Background: Abdominoplasty represents one of the most frequently performed aesthetic procedures worldwide, with particular challenges in post-weight loss patients. This systematic review examines the incidence, risk factors, and management strategies for complications following abdominoplasty in this specific patient population. Methods: A comprehensive literature search was conducted across PubMed, MEDLINE, Embase, and Cochrane databases from January 2000 to March 2024. Studies reporting complication rates following abdominoplasty in post-weight loss patients were included. Meta-analysis was performed where appropriate data was available. Results: Analysis of 42 studies comprising 24,861 patients revealed local complication rates of 10-20% and systemic complication rates below 1%. Seroma formation represented the most prevalent local complication (23.6%), followed by infection (13.9%), bleeding (11.1%), and hematoma (6.9%). Patients with BMI >30 kg/m² demonstrated significantly higher complication rates (15.2%) compared to non-obese patients (7.3%). Scarpa fascia preservation significantly reduced seroma occurrence (9.4% vs 26.2%, p = 0.011). Progressive tension sutures virtually eliminated seroma formation (0.1% incidence) compared to traditional rates of 5-43%. Conclusions: Post-weight loss abdominoplasty carries substantial complication risks that vary with patient characteristics and surgical techniques. Obesity, smoking, diabetes, and extended operative times represent primary predictors of adverse outcomes. Technical modifications including Scarpa fascia preservation and progressive tension sutures significantly improve outcomes. Comprehensive preoperative risk assessment and tailored surgical approaches optimize results in this challenging patient population.