Body contouring of massive weight loss patients is the latest frontier in plastic surgery. It is important to become familiar with the presentation of these patients and with the delineation and effective treatment of their deformities. Because they usually present with circumferential excess, circumferential belt lipectomy treats their truncal contour as a unit. This article details the preoperative work-up, intraoperative technique, and postoperative course for the belt-lipectomy patient. Results and how to predict them are discussed. Complications are enumerated and suggestions offered for avoiding them.