Does Panniculectomy include muscle tightening?

A panniculectomy is a surgical procedure that removes excess skin and fat from the lower abdomen. It’s commonly performed on patients who have lost a significant amount of weight and have excess skin hanging from their belly area. This excess skin is called a “pannus” or “apron”.

Some patients wonder if a panniculectomy also includes muscle tightening or repair. The short answer is no – a standard panniculectomy focuses solely on removing excess skin and fat. It does not address weakened or separated abdominal muscles.

However, a variation called a “fleur-de-lis panniculectomy” may incorporate muscle tightening. We’ll discuss the key differences between a regular panniculectomy and a fleur-de-lis panniculectomy below.

What is a panniculectomy?

A panniculectomy is a surgical procedure to remove a large pannus or apron of excess skin and fat from the lower abdomen. This pannus usually develops after major weight loss of 50-100+ pounds.

When large amounts of weight are lost, the skin and subcutaneous fat in the lower abdomen does not shrink back adequately. Instead, it hangs down over the pubic area as an overhanging pannus. This can cause a number of physical and emotional problems:

– Rashes, ulcers and infections under the pannus
– Difficulty exercising and mobility issues
– Poor posture and back pain from the pull of excess tissue
– Leaking urine or stool from the folds of skin
– Discomfort during intimacy
– Low self-esteem and embarrassment about appearance

A panniculectomy is considered a reconstructive procedure rather than a cosmetic one. Removing the pannus often dramatically improves quality of life and resolves functional problems.

During a standard panniculectomy, the surgeon makes a horizontal incision just above the pubic area. The excess tissue is detached from the abdominal wall all the way up to the ribs. The overhanging pannus is then removed, and the remaining skin stapled or sutured into a tighter, more shapely profile.

The panniculectomy does not tighten or modify the abdominal muscles themselves. However, removing the heavy pannus eliminates the downward pull on the muscles. This may allow them to return partially toward their original position.

What is a fleur-de-lis panniculectomy?

A fleur-de-lis (French for “lily flower”) panniculectomy takes the additional step of repairing the vertical muscle separation that often occurs after major weight loss.

Significant weight fluctuation can weaken the connective tissue and cause the two vertical abdominal muscles (rectus abdominis) to move apart. This separates the muscles down the midline of the abdomen, creating a bulge or widened gap.

A fleur-de-lis panniculectomy tightens those muscles and brings them back together. Along with removing excess skin, this helps to flatten and tone the abdominal area.

The name comes from the fleur-de-lis pattern of the surgical incisions:

– One horizontal incision is made just above the pubic bone, like a regular panniculectomy
– Two vertical incisions are made as well, one running up the middle of each rectus abdominis muscle

Through these three incisions, the surgeon can:

– Remove excess skin and fat (panniculectomy)
– Release and tighten the rectus abdominis muscles
– Repair divots or bulging areas between muscles
– Stitch the muscles and midline fascia back together

This dual approach helps the abdomen heal in a tighter, firmer, and more aesthetically pleasing contour. However, the fleur-de-lis technique is more complex and involved than a standard panniculectomy.

Does a panniculectomy tighten muscles?

The short answer is no: a basic panniculectomy focuses solely on removing excess skin and fat. It does not incorporate muscle tightening or repair.

However, there are some caveats to this rule:

Partial tightening effect: Removing the heavy pannus eliminates the constant downward pull on the abdominal muscles. This may allow the muscles to move back into a slightly more natural position without sagging. But no direct muscle modification is done.

Temporary placation stitches: In some cases, the surgeon may use absorbable sutures to “tack up” the upper abdominal muscle edge where it meets the ribcage. This provides mild uplift. But it does not bring closer together or permanently alter the abdominal muscles.

Fleur-de-lis technique: As described above, a fleur-de-lis panniculectomy is specifically designed to tighten vertical muscles along with removing excess skin. So this dual-purpose technique does incorporate muscle tightening, unlike a regular panniculectomy.

Let’s summarize the key points:

Standard panniculectomy Fleur-de-lis panniculectomy
Removes excess lower abdominal skin/fat Removes excess lower abdominal skin/fat
Does not tighten muscles Tightens vertical rectus abdominis muscles
Horizontal incision only Horizontal + vertical incisions
Less complex surgery More complex surgery
Focuses just on removing pannus Also repairs muscle diastasis

Results to expect from a panniculectomy

The results of a panniculectomy primarily relate to removing the lower abdominal pannus and overhanging skin. Patients can expect:

– A flatter, smoother abdominal contour
– Less sweat and irritation under abdominal folds
– Relief from discomfort and functional problems
– Improved ability to move, walk, and exercise
– Potentially less back pain and improved posture
– A more comfortable fit into clothing
– Greater confidence in appearance

Without direct muscle modification, the panniculectomy does not provide significant abdominal firming or toning. Mild tightening may occur from loss of the heavy pannus, but muscles are not tightened directly.

