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A 38 year old Hispanic female presents to your office requesting a “tummy tuck”. She says she expected her body to return to her usual habitus after the birth of her last child three years ago but is unhappy with her current physical appearence. She denies any medical conditions or taking any medications. Her past surgical history is significant for an emergency exploratory laparotomy for appendicitis 6 years prior to presentation. She developed no postoperative complications. She delivered her two children via spontaneous vaginal delivery. Her physical exam is remarkable for a BMI of 31kg/m2. Abdominal inspection reveals a 10-cm vertical scar extending from 2-cm below the

A 35 year old black female status post roux-en-y gastric bypass surgery 2 years ago presents to your office with a chief complaint of “sagging skin” secondary to massive weight loss. She has lost a total of 50% of her excess body weight. She has excess skin on her trunk, upper arms and thighs that causes her discomfort when walking and exercising. She is pleased with her weight loss, but embarrassed by the appearance of her skin. She says her low self-esteem and poor body image has discouraged her from dating and going out in public with her girlfriends. Her weight has been stable at 192 lbs. for the past three months.