Hi Alvin, thanks for your question. An incision is made in the lower abdomen and a W-shaped scar is made. To deal with the large amount of extra skin, after massive weight loss, vertical incisions are added to the belly. The skin of the belly is then lifted, exposing the muscles. The belly button (umbilicus) is protected, and the skin is lifted all the way to the ribs and to the bottom of the breastbone, with most if not all of the skin between the belly button and the pubis – removed. The rectus muscles are sewn together, a cut is made in the skin and the belly button is popped through. Two drains are placed. The wound is closed, usually in two layers, with a deep layer of dissolving stitches and a superficial layer of stitches.