Morbidly obese patients may present with abdominal pannus overlying not only the pubis but also the knees. This large quantity of skin is symptomatic with pain, rashes, cellulitis, lymphedema, and/or osteoarthritis aggravation. This procedure should be reserved for individuals who have demonstrated efforts toward weight loss and fitness, but who are hindered by the symptomatic pannus. These patients are challenging surgical patients at risk for venous thromboembolism, blood loss, hypothermia, and wound healing problems.