A mother of 3 (including twins) in her early 40’s who is bothered by bulging and loose skin of her abdomen. She would like to be comfortable wearing fitted clothing. She is 4’10” and 124 lbs and is shown before and again, 1 year after an extended abdominoplasty. She has severe stretching of the abdominal wall from her pregnancies and her umbilicus is deviated to her right. I was moved back towards the midline using a “plumb-line” guide suture during the plication of the stretched abdominal muscles. An extended abdominoplasty extends the incision a little more laterally to give better contouring of the anterior lateral flanks. She has had an excellent correction of her abdominal contour and loves being able to wear fitted clothes and t shirts now.