Background: The abdominal pannus is a well known medical condition of a large overhanging apron of skin and fat that extends well beyond the waistline.
There are five degrees of an abdominal pannus from a grade 1 that rests on the mons pubis to a grade 5 that hangs down to the knees. An abdominal panniculectomy procedure should not be confused with a more traditional tummy tuck. 1) Large abdominal panniculectomies can be safely done in an outpatient surgery center if the patient is otherwise healthy. 2) Enough abdominal pannus is removed to relief the obstruction on the pubic area and eliminate any overhang on the groin creases. 3) The most likely complication from any abdominal panniculectomy is a seroma or fluid collection. The abdominal pannus is a stomach deformity where any amount of tissue hangs over the waistline.
But despite the popularity and widespread availability of bariatric surgery, not every obese patient undergoes it or is eligible to do so. In the October 2014 issue of the Annals of Plastic Surgery, an article was published entitled “Supersize” Abdominal Panniculectomy: Indications, Technique, and Results’. The relevance of this paper is that it demonstrates that larger abdominal panniculectomies can be done and offer a dramatic improvement in mobility and function of the patient. Not infrequently, there may be a need for a panniculectomy to be done with other abdominal and pelvic procedures such as hernia repair, hysterectomy, and even gastric bypass surgery. Interestingly, an abdominal panniculectomy is not considered medically necessary when the main reason it is being performed is to relieve back, hip and knee pain. One procedure that is never needed and certainly not medically covered as part of a panniculectomy is liposuction. The abdominal panniculectomy is a variation to the traditional tummy tuck or abdominoplasty.  The pannus  or abdominal apron is that overhang of skin and fat that extends below one’s waistline. The abdominal panniculectomy, historically, refers to the pre-bariatric surgery era when extremely overweight patients had large skin and fat overhangs.
The abdominal panniculectomy is different than a true tummy tuck in that the skin edges are not as undermined, no muscles are tightened, and no areas are treated by liposuction.  It is simply an amputation of whatever overhangs the waistline. Because of the relief of medical symptoms, the abdominal panniculectomy may be covered by insurance.
Since the advent of bariatric surgery and the rise in the number of such procedures every year, a traditional body contouring plastic surgery procedure is undergoing a change.
Panniculectomy surgery is a reconstructive procedure performed to remove a panniculus, sometimes referred to as a pannus or overhanging abdominal apron.
In the recent past, prior to weight loss from bariatric surgery, an abdominal pannus was quite large (as was the patient) and quite hefty in weight. While removal of a massive abdominal pannus solved a few health problems for the very obese patient, it did little for their general well-being or improve longevity.
These sizes of abdominal pannuses are much more manageable, have fewer complications after their removal, and the patients are overall much healthier. A panniculectomy is a very close cousin to a tummy tuck or abdominoplasty.  The term pannus refers to a large apron of skin and fat that hangs over the waistline. In the historic obese patient, there was a significant improvement in the patient’s quality of life as the skin and infectious symptoms that it caused were eliminated as well as the weight removal improved back and knee pain. The cost of any type of elective plastic surgery plays a major role in the decision to undergo the procedure(s). Disclaimer: The information contained on this website should not be construed as medical advice. Take a look at this before and after photo.  Depressing, huh?  BTW – this is NOT my patient!
Even if the surgeon were really, really aggressive and went inside the abdomen, it still would not be possible to remove this fat.  The structures that collect the fat are either vital organs or carry the blood vessels to vital organs. A healthy lifestyle goes a long way towards a pleasing figure, but sometimes even the most dedicated gym rat will need a little help. In late 2013, Adams launched the Natural News Forensic Food Lab, where he conducts atomic spectroscopy research into food contaminants using high-end ICP-MS instrumentation.
In addition to his lab work, Adams is also the (non-paid) executive director of the non-profit Consumer Wellness Center (CWC), an organization that redirects 100% of its donations receipts to grant programs that teach children and women how to grow their own food or vastly improve their nutrition. With a background in science and software technology, Adams is the original founder of the email newsletter technology company known as Arial Software. Adams is well known for his incredibly popular consumer activism video blowing the lid on fake blueberries used throughout the food supply. Adams has also helped defend the rights of home gardeners and protect the medical freedom rights of parents. In addition to his activism, Adams is an accomplished musician who has released ten popular songs covering a variety of activism topics. CDC investigation of Chipotle further supports corporate sabotage (bioterrorism) as likely source of E.