Note that a panniculectomy removes skin and fat only. It does not remove stretch marks or address loose skin on the thighs, back, arms, or other areas. Many patients combine panniculectomy with procedures like thigh lifts, breast lifts, and arm lifts for optimal contouring following weight loss.

Recovery after a panniculectomy

Panniculectomy recovery typically takes about 6 weeks with restrictions on exercise and heavy activity. Early walking is encouraged to prevent blood clots.

There will be significant incisional pain, swelling, and bruising during the first week.Patients also need to monitor the site for wound separation, fluid buildup, infection, and bleeding.

Most patients take 2-4 weeks off from work and regular activities. After 6 weeks, vigorous exercise can resume. It may take 3-6 months for residual swelling to fully resolve and the final results to become visible.

Compared to a fleur-de-lis panniculectomy, the recovery time is usually shorter after a standard panniculectomy since it is a less complex surgery. But the panniculectomy incision is still very long, so healing does require dedication and patience.

Good candidates for a panniculectomy

The best candidates for a panniculectomy include:

– Men or women with a large, heavy pannus causing discomfort and functional impairment
– Patients whose weight has stabilized after losing 50+ pounds
– Nonsmokers, or smokers willing to stop smoking for several weeks before and after surgery
– Patients without major health problems that impair healing
– Patients with reasonable expectations who understand the scarring involved

Pregnancy may temporary enlarge the pannus again, so women considering future pregnancies may wish to postpone panniculectomy surgery. Patients who need to or want to lose more weight should also wait.

Is a panniculectomy worth it?

For suitable candidates struggling with a heavy pannus, a panniculectomy can certainly be worth it. Removing the excess tissue can dramatically improve:

– Mobility, stamina, and ability to exercise
– Comfort while sitting, walking, and sleeping
– Hygiene
– Prevention of rashes and skin infections
– Bladder and bowel function
– Intimacy and sexuality
– Self-confidence
– Emotional health

The benefits often go far beyond just cosmetic enhancement. This reconstructive surgery can reduce pain, discomfort, and embarrassment while enabling a more active lifestyle.

However, a panniculectomy does produce a long incisionscar across the lower abdomen. Some residual loose skin may remain. And there are surgical risks to consider. Consulting with a board-certified plastic surgeon is important to determine if a panniculectomy is likely to achieve the desired goals.

For those with muscle diastasis as well, a fleur-de-lis panniculectomy may provide more muscular firming and tightening results. Though recovery is longer, the combined approach can produce both functional and aesthetic enhancement.

Can a panniculectomy help me get a flat tummy?

A panniculectomy cannot provide the type of “six-pack abs” flat tummy look that one might see on a fitness model. But by removing the excess skin and pannus, the procedure can dramatically flatten and contour the lower abdomen.

Keep in mind the panniculectomy:

– Does not remove stretch marks or loose skin above the navel
– Does not tighten or strengthen abdominal muscles directly
– Produces a long scar across the pubic area

For those with severe skin laxity, the belly may still not appear particularly flat or tight after panniculectomy surgery. But the drooping pannus will be eliminated, allowing clothes to fit more smoothly.

Other procedures that enhance abdominal flatness include:

– Abdominoplasty (tummy tuck): Removes loose skin, repairs muscle separation, and tightens remaining skin
– Liposuction: Permanently removes deep fat for contouring
– CoolSculpting: Reduces stubborn fat bulges through cryolipolysis
– Muscle-tightening surgeries: Can surgically repair diastasis recti for a sleeker abdomen

Depending on the patient’s unique needs, a plastic surgeon may recommend combining the panniculectomy with other body contouring techniques for the best results.

Can a panniculectomy get rid of stretch marks or loose skin?

A panniculectomy can eliminate stretch marks, loose skin, and fat within the skin that is surgically removed from the lower abdomen. However, it does not address stretch marks or loose skin outside that surgical area.

The incision for a panniculectomy runs just above the pubic bone, from hip to hip. Skin above that incision line is not modified.

