This patient in her upper 40’s lost nearly 150 pounds after a gastric sleeve procedure. She was left with severe abdominal laxity and excess skin causing rashes and painful skin tears under her pannus. Here she is 4 months after a functional lower abdominal panniculectomy combined with additional removal of a vertical wedge in the midline for a “ fleur-de-lis” pattern of tissue removal. This allows for additional tightening not only in the traditional pulling down fashion, but also narrows the waist and pulls laxity in from the sides. Her scars remain pink at only 4 months postop but will fade significantly and be fairly faint by 1 year after her surgery.