While the treatment of patients by skin reduction following massive weight loss is increasing, the conclusions of this study from the Netherlands finds that the Pittsburgh Rating Scale is not entirely suitable for this classification purpose and another system must be found. Another classification that I am relieved to be allowed to forget. 

Classification of contour deformities after massive weight loss: The applicability of the Pittsburgh Rating Scale in The Netherlands.
Van der Beek ESJ, Verveld CJ, van Ramshorst B, et al.
JOURNAL OF PLASTIC, RECONSTRUCTIVE & AESTHETIC SURGERY
2013;66:1039-44.
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