Removal of excess skin after massive weight loss: challenges and solutions

Figures & data

Table 1 National Institutes of Health (NIH) classification by body mass index (BMI)

BMI (kg/m^2)	Class
25–29.9	Overweight
30–34.9	Class I (low risk) obesity
35–39.9	Class II (medium risk) obesity
≥40	Class III (high risk) obesity

Table 2 Classification of morbid obesity

Type of obesity	BMI (kg/m^2)
Obesity	BMI >30
Severe obesity	BMI >35
Morbid obesity	BMI >40
Superobesity	BMI >50
Supersuperobesity	BMI >60

Abbreviation: BMI, body mass index.

Table 3 Pittsburgh weight loss deformity scale

Area	Scale	Definition
Arms	0	Normal
	1	Adiposity with good skin tone
	2	Loose, hanging skin without severe adiposity
	3	Loose, hanging skin with severe adiposity
Breasts	0	Normal
	1	Ptosis grade 1 or 2 or severe macromastia
	2	Ptosis grade 3, or moderate volume loss, or constricted
	3	Severe lateral roll and/or severe volume loss with laxity
Back	0	Normal
	1	Single fat roll or adiposity
	2	Multiple skin and fat rolls
	3	Ptosis of rolls
Abdomen	0	Normal
	1	Redundant skin with rhytides or moderate adiposity without overhang
	2	Overhanging pannus
	3	Multiple rolls or epigastric fullness
Flank	0	Normal
	1	Adiposity
	2	Rolls without ptosis
	3	Rolls with ptosis
Buttocks	0	Normal
	1	Mild to moderate adiposity and/or mild to moderate cellulite
	2	Severe adiposity and/or severe cellulite
	3	Skin folds
Mons	0	Normal
	1	Excessive adiposity
	2	Ptosis
	3	Significant overhanging below symphysis
Hips/lateral thigh	0	Normal
	1	Mild to moderate adiposity and/or mild to moderate cellulite
	2	Severe adiposity and/or severe cellulite
	3	Skin folds
Medial thigh	0	Normal
	1	Excessive adiposity
	2	Severe adiposity and/or severe cellulite
	3	Skin folds
Knees/lower thigh	0	Normal
	1	Adiposity
	2	Severe adiposity
	3	Skin folds

Figure 1 Brachioplasty.

Figure 2 Upper back lift.

Figure 3 Breast reshaping.

Figure 4 Abdominoplasty.

Figure 5 Panniculectomy.

Figure 6 Lower back lift.

Figure 7 Thigh lift.