Most general surgery, obstetrics and gynecology, oncology, urology, and other surgical procedures use abdominal incisions. Because of this, it is not uncommon to encounter patients with existing abdominal scars who come in for abdominoplasty and abdominal body sculpting. Although laparoscopic surgery has reduced the length of some common surgical scars, we often encounter large surgical scars that cross important areas of soft tissue blood flow. Fortunately, many of these existing scars are located in the area that will be resected during a standard abdominoplasty. Large scars that lie outside of the abdominoplasty resection area require careful analysis and modification of the standard abdominoplasty design. The presence of these scars should not be an absolute contraindication to abdominoplasty and abdominal body sculpting, but rather, careful planning can provide each patient with an individualized surgical design to reduce the rate of complications, especially ischemic necrosis; and to safely achieve optimal cosmetic results.