This is a 41 year-old female with a history of a laparoscopic sleeve gastrectomy two years ago with over eighty pounds weight loss and a symptomatic ventral hernia contained in a large pannus. The hernia, just above the pubic symphysis, contained both small and large bowel. A two-team approach was planned for a panniculectomy with plastic surgery and concomitant ventral hernia repair with general surgery. Pre-operative images demonstrate the hernia and markings for the surgery. The plastic surgery team began with a low transverse incision. A large lipocutaneous flap was elevated and dissected off the hernia sac using a combination of blunt and sharp techniques minimizing the cranial limit of the flap to avoid excessive devascularization of the abdominal wall. General surgery then incised the hernia sac, ensured viability of sac contents, dissected the sac off the abdominal wall, excised the sac and reduced its contents into the abdomen. An intraperitoneal onlay mesh (polypropylene mesh with a hydrogel barrier) was placed through the fascial defect which was primarily closed followed by laparoscopic tacking of the mesh to the abdominal wall using a double crown technique with absorbable tacks. Plastics then completed a large panniculectomy which was extended above the umbilicus and then closed in layers. The patient did well after surgery, was hospitalized for two days, had no complications, and demonstrated a very substantial improvement of the abdomen following removal of the large pannus and hernia repair.