Postbariatric body contouring surgery has grown in prevalence, mirroring the ascent of weight loss surgery. With the rise in prevalence of this subset of plastic surgery procedures, we are gaining wisdom about technique, safety, and outcomes associated with this patient population. The pearls of patient management include discussion about characteristics specific to massive weight loss patients, patient preparation for surgery, intraoperative safety measures, markings, surgical options in a landscape of scars, management of the total body lift, volumetric augmentation, and postoperative care. The aim of this review is to share these pearls and pitfalls to assist in patient management and in optimization of outcomes.