Bariatric surgery remains the treatment of choice for the extremely obese patient, with an exponential growth in the number of procedures performed in response to the obesity epidemic. There are a variety of bariatric procedures available, which differ according to the method in which they achieve sustained weight loss. Plastic surgeons are beginning to see large numbers of patients who have undergone bariatric surgery and who have sustained massive weight loss (MWL) for evaluation of complex and lengthy-body contouring procedures. Proper evaluation of the patient who has sustained MWL requires an understanding of the physiologic impact of different bariatric procedures with particular knowledge of potential long-term nutritional complications.