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Panniculectomy
Panniculectomy
After losing a significant amount of weight, many patients are left with a fold of loose skin and tissue that hangs over the lower abdomen. This is called a pannus, and no amount of diet or exercise will remove it. A panniculectomy is the surgical procedure that does. Combined, our surgeons have spent over four decades patients finish what their weight loss started.
Recognized as body contouring specialists, Dr. James Koehler and Dr. Vincent Gardner are some of the top cosmetic surgeons in the Mobile-Pensacola metro area. Eastern Shore Cosmetic Surgery offers a wide range of plastic surgery procedures for both men and women, and we are known for our caring commitment to a patient-first approach while achieving absolutely excellent results.
Are You a Candidate?
A pannus is excess skin and the subcutaneous tissue on the abdomen, stretched out over years of carrying additional weight and left behind once that weight is gone. Skin has a limited ability to contract, and after major weight loss, particularly loss of 75 pounds or more, it usually cannot. The fold that remains is permanent without surgery.
For most patients this is not only about appearance. A pannus that hangs over the pubic area traps moisture and heat against the skin. Patients describe:
- Persistent rashes, irritation, or open sores in the fold that return no matter what is applied to them
- Recurring skin infections requiring repeated courses of treatment
- Difficulty keeping the area clean and dry
- Clothing that does not fit despite reaching a goal weight
- Interference with walking, exercise, and intimacy
A panniculectomy removes the overhanging apron of skin and tissue from the lower abdomen. Unlike a tummy tuck, it does not tighten the abdominal muscles underneath and it does not narrow or reshape the waist.
The Procedure
A panniculectomy is performed under general anesthesia. The incision is horizontal and placed low on the abdomen, positioned to sit below the waistband of most clothing. In patients with a very large pannus, a vertical component is sometimes needed as well, which is discussed in detail beforehand so there are no surprises.
The overhanging wedge of skin and tissue is removed, drains are placed to prevent fluid collection, and the incision is closed in layers. Surgery generally takes two to four hours depending on the volume of tissue removed and whether other procedures are performed at the same time.
Most patients go home the same day. Some stay one night, particularly when the panniculectomy is combined with additional procedures.
After GLP-1 Weight Loss
Weight loss on semaglutide, tirzepatide, and similar medications produces the same loose skin that bariatric surgery does, and often faster, because the weight comes off quickly and the skin has even less time to respond.
The surgical options are identical. What differs is the conversation about maintenance. Because GLP-1 weight loss can reverse if the medication is stopped, we talk candidly about your plan for holding your weight before scheduling surgery. Regaining significant weight afterward will affect the result, and that is worth knowing in advance rather than discovering later.
If you are just beginning your weight loss journey, our medically supervised weight loss program is worth a closer look. With additional support and guidance, you can have the healthiest and safest possible experience in reaching your goal weight.
Panniculectomy Recovery
After surgery, drains are typically in place for one to two weeks. A compression garment is worn for roughly six weeks. Most patients with desk jobs return to work at two to three weeks, and to unrestricted activity including exercise at around six weeks.
Swelling continues to settle for several months, and the incision continues to fade for a year or longer. Your specific timeline depends on how much tissue was removed and whether other procedures were performed at the same time. You will be given written instructions and seen for follow-up throughout.
We are excited to offer Pro-Nox pain relief that can be added to any of the in-office procedures we perform. Pro-Nox is an inhaled analgesic that gives our patients 100% control through self-administration. Get short-term pain, anxiety, and stress relief without having to “go under.”
Dr. Koehler
Educated at the University of Alabama and in practice for over 20 years, Dr. Koehler is a board-certified cosmetic surgeon who is devoted to providing exceptional results.
Dr. Gardner
A triple-board-certified surgeon specializing in both cosmetic and venous procedures, Dr. Gardner brings a depth of expertise, compassion, and innovation to our practice.
