The operation is performed through an incision along the lower abdomen, just above the pubic hairline. The length of incision depends on the size of the problem and may extend from one hipbone to the other. Another small circular incision is made around the belly button, which is left attached on a stalk to the abdominal wall. The skin and fat are then freed up to the rib cage. The abdominal muscles are revealed and pulled by stitching them together along the mid line. This achieves a flatter, firmer abdomen, better waist and longer lasting result. The excess skin and fat is removed, and the remaining skin and fat is pulled down as a flap and stitched to the lower end of the incision. This usually requires the patient to be flexed at the hips at the time of the operation. Stretch marks and old scars in the lower part of the abdomen will be removed during the course of the surgery, but all of these may not be gone. The belly button is brought out through a small incision, and stitched to the skin, in its new position. Drains are left beneath the skin flap for up to 48 hours following the operation. In some cases, if needed, fat may be removed from the flanks using liposuction. The only stitches to be removed are around the belly button, in one week. The main wound is sutured with buried absorbable material.