This informative article, which kicks off this excellent edition of Clinics in Plastic Surgery, provides a sensible and balanced review of when, why and what to do with the massive weight loss patient group. The recommended wisdom will be familiar to a lot of bari-plastic surgical teams across the UK. Timing of body contouring surgery should be a minimum of one year from bariatric surgery, with weight stability for at least three months. BMI should be less than 30, unless for functional / physical indications. Medical comorbidities should be formally reviewed and optimised prior to surgery, and special consideration given to deep vein thrombosis / pulmonary embolism (DVT / PE) risks. Nutritional assessment of this patient group is imperative; formal review by the bariatric team including nutritionist / dietician with protein intake, supplements, micronutrients and physical condition all required. An assessment of the patient’s psychosocial status is mandatory; with the standard aesthetic case approach plus review of support networks and professional optimisation of formal psychiatric conditions. The case for combined / multiple procedures is discussed, commonly used combinations stated, along with the disadvantages. This is a great summary of the issues involved in the assessment of massive weight loss patients, ideal for surgeons new to this area and for those close to exams!