Carrying around folds of dense, heavy skin in your lower abdomen is not only uncomfortable, it's dangerous


    panniculus - n. a dense layer or fold of fatty growth, consisting of subcutaneous fat in the lower abdominal area that hangs down into or beyond the genital area, often causing extreme discomfort and infection, among other risks.

    What is panniculectomy surgery?

    During a panniculectomy, we surgically remove excess fat and skin that may hang down over the genital area and thighs. Known as the panniculus (and often incorrectly referred to as the panus), this hanging fat and skin often occurs among people who have lost massive amounts of weight after bariatric surgery or pregnancy. Although many people assume that hanging fat and skin in these areas is strictly a cosmetic problem, patients suffering from the condition know that this is far from the truth. Often, these hanging folds of skins are so heavy they cause back problems and skin chaffing, followed by rashes, cellulitis, and frequent ulcerations of the skin.

    How is a panniculectomy different than a tummy tuck?

    Although sometimes performed in conjunction with an abdominoplasty (or tummy tuck), panniculectomy surgery is a very different operation. First, a panniculectomy is typically considered a medically necessary reconstructive procedure to restore patient function while a tummy tuck falls within the plastic surgery category as an elective surgery performed with cosmetic intent. A panniculus sits below the abdomen, and typically begins to cause functional impairments as it gets larger and begins to hang around the hairline of the pubis. In the most extreme cases, it can hang past a patient's knees, causing severe discomfort and the inability to perform normal functions of daily living. During panniculectomy surgery, we remove the panniculus and restore a patient's ability to walk, sit more comfortably, and re-engage in normal daily activities.

    What causes a hanging panniculus?

    Generally, an overhanging panniculus is the result of extreme weight loss. It is seen most typically in patients who lose over 100 pounds because our skin does not retain elasticity and the ability to "shrink" when and if the fat underneath it does. Thus, when the underlying fat is lost, the skin begins to sag. Many times, patients desiring panniculus removal have previously had some form of bariatric surgery, but this is not always the case.

    Does insurance cover panniculectomy surgery?

    Most of our insured patients do receive a medical benefit for their panniculectomy surgery. We perform this reconstructive procedure with a goal of restoring function and the ability for a patient to resume their normal functions of daily living. In many instances, patients desire a more comprehensive procedure that extends into the cosmetic realm and goes beyond what is medically necessary. Most frequently, insurance coverage regarding panniculectomy surgery Involves the removal of hanging excess skin/fat in a transverse or vertical wedge but does not include muscle plication, neoumbilicoplasty or flap elevation.


    We are comfortable reviewing all options with patients to ensure you have the highest possible level of satisfaction after your surgery - from a clinical, functional, aesthetic, and financial perspective. Patients appreciate Dr. Bindewald's comprehensive explanations in a completely clinical, no-pressure environment. His goal with your panniculectomy surgery is to get you back on your feet, into the happiest and healthiest individual you can be.

    How satisfied are patients with their panniculectomy surgery?

    As with many conditions that severely affect both a patient's functional ability as well as their psyche, people who choose to undergo surgery to remove an overhanging panniculus are highly satisfied with their results, even given the complexity of the procedure and extensive recovery. A 2008 study in the Annals of Plastic Surgery reports an 81% satisfaction rate.


    RealSelf.com, a website dedicated to getting real comments from U.S. plastic surgery patients, calculates a 98% "worth it" rating, out of 262 patient votes. Patients report an overall improvement in their quality of life after panniculectomy surgery, and this type of surgery continues to grow in popularity.

  • Q&A with Dr. Matt Bindewald

    How long do I have to wait after bariatric surgery before getting a panniculectomy?

    Before scheduling panniculectomy surgery, we will want to make sure you have stayed at a stable weight for at least 6 months, and that it has been at least 18 months since any previous bariatric surgery.

