregnancy.
An in person or video consultation with a board certified Plastic/Cosmetic Surgeon will give you a better insight on the procedure that's right for you. Hope this helps!
Best, 

Dr. Babak Moein

The panniculectomy involves only the removal of excess skin/fat that hangs over the genitals and/or thighs.  It does address hygiene issues, rashes/infections, etc. When a panniculectomy is done, there is no tightening of the underlying muscles and tapering of the waist so you do not get the contour shape. Panniculectomy is only the removal of the skin below the belly button, so the best aesthetic results may be attained with a TT.

Dear pink03color,
In order to qualify for panniculectomy, your pannus should be causing you symptoms (most common are rash, repeated infections, etc.). 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

Hello! Thank you for your question. Unfortunately, from the photos you shared, your abdomen does not appear to hang down (fold) as much as would likely be required by insurance to be considered a Panniculectomy. In South Carolina, most insurances require the abdominal skin to hang down lower than the pubis. Most insurance also requires a substantial amount of documentation from other MD's that support skin fold issues like rash, open sores, yeast, etc.   You appear to be a good candidate for Diastasis Recti repair and an Abdominoplasty. This would help with the projection of your abdominal muscle and help with the weakness you had mentioned.  Always consult with a Board Certified Plastic Surgeon near you. Best of luck! 

If you are addressing insurance coverage, each carrier has different criteria. Many want proof of intractable rashes for a year and failure of IV antibiotic treatment. Your overhang would not qualify as a medically necessary procedure.