I WOULD like to emphasize that my new method for surgical treatment of abdomina1 obesity must not be looked upon as one that comes to the aid of the woman who is unabIe through Iaziness or lack of determination to restrict her diet. Such persons are not my main concern. They are difficult patients who seek the surgeon’s heIp only because of vanity. On the other hand, such patients are aIso difficult to satisfy and I wouId Iike to warn surgeons who embark upon corrections of abdomina1 obesity to be carefu1 and consider in great detai1 each aspect of the condition before undertaking any surgica1 intervention. Up to date no technic exists which can give perfect cosmetic resuIts. Because the main object of these patients is the aesthetic appearance, they are bound to remain dissatisfied with the uItimate outcome of the operation; and the surgeon is heading for troubIe shouId he undertake the correction Iightheartedly. I cannot emphasize too strongIy the issue of the recent court proceedings in CaIifornia when a middIe-aged woman sued the plastic surgeon for dishguring her after an operation of this natur-and what is more surprising stiI1, the reward of $IOO,OOO to the patient. I personahy am of the opinion that such an unfortunate incident wouId never have arisen if the surgeon had carefuIIy considered the diffrcuIties of such an intervention and expIained in exact terms what the patient shouId expect from an operation of this kind. bear in mind three principa1 factors: (I ) functional disabirity which cannot be corrected by any other means than surgery; (2) exclusion of endocrine disorders or, if present, preIiminary treatment of the disease; (3) wiIIing and honest collaboration by the patient herseIf. When these three factors are we11 considered and the patient is toId that she cannot expect an aesthetically perfect resuIt other than be enabIed to become a norma person again, the surgeon is justified to undertake the operation. HistoricaIIy, correction of abdominal obesity is not a new technic. We have records dating from 1899 of such an operation being performed by KeIIy who even then distinguished two separate types of obesity. Kuester in 1926 produced a more detaiIed class&cation of abdomina1 obesity. One is known as diffuse abdomina1 obesity which as a ruIe is a part of genera1 adiposity. This usually comes to the attention of the physician as being due to endocrine disorders. Of interest to the surgeon is the type of obesity known as pendulous abdomen (venter propendens). This can be complicated with proIapse of the abdomina1 waI1 which appears either diffuse over the whoIe of the abdomen or is IocaIized around the midline. Not onIy femaIe patients suffer from abdomina1 obesity. The condition can aIso be seen in men although it is more pronounced in women and it is they who usuaIIy seek rehef. It is obvious, therefore, that my primary Etiology and Clinical Aspect. The etiolconcern is with the correction of abdomina1 ogy of Iocalized abdomina1 obesity is not obesity due to a disease and, furthermore, we11 known. Often endocrine dysfunction is when it not onIy disfigures the patient responsibIe but sometimes patients norma herself but aIso interferes with her norma in every other way are afhicted with it. physioIogic functions. Before undertaking Neither heredity nor racia1 factors pIay any the operation, however, the surgeon must roIe while the tendency is toward middle-