Technically the proper term is a panniculus but it is far more commonly referred to as a pannus. While no abdominal pannus is pleasant for the patient the grade 5 pannus is the most disabling.
The scope of the problem being treated would indicate such but how the operation is performed and under what circumstance is also vastly different. The term, pannus, is derived from a latin word for apron so it is fitting that any overhang is referred to as such. This still leaves certain patients who are overweight that suffer from a large pannus with all of its associated symptoms.
In this paper, the authors reviewed a series of 26 patients over a six year period that had abdominal panniculectomies performed that weighed over 10 kgs. However, it creates a large abdominal incision and has a lot of ‘dead space’ inside to heal. In the long run it will be very much worth it but expect a healing period of two to three months for a full recovery.
This recontouring of the abdominal wall area is exclusively done for cosmetic purposes to create a more flat and firm abdomen. While the pannus produces a stretching of the tissues from the anterior abdominal wall, such effects are not treated by any form of muscle plication as in a tummy tuck.
While it may seem obvious that getting rid of an obstructive pannus could only benefit the results of these surgeries, the insurance companies rarely see it this way. Even though the sheer weight of grade 4 and 5 pannuses clearly strain these areas, this consideration alone is insufficient for medical coverage. In fact, thinning out of an abdominal skin flap with liposuction can impact its blood supply and create wound healing problems.
Abdominal pannuses can exist in overweight as well as extreme weight loss patients after bariatric surgery.


Heavy pannuses were surgically removed to relieve the medical symptoms that they caused such as skin irritations and rashes from the moisture and heat that builds up underneath it. In the obese patient, this pannus may have considerable weight anywhere from 30 lbs or higher. Since the panniculectomy procedure in the bariatric surgery patient today weighs considerably less and often only involves improvement of an undesired contour, it is often called cosmetic by one’s health insurance. Because of the amount of excess tissue present, removal may need to extend way into the back and include a vertical cutout as well as that in the horizontal dimension.
That procedure is the abdominal panniculectomy…or the cutting off of one’s overhanging pannus.
The pannus frequently contributes to a number of health problems, including chronic wounds and skin infections due to the moisture underneath the skin folds.
Many of these pannuses would hang at least down to the middle of the thighs and often to the knees. Along came bariatric surgery and we have seen a fortunate change in the large abdominal pannus patient.
The typical pannus that is removed today, often part of a circumferential lower body lift, weighs 10 lbs. At that time, many abdominal panniculectomy procedures were done to relieve the medical symptoms that the pannus caused.
This is different than a true tummy tuck in that the skin edges are not as undermined, no muscles are tightened, and no areas are treated by liposuction.  It is simply an amputation of whatever overhangs the waistline.
Because of the relief of medical symptoms, the abdominal panniculectomy  was often covered by insurance. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience.
Due to security issues and lack of support for web standards, it is highly recommended to take a few minutes and upgrade your web browser. The boom in injectables and medical skin care has revolutionized the way plastic surgeons think about and treat facial aging. Nobody likes it, and the internet is full of ads that promise all sorts of ways to get rid of it. With this research, Adams has made numerous food safety breakthroughs such as revealing rice protein products imported from Asia to be contaminated with toxic heavy metals like lead, cadmium and tungsten. He has also exposed "strange fibers" found in Chicken McNuggets, fake academic credentials of so-called health "gurus," dangerous "detox" products imported as battery acid and sold for oral consumption, fake acai berry scams, the California raw milk raids, the vaccine research fraud revealed by industry whistleblowers and many other topics. Adams is widely recognized to have made a remarkable global impact on issues like GMOs, vaccines, nutrition therapies, human consciousness. Obesity is a horrible thing that not just related to the health, but also to your appearance. It not only obstructs the urinary stream and causes associated hygiene issues but its sheer weight makes mobility difficult. Because of chronic skin infections and urinary obstruction he had been to the hospital numerous times. There are many large blood vessels that supply the abdominal pannus and intra- as well as postoperative bleeding is always a risk. In days before bariatric surgery, abdominal panniculectomy surgery was very common and it was almost always associated with morbid obesity. There has been some understandable reluctance to operate on such overweight patients due to the increased risk of complications that is known to occur . As a result, wound complications are common (and to be largely expected) and  revisits to the operating room for their management are not rare.