So while the procedure can remove stretch marks and excess tissue on the pannus itself, patients may still have:

– Stretch marks on the upper abdomen, flanks, back, thighs, arms, and breasts
– Loose skin around the umbilicus, upper abdomen, back, and other zones

For optimal contouring after major weight loss, many patients choose to combine a panniculectomy with additional body lift procedures, such as:

– Belt lipectomy: Circumferential surgery to tighten the torso
– Extended tummy tuck: Removing loose upper abdominal skin
– Thigh lift: Reduces loose thigh skin for a slimmer contour
– Arm lift: Tightens drooping upper arms
– Breast lift: Raises and firms sagging breasts

Although the panniculectomy cannot specifically treat stretch marks and loose skin outside the lower belly region, it can complement other procedures designed to remove them.

What’s the difference between a panniculectomy and abdominoplasty?

Both a panniculectomy and abdominoplasty (tummy tuck) remove excess tissue for a flatter, tighter abdomen. However, a tummy tuck is more comprehensive:

Panniculectomy Tummy tuck / Abdominoplasty
Removes pannus and skin overhang only Removes skin and fat from entire abdomen, side to side
Does not tighten muscles Tightens abdominal muscles
Less scarring More extensive scarring
No belly button repositioning Belly button is repositioned up higher
Shorter procedure time Longer procedure time
Focuses just on removing the pannus Reshapes entire abdominal contour

The board-certified surgeons of ABC Plastic Surgery can help determine whether a panniculectomy or tummy tuck better suits your needs after consulting in person.

Can a panniculectomy get rid of a hanging belly after pregnancy?

For some women, pregnancy leaves behind loose abdominal skin that hangs down like an apron. This may be compounded by a vertical separation of the rectus abdominis muscles called diastasis recti.

In mild cases, building core strength with abdominal exercises may tighten the muscles back together. But if excess skin and fat hangs down severely, exercise alone is usually not enough.

A panniculectomy can successfully remove a hanging post-pregnancy belly by:

– Eliminating the lower abdominal skin and fat that sags down
– Removing any stretched out, split abdominal muscles if a fleur-de-lis technique is used
– Tightening the remaining skin for a smoother, flatter, firmer belly

However, a panniculectomy will not address loose skin or muscle separation in the upper abdomen. An abdominoplasty (tummy tuck) may be more appropriate to fully tighten the entire abdominal area after pregnancy.

Neither surgery will reduce stretch marks, although they may remove those located on the excised skin. Consulting with a board-certified plastic surgeon is the best way to decide if a post-pregnancy panniculectomy can remove your specific hanging belly concerns.

Should I get a panniculectomy or tummy tuck after pregnancy?

There are pros and cons to both options for addressing a post-pregnancy belly hang:

Panniculectomy advantages:

– Removes lower abdominal skin and fat overhang
– Shorter procedure time and faster recovery
– May include fleur-de-lis technique to tighten vertical muscles
– Smaller incision scar than a tummy tuck
– Typically cheaper cost than a tummy tuck

Tummy tuck advantages:

– Tightens entire abdominal area, not just lower abdomen
– Repairs muscle separation from top to bottom
– Removes stretch marks on excised skin
– Creates “six-pack” muscle look
– Flattens bulging sides as well as front
– Provides more dramatic slimming effect

Neither surgery will improve skin tone or remove stretch marks outside the surgical zones.

If the excessive skin and bulge is focused on the lower pannus, a panniculectomy may suffice. If laxity and muscle diastasis affects the entire abdomen, a tummy tuck may be more suited.

An experienced board-certified plastic surgeon can suggest the optimal treatment plan based on a patient’s post-pregnancy concerns, anatomy, and goals. Often a combination approach is recommended for the best outcome.


In summary, a standard panniculectomy does not incorporate muscle tightening or repair. The surgery focuses solely on removing the lower abdominal pannus and overhanging skin.

However, a variation called a fleur-de-lis panniculectomy is specially designed to tighten separated abdominal muscles along with removing excess tissue.

While a panniculectomy alone will not provide dramatic muscle tightening, flattening the pannus and eliminating the constant pull of gravity on the abdomen may allow the abdominal muscles to rest in a slightly improved position.

Removing the excessive lower abdominal skin can certainly create a smoother, flatter, firmer contour. But only techniques like a fleur-de-lis procedure, full tummy tuck, muscle repair surgery, or intense strength training can actively tighten and tone the abdominal muscles.

Leave a Comment