Abdominal panniculectomy addresses skin and fat excess, as well as laxity, and allows for the removal of previous scars, ulcers, chronic sinus, and foreign bodies present on the surface of the abdominal wall. It is associated with an increase in quality of life, and has a positive impact on patients’ physical, psychological, and social functioning. It is also associated with a significant reduction in postoperative hernia recurrence rates. The patterns of panniculectomy most commonly performed are (1) conventional, (2) limited, (3) vertical, (4) combined horizontal and vertical, and (5) circumferential. Smoking, obesity, uncontrolled diabetes, malnutrition, and hemorrhagic disorders are relative contraindications. The design of the incision is of paramount importance, and has to not interfere with stomas, not block the blood supply of the entire skin and the wound, and provide an appropriate aesthetic result. The degree of subcutaneous undermining has to be minimized to decrease the postoperative morbidity. Local complications of panniculectomy include surgical site infection, seroma, wound dehiscence, skin and fat necrosis, and hematoma. Liposuction, progressive-tension sutures, incisional negative-pressure wound therapy, multimodal analgesia, and thromboprophylaxis represent evolutions that maximize outcomes.