This operation is performed to ‘tidy up’ folds of skin on the back, particularly in the lumbar area, after considerable or massive weight loss.

Done under a general anaesthetic (asleep), it involves making an incision across the upper back, in the brastrap line for women, extending into each armpit. The whole of the back skin below this is then surgically separated from the underlying muscle down to the lower lumbar area. After significant bleeding has been stopped, the skin is pulled firmly upwards and all the excess is removed. The new cut edge is then repaired in line with the original incision, generally with dissolvable stitches.

It is usual to spend 2 to 3 nights in hospital before resting at home and strenuous activity should be avoided for at least 4 weeks. Athough clear fluid will sometimes continue to accumulate under the skin for several weeks after surgery and to require tapping off from time to time on an outpatient basis, the trade-off is a much smoother back at the expense of the bra-line scar (see photos).