Your Source for Cosmetic Surgery
After Weight Loss
Patients after major weight loss rarely have a concern confined to one area. Loose skin commonly affects the abdomen, the arms, the thighs, the breasts, and the face at the same time. Combining procedures in a single operation means one anesthetic and one recovery instead of several.
Whether that is appropriate depends on your health, the total operative time, and what you are trying to accomplish. It is one of the main things we will discuss at your consultation.
You can learn more about all the after weight loss plastic surgery procedures we perform on our site, and we will provide more details on the procedures that could make sense for you following your consultation appointment.
Panniculectomy FAQs
What is the difference between a panniculectomy and a tummy tuck?
A panniculectomy removes the overhanging apron of skin and tissue from the lower abdomen. It does not tighten the abdominal muscles underneath and it does not contour the waistline. A tummy tuck, or abdominoplasty, removes excess skin and also repairs separated abdominal muscles and reshapes the waist. Panniculectomy addresses the overhang. Abdominoplasty addresses the shape. Many patients after major weight loss are candidates for both, and the two are often performed together.
Does insurance cover a panniculectomy?
Sometimes. Insurers may classify a panniculectomy as reconstructive rather than cosmetic when the pannus causes a documented medical problem. Criteria vary by carrier but commonly include a pannus that hangs to or below the pubic area, recurring rashes or skin infections in the fold that have not resolved after several months of medical treatment, clinical photographs, and a period of stable weight following bariatric surgery or major weight loss. Eastern Shore Cosmetic Surgery does not file insurance claims. We are a self-pay practice. We will provide the operative report and supporting documentation you need to submit a claim to your own insurer for possible out-of-network reimbursement.
How long after bariatric surgery can I have a panniculectomy?
Most patients are ready once their weight has been stable for roughly six to twelve months, which for bariatric patients is usually twelve to eighteen months after their weight loss procedure. Operating before weight has stabilized risks a result that changes as the body continues to change. Nutritional status also matters after bariatric surgery, and lab work is reviewed during your consultation.
Will a panniculectomy make my stomach flat?
Not by itself. A panniculectomy removes the overhanging fold. It does not tighten the abdominal wall or narrow the waist, so some patients still have looseness or fullness in the upper abdomen afterward. Patients who want a flatter, more contoured result are usually looking at a tummy tuck, or at a panniculectomy combined with muscle repair. Your surgeon will tell you honestly which procedure matches the result you are describing.
What is recovery like after a panniculectomy?
Most patients go home the same day or after one night. Drains are usually in place for one to two weeks and a compression garment is worn for about six weeks. Desk work is typically possible at two to three weeks, and unrestricted activity including exercise at around six weeks. Swelling continues to settle for several months. Your specific timeline depends on the extent of tissue removed and whether other procedures were performed at the same time.
How much does a panniculectomy cost?
Cost depends on the extent of the procedure, whether it is combined with other surgery, anesthesia, and facility time, so a meaningful number requires an in-person evaluation. We provide a written quote at your consultation, and financing options are available. Because we are a self-pay practice, the quoted price is what you pay, with no surprise billing afterward.
Do both surgeons perform panniculectomy?
Both Dr. James Koehler and Dr. Vincent Gardner perform body contouring after major weight loss. Which surgeon you see can be discussed when you schedule, and either will give you a direct assessment of whether a panniculectomy, an abdominoplasty, or a combination is the right procedure for your situation.
Contact us online using the “Message us” feature at the bottom of our website or you can call us at 251-929-7850 to learn more about our practice or to schedule your consultation.
Written By: Dr. James Koehler
A board-certified cosmetic surgeon in Fairhope, AL, Dr. James Koehler earned his MD from the University of Alabama and completed several post-doctoral residencies, internships and fellowships. He returned to Alabama to be closer to family and serve patients in the local community with a full range of cosmetic surgery procedures for the face, breast and body.
More about Dr. James Koehler | Last Reviewed: September 16th, 2026
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