A significant increase in bariatric procedures has led to success in maintaining long-term weight loss. The increasing population of patients who have lost massive amounts of weight also has led to a growing responsibility placed on body-contouring surgeons to perform safe and cautious procedures in this inherently difficult patient population. We stratify risk groups and present several case reports and a systematic review of safety precautions. The risks and complications of body contouring can be minimized by a team approach with a meticulous attention to patient evaluation, preoperative planning, safe detailed operative measures, and thorough postoperative care.