A panniculus refers to the heavy mass of excess skin and fat around the abdomen that hangs down. It usually appears after extreme weight loss. Doctors can treat the condition with a surgical procedure called a panniculectomy. A panniculus can get very uncomfortable as the heavy loose skin can affect mobility. It increases susceptibility to skin infections and rashes due to excessive sweating and rubbing of the skin.

There are different grades of panniculus, which increase in severity. Grade 1 panniculus usually hangs down to the pubis, while a grade 5 may reach over the knee.  

A panniculectomy procedure can reshape the abdomen by excising the excess skin and fat. The surgery itself does not tighten muscles. Tummy tuck surgery is usually necessary to target deeper tissue layers.

The surgery is an outpatient or inpatient procedure that requires general anesthetic and will take 2-4 hours.

The surgeon will first create a horizontal incision across the hip bones. The length of the cut will depend on the amount of skin that needs to be removed. A vertical incision will also be necessary for patients with transverse excess skin and tissue. Once the excess skin and fat are removed, the surgeon will pull down the flap of the skin and reposition the belly button  as necessary. Once everything is aligned, the site is stitched up with sutures. Surgical drains may be inserted into the incision areas to avoid fluid retention, which will aid healing and prevent complications.

Patients will also have to wear compression garments for support.