Surgery is one of the most effective approaches for weight reduction, among the many treatment concepts for obesity and morbid obesity that with their complex symptoms and comorbidities have reached epidemic proportions. After successful weight loss, from the medical point of view, the therapeutic aim of this treatment option must be to restore the deformed integument to a normal shape to break through the vicious circle of psychosocial disintegration of the patient. This brings to mind a remark of my predecessor, Walter Deutschmann: “If he has in fact lost weight, he should be rewarded.” That means that the misshaped skin should be restored to a normal appearance.

If we have seen an enormous increase in conventional body-shaping operations since the turn of the millennium, in part due to the increase in life expectancy and/or affluence, this applies as well to postbariatric body shaping in the past decade. However in contrast to the aforementioned group, we are increasingly confronted with young people who do not count among the winners in the race for wealth. The deformities of the body surface vary and affect the entire body. With the disproportional distribution of deformities and differences in the degree of residual obesity, the situation upon presentation is highly individual, so that generalizations are only of limited usefulness. Each new patient requires individual answers that may be anything but routine, challenging even an experienced surgeon. There can be no doubt that plastic surgery is still in a learning process, but results from the USA indicate that regardless of their greater experience we are in good company.

So, it is time to have a look at the current situation from the points of view of the medical universities in Graz, Vienna, and Innsbruck, with special emphasis on complications and epidemiology. I am especially grateful to the authors who have contributed to this main topic, while at the same time I regret that due to limitations of space, we have not been able to include the valuable experience of other centers that are active in this field.