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Discover a New You With Plastic Surgery Post-Weight Loss With GLP-1 Medications

Patients who experience significant weight loss from GLP-1 agonists (such as semaglutide) often develop loose or sagging skin, decreased skin elasticity, and changes in body contour. Both surgical and non-surgical plastic surgery treatments can help restore body aesthetics and functionality.

Recent Research on Body Contouring Cosmetic Surgery Procedures After Massive Weight Loss

A recent article in the Aesthetic Surgery Journal by Lewis, JE, et. al. looked at complications in two groups of patients undergoing surgical procedures for body contouring.  One group had used semaglutide to achieve weight loss. The control group had not taken any of these medications. Both groups were composed of non-diabetics and were controlled for various variables to minimize the differences between the two groups. Their findings were quite informative. Those patients in the semaglutide group had a significantly higher incidence of complications following surgery.  These risks included wound separation (dehiscence), delayed wound healing, a higher infection rate, more post-surgical nausea and vomiting, a greater percentage of hypertrophic scars, and more post-operative pain. The authors postulated that some of this increased risk of complications was due to nutritional deficiencies and alterations in immune function.

The authors had several recommendations in their conclusions:

1. Stop the GLP-1 medication sufficiently prior to the surgery. They recommended 1-4 weeks, although a longer period might be better to regain immune function and restore proper nutritional status
2. Screening for nutritional deficiencies and supplementation as needed.
3. Breaking up the bariatric procedures into multiple smaller procedures rather than trying to perform all the needed procedures in one day.

At Rothaus Plastic Surgery, we concur with all 3 recommendations and have been following similar recommendations for our body contouring and massive weight loss patients for some time. We have recently been doing our body contouring as stage procedures under local anesthesia and have been able to treat patients’ abdomens, thighs, breasts, back, and buttocks in this manner.

An alternative approach we follow is to encourage the patients to consider and treat the changes to their skin and soft tissue throughout the GLP-1 journey as they lose weight. For these patients, treatment with a variety of devices and injectables might not only improve their skin during this period of rapid weight loss but might also obviate the need for, or at least, the magnitude of the required surgical procedures.  What are some of these surgical and non-surgical options?

Body Contouring Surgeries After Weight Loss

Body Lift (Circumferential Body Lift or Lower Body Lift)

• Purpose: Removes excess skin and fat around the waistline, abdomen, hips, and lower back.
• Procedure: An incision around the body (circumferential), removing excess skin and tightening underlying tissues.
• Downtime: Typically 3–6 weeks.
• Anesthesia: General
• Surgical Time: 4-8 hours

Abdominoplasty (Tummy Tuck)

• Purpose: Tightens abdominal muscles, removes excess abdominal skin.
• Procedure: Horizontal incision from hip to hip, removing loose skin and repairing muscle separation.
• Downtime: Usually about 3–4 weeks.
• Anesthesia: local with sedation, epidural, or general
• Surgical Times: 2-4  hours

Brachioplasty (Arm Lift)

• Purpose: Reduces excess skin and fat in the upper arms (“bat wings”).
• Procedure: Incision along inner arms or within the axilla to remove excess skin and tighten loose skin. Often accompanied by laser lipolysis in our practice.
• Downtime: Around 7-10 days
• Anesthesia: Tumescent, local with sedation, general
• Surgical time: 1 ½ to 2 hours

 Mastopexy (Breast Lift) or Reduction

• Purpose: Reshapes and lifts breasts that sag after weight loss.
• Procedure: Removes skin, reshapes tissue, raises nipple position.
• Downtime: 1 week of initial recovery.
• Anesthesia: local with or without sedation, general
• Surgical time: 2 – 3 hours

Thigh Lift

• Purpose: Removes excess skin and fat from inner and outer thighs. Often accompanied by laser lipolysis in our practice.
• Procedure: Incision placed in the groin or inner thigh, removing loose skin.
• Downtime: Around 2–4 weeks.
• Anesthesia: tumescent (local), local plus sedation, general
• Surgical time:  2 ½- 4 hours

Facelift and Neck Lift

• Purpose: Addresses loose skin in the face and neck.
• Procedure: Removes excess skin and tightens underlying tissues.
• Downtime: 4-5 days
• Anesthesia: Local with or without sedation
• Surgical time: 2-3 hours

Non-Surgical Body Contouring Procedure Options After Weight Loss

Radiofrequency Microneedling(RF) Skin Tightening (e.g., Virtue RF )

• Purpose: Stimulates collagen production, tightening loose or crepey skin on the face, neck, abdomen, arms, and thighs.
• Procedure: RF energy is delivered by needles to deeper skin and subcutaneous layers for skin and subcutaneous tissue remodeling.
• Downtime: Minimal to none, mild redness or swelling for 1–3 days.

Ultrasound-based Treatments (Sofwave)

• Purpose: Tightens skin on the face and neck as well as the body. It can treat cellulite as well.
• Procedure: Ultrasound energy stimulates collagen deep within the skin layers.
• Downtime: Little or no downtime.

Injectable Treatments

• Dermal fillers: Restore facial volume loss due to significant weight reduction.
• HyperDilute Radiesse and Sculptra (Poly-L-lactic acid): Gradually stimulates collagen, improving skin texture and restoring volume.
• Downtime: Usually, minimal to no downtime is necessary; minor swelling or bruising is possible.

Laser Skin Tightening and Resurfacing (Helix)

• Purpose: Tightens skin and improves skin tone, elasticity, and texture.
• Procedure: Lasers create controlled micro-injury, stimulating collagen regeneration and contraction.
• Downtime: Varies from mild redness (2–3 days) to 1–3 weeks for more aggressive treatments.

Diode, RF and EMS (e.g. Physiq and Physiq 360)

• Purpose: Reduces residual stubborn fat pockets that remain post-weight loss.
• Procedure: Controlled heating of fat cells, gradually removing them over several weeks, and toning of underlying muscle.
• Downtime: Minimal; minor discomfort

Next Steps and Scheduling a Consultation

• Consult a board-certified plastic surgeon to assess individual skin elasticity, amount of excess skin, health status, and aesthetic goals.
• Non-surgical methods are typically combined with surgical procedures for optimal outcomes.
• Ensuring stable weight (usually for at least 6–12 months post-weight loss) is important prior to surgery to maximize outcomes and longevity of results.

These options should be personalized based on the findings during the consultation, a patient’s specific needs, expectations, health condition, and lifestyle preferences. To get started, schedule a consultation today by calling our NYC office or messaging us via our online contact form.