This is a petite 39-year-old mother of 3 who presented with a very large rectus diastasis, dense central stretch marks, and very thin attenuated skin of the abdomen. The patient was made aware during her consultation that her preoperative soft tissues were compromised and that she may require mesh to reinforce the abdominal wall repair; one just below the umbilicus at the site of a previous tubal ligation, and two above the umbilicus. The hernia contents consisted of pre-peritoneal fat and this was imbricated into the abdominal wall and the facial defects were repaired. During surgery, I removed 262 grams of excess skin and tissue to achieve the results seen here in photos taken at her 1 year follow up appointment.