The demand for body contouring procedures is on the rise worldwide, especially in the United States (US), where over a third of the population is obese. Approximately 10% of Americans are eligible for weight loss surgery, with around 256,000 undergoing bariatric surgery annually. While weight loss surgery is highly effective for improving overall health, it often results in excess skin around the lower trunk, creating a deflated appearance. Postpregnancy changes can also lead to a similar aesthetic. The presence of redundant skin folds can lead to dermatitis, hygiene issues, infections, and clothing and physical activity challenges. Moreover, excess skin and fat can contribute to psychosocial concerns, commonly alleviated through body contouring procedures. Following the trend, there has been a consistent increase in the demand for body contouring procedures. In 2020 alone, American surgeons performed 46,577 such procedures on individuals who had undergone significant weight loss.[2] While traditional abdominoplasty, or "tummy tuck," has been the go-to option for addressing excess skin around the lower trunk in massive weight loss patients, it often falls short in addressing issues like flank and back rolls, leading to less-than-desirable cosmetic outcomes. Consequently, belt lipectomy is preferred for a more comprehensive lower body contouring solution.[4] Removing excess skin and fat from the abdomen dates back to the early 1800s when it was primarily used for wound coverage, with little attention paid to scar placement or the resulting body contour. The first documented panniculectomy, then known as "dermolipectomy," took place in 1890 in France by Demars and Marx. French surgeons later refined the technique to include procedures that preserved the umbilicus. The US saw its first reported cases of abdominal contouring and cosmetic abdominoplasty in 1899, performed by Kelly and a team of gynecologists at Johns Hopkins in Baltimore. In 1924, Thorek conducted what is believed to be the first umbilicus-preserving abdominoplasty, using a low transverse incision and umbilical transposition. The belt lipectomy, introduced by Somalo from Argentina in 1940, marked a significant advancement in body contouring procedures. In 1991, Dr Lockwood introduced the lateral tension abdominoplasty, emphasizing crucial concepts for successful trunk contouring, such as the superficial fascial system (SFS). Body contouring of the lower trunk encompasses various procedures that serve distinct purposes. A belt lipectomy, also known as circumferential body lift, lower body lift, or torsoplasty, involves the removal of excess skin and fat around the lower trunk to enhance contour and reduce skin laxity. This comprehensive procedure often includes formal abdominoplasty, a "tummy tuck," which entails extensive undermining through the epigastric region, relocation of the umbilicus, and rectus diastasis plication. Belt lipectomy may be coded as an additional procedure alongside abdominoplasty or panniculectomy. Both belt lipectomy and abdominoplasty are typically considered cosmetic surgeries. Conversely, panniculectomy focuses solely on removing the panniculus (excess skin and fat) without relocating the umbilicus or extensive undermining. This procedure is often medically necessary to alleviate symptoms such as intertriginous rash or functional issues. Due to this medical necessity, panniculectomy may be covered by insurance. The distinction between cosmetic and medically necessary procedures often results in insurance companies not covering belt lipectomy and abdominoplasty, while panniculectomy stands a better chance of being covered. In cases where a patient desires both cosmetic improvement and medical necessity, it may be appropriate to discuss insurance billing for panniculectomy while opting for self-payment to cover the additional surgeon's fee and operating room time required to complete the belt lipectomy.