  • Panniculectomy is typically considered a medically necessary procedure when all of the following conditions are met:

    • the panniculus hangs at or below the symphysis pubis (which is where your left and right pubic bones connect above your genitalia) - medical Grade 2 or higher
    • the panniculus is the primary cause of skin conditions that require but are not responsive to less invasive medical treatment
    • the patient is experiencing some type of functional impairment caused by the panniculus
    • the panniculus interferes with normal activities of daily living
    • Surgical removal of the panniculus is expected to resolve the functional impairment

  • Other Panniculi Facts

    Panniculectomy and abdominoplasty are the most common post-bariatric surgeries

    In 2015 there were 196,000 bariatric procedures performed and 50,165 body contouring procedures performed after massive weight loss, panniculectomy and abdominoplasty surgery being the most common. Why? Because most patients who experience extreme weight loss (regardless of whether or not it was the result of bariatric surgery), lose a significant amount of weight in the abdominal and lower abdominal regions. The excess hang from skin in this area can cause extreme discomfort and many medical problems.

    Grades of Abdominal Panniculi

    Similar to other medical diagnoses, abdominal panniculi is graded and classified by size, extent of hang, and level of severity. Getting an accurate diagnosis of your condition is essential in determining insurance coverage for surgical removal as well as the extent of surgery you may require. Abominal panniculi is categorized into 5 grades. Clinical studies have also recommended the addition of 3 Types, with an A and a B level within each Type to identify whether the panniculus is large and interferes (b) or is small and does not interfere (A) with a patients ability to perform normal activities. We have provided a simplistic model of an abdominal panniculi grading scale below.

    Patients overwhelmingly elect surgical intervention at Grade 2 and higher.

    Abdominal Panniculi Grading Scale

    Grade ||| Description ||| Severity

    1 ||| Panniculus barely covers the hairline of the pubic area but not the genitalia ||| mild to medium

    2 ||| Panniculus extends and covers the genitalia ||| mild to high

    3 ||| Panniculus extends and covers the upper thigh ||| high and extremely visible

    4 ||| Panniculus extends and covers the mid thigh ||| severe

    5 ||| Panniculus extends and covers the knees or beyond ||| severe

    What do you mean when you discuss a patient's ability to perform daily activities?

    Although every patient is different, we have to have some system to measure the extent, or degree, of affect that certain medical conditions have on patients. When a patient has a medical condition that precludes them from performing many of the "normal" functions of daily living, we typically find this a high risk to the patient and encourage medical intervention. In one of the more simplistic measurement models, activities of daily living include:

    • Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
    • Lifting or carrying groceries
    • Climbing several flights of stairs
    • Climbing one flight of stairs
    • Bending, kneeling, or stooping
    • Walking more than a mile
    • Walking several blocks
    • Walking one block
    • Bathing or dressing yourself
  • Contact Us Today

    Are you considering panniculectomy surgery? Dr. Matt Bindewald has extensive experience with panniculectomy surgery and is one of the few surgeons in San Antonio who perform this complex procedure. In fact, many physicians from all over Texas refer patients to Dr. Bindewald for his panniculectomy expertise. He is known for his attention to detail when planning the techniques and tools he will use during your surgery to achieve the best functional and aesthetic outcome for your unique situation.


    Dr. Bindewald's exacting techniques and artistry, combined with our transparency in pricing, has resulted in patients who are overwhelmingly pleased with their final outcome as well as their pocketbook. Most insurances cover panniculectomy surgery; our expert team will work extensively with both you and your insurance company to ensure we get all required pre-authorizations and fulfill any other necessary guidelines they may require.


    We accept and welcome patient questions both online and in person; Dr. Bindewald responds to all patient inquiries directly. Our HIPAA-compliant website and email ensures your utmost discretion and privacy when sending communication to our surgical team.


    Contact us online or schedule an appointment in our San Antonio office today. You can reach us at the phone number or email address listed below, through this web form, or schedule your own appointment via our online request form, which can be accessed here.

    7950 Floyd Curl Drive, Ste. 1009
    San Antonio, TX 78229
    Mon-Thurs, 8am-5pm
    Fri, 8am-12pm