49 year old male who underwent gastric sleeve surgery in 2016 and subsequently lost 190 pounds. At the time of his consult in 2018, the patient had a large abdominal panniculus and his weight had been stable for more than 6 months. He also suffered from skin rashes under the skin fold beneath the panniculus. He underwent a panniculectomy in 2018 and a total of 19,413 grams of skin and tissue was removed from his abdomen (43lbs). The patient will require a second surgery after he has lost additional weight.