This 39 year-old man lost over 450 lbs. by diet and exercise. He has significant loose, stretched, and sagging skin of the abdomen, hips, thighs (inner and outer), chest area, and upper back (flanks). He underwent outpatient circumferential beltlift at Minneapolis Plastic Surgery, and had 15.0 lbs. of excess skin and additional fat removed. Three months later he had inner thigh lift to complete the skin tightening of his legs. He is planning chest and flank skin removal next.