The abdominal pannus occurs exclusively in morbidly obese individuals or following substantial weight loss, most commonly bariatric surgery.
Citing that there is ‘insufficient scientific literature’ to support any benefit, these combined procedures are usually denied.
I have performed over the years numerous panniculectomies that were requested by an orthopedic surgeon to first be done before they would consider knee replacement surgery.
The wound edges in closing a panniculectomy are already compromised from chronic swelling and lymphedema in many cases. With an obese patient, panniculectomies were associated with high wound complication rates due to the size and depth of the cut outs. To be considered medically eligible for insurance coverage, there has to be very specific criteria that are met and a documented trail of medical records that substantiate symptoms related to the pannus. This does leave long scars but patients with these skin excess problems always feel that it is a good trade-off.
I have seen a few that hung well below the knee and one that hung down and rested on the floor. As bariatric surgery has helped patients lose a lot of weight, so has the size of abdominal pannuses decreased.
Specifically, skin irritations and rashes (known as panniculitis) resulted from the always present moisture and heat in the underlying skin fold. Since the panniculectomy procedure in the bariatric surgery patient  today weighs considerably less and often only involves improvement of an undesired contour, it is often called cosmetic by one’s health insurance. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. Adams was the first food science researcher to document high levels of tungsten in superfoods. It causes tremendous strain on the back and knees and leads to early deterioration of both. But despite his obvious need for a surgical solution, he stated that no one would take on his case because it was too dangerous or difficult. The operation needs to be performed as expeditiously as possible to get the patient off the operating room table as soon as possible. Because of bariatric surgery, the most common abdominal panniculectomy today is much smaller and is done after large amounts of weight loss.
The indications for surgery were typical including a large amount of overhanging abdominal skin and fat (hangs down to mid-thigh level) that was associated with underlying chronic skin infections, history of panniculitis, and the presence of a hernia.
This type of abdominal surgery should be confused in this regard with the more common tummy tuck.
Debate frequently ensues from the insurance company in the medical merits of removing Grade 1 and 2 types. How they can not easily see that such benefits  as improved surgical access and less risks for wound healing problems after surgery is a mystery to me. Apparently, the musculoskeletal problems that it causes by orthopedic specialists is not sufficient evidence for medical coverage.
Such surgical removals of abdominal  overhangs today await weight loss through bariatric surgery first, leaving a smaller pannus on a thinner person. Most importantly, photographs must demonstrate that the pannus hangs onto or below the groin creases.


The biggest complications from these procedures is a seroma or build-up of fluids which is why drains are needed for several weeks after surgery. My personal ‘record’ for an abdominal panniculectomy was a patient who weighted 715 pounds and a pannus that weighed 96 lbs. Most abdominal pannuses that I see today are in the bariatric surgery patient or someone that has lost over 100m lbs.
In some cases, the size of the pannus and its amount of overhang actually cut off some of the blood supply and lymphatic outflow resulting in swelling and infection. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. He also discovered over 11 ppm lead in imported mangosteen powder, and led an industry-wide voluntary agreement to limit heavy metals in rice protein products to low levels by July 1, 2015. When performing the operation as just an overnight stay, the patient must have few other medical problems and be motivated to get up and moving as soon as possible after surgery.
These pannuses are largely skin and the overall health of the patient is generally good since they are more weight appropriate for their height. Of the 26 patients, the mean pannus weight removed was over 15 kgs with a followup period of over a year. A CT scan done before surgery can help discover a hernia which can be very difficult if not impossible to pick up on a physical examination of a large pannus. Such concomitant coverage can be obtained if the documentation of skin problems is first obtained however. Removing these large pannuses required some clever intraoperative methods to hoost them up (known as the ‘china wall’) just to get underneath it to do the cutting.
Surgically removing the pannus was common then but the complication rate was high due to the patient’s obesity. And since it's from Apple, it also reads all your emails and forwards them to government spy agencies. Another problem caused by this thing is you feel so difficult to find the best dress for you. Without adequate written evidence of symptoms, these lower grade abdominal panniculectomies will be viewed as a cosmetic procedure.There is little question that a massive overhanging apron of fat and skin creates chronic and unremitting skin problems underneath it. Because of the magnitude of the abdominal wall resection, wound complications after large abdominal panniculectomies were the norm with fluid build-ups and problems with healing of the incision. Today, surgical removal of any abdominal overhang would await weight loss through bariatic surgery.
Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques.
If you live in United Kingdom, you have to provide money to pay the fat removal surgery cost that is about ?1,500 – ?5,000. For the out of town patient this means that they will have to get some medical care at home to get it removed. In addition to the need for enhanced personal hygiene (which is very difficult), treatment of these skin conditions may require antifungal creams and powders and occasionally antibiotics.
He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.
The rate of major complications, defined as those complications requiring a return to the operating room, was just over 10%. Get your iSuck today and get rid of all that belly fat!#2) Become infected by a zombie -- zombies are thin!Have you ever noticed that nearly all zombies are incredibly thin? This is one of the quickest ways to lose weight: find a zombie and let them bite you.Soon, you too will become an undead zombie, giving you incredible strength while shedding excess pounds at a pace you never thought possible! You will also be immune to pain and will never again have to use your brain, since it's been turned to mush.Of course, there is the down side that you won't be a conscious being anymore, but that actually makes you more popular and more qualified for a government job! It's painless!Once the fat is gone -- and hopefully before they get to the guts -- you are lifted out of the water and sewn back together by medical professionals. Plus, if anyone asks about the scars, you can tell them an awesome story about how you were a world-class surfer and almost got eaten by a shark. And then, of course, after it's all done you get to explain to them why their head is suddenly attached to a fat body. Drag them into the surgery center and prepare to eliminate all your body fat once and for all by swapping bodies!Please try to find someone who is roughly your same age. If you slap your old fat head on top of some young kid's body, the combination will terrorize all the children on the playground. It's great to appear thin, but for God's sake at least try to appear human.#6) The human dehydration machineEver notice how a grape looks much smaller when it's a raisin? Shaped like a coffin and running on standard household electricity, it can give you that amazing "raisin skin" look that's all the rage these days. Everybody loves raisin skin!NASA is also investigating the device for long-term space travel preservation of astronauts. So far, experiments are successful on the dehydration stage, but not so successful on the RE-hydration stage.
More volunteers and "interns" are needed!#7) Do a deal with the devilWord on the street is that the Devil is currently offering belly fat reduction magic in exchange for your soul.
Sign on the dotted line and you, too, can become a thin, supermodel-looking servant of Satan himself.The Devil will magically remove all your belly fat and have it implanted in Michael Moore. So everybody wins!It's not just the reduction of belly fat you get to enjoy, either: You also receive a free nip-and-tuck facelift to make you look even more demonic.This surgery has already been performed on Lady Gaga, and you can see it worked!
Janet Napolitano signed up for the procedure but the devil got so frightened by her that he refused to cooperate.#8) Accelerate all your friends toward the speed of light so that they gain mass, making you look thinner by comparisonAccording to Einstein's theory of general relativity, all objects gain mass as they approach the speed of light.
So the way this works is you round up all your friends, stuff them into a spaceship, launch them toward Alpha Centauri and kick in the engine afterburners.As they approach the speed of light, they will all gain enormous quantities of mass. As this happens, you can point your finger into space and laugh and them sardonically, repeating, "You're so MASSIVE! Ha ha!"Any of your friends who are not physicists will not get the joke, but what do they know, anyway?#9) The time machine methodBecause everybody in the world keeps getting fatter and fatter with time, if you rocket yourself forward in time a few hundred years, you will emerge looking totally thin compared to everyone else!Yes, it's the time machine method of (relative) weight loss!
You don't actually lose any weight, but it appears that you did, and that's all that really matters, right?"Fast Forward Time Machines" are currently available at CVS pharmacies, near the photo booths. Simply insert your credit card in the slot, use the keypad to enter the year you'd like to be sent to, then squeeze your body into the temporal vessel and press the "GO" button.Physics takes care of the rest, and when you re-emerge from the machine in the future, you'll be the thinnest person around! Have you ever noticed that aliens always grow in your torso and eat up all your belly fat before bursting out of your chest?During this hibernation time, you are awesomely thin!Just find an alien to inject an egg through your mouth, then wait for the fat-reducing action to begin! While you may notice some discomfort, it's all worth the new, improved you!Plus, you can tell all your friends, "Aliens ate my belly fat, and I didn't even have to do Pilates." They will be envious, which is the whole point, right?



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