See? Safer.
The note that comes with the Newsweek headline of October 18. Good study. Nothing changes.
The Numbers, Without the Headline
UTHealth Houston. 2,028,601 elective inpatient operations, Epic Cosmos, 2016 to 2024, American Society of Anesthesiologists meeting this month. The 145,610 on a GLP-1: 11 percent lower odds of a major cardiac event (1.0 percent against 1.1), 8 percent lower odds of infection (4.9 against 5.3). Observational. No last-dose date. Nothing on aspiration.
My read: the weight came off first, and the gut still works.
“We also see that GLP-1 patients are healthier than bariatric patients, because bariatric patients also have the nutritional deficit; we’re taking out intestinal parts that absorb nutrients. So the complications are lower and the healing is better.”
“There are unique risks in this population, and the post-bariatric patients are still at higher risk for wound complications than the GLP-1 patients. This has been seen in recent studies, and it’s not surprising, because the bariatric patients do have more nutritional deficiencies, and they often have a much higher percentage of body weight loss.”
Healthier than 60 pounds ago. Safer. Not the same as ready.
The Two Weeks
“Our practice really hasn’t changed because of the increase in GLP-1 weight loss patients. We still do our complete workup and consultation prior to surgery. The financing is done in the same terms. I think the most important thing with GLP-1 patients is to stop the GLP-1 medication two weeks prior to surgery. Otherwise, it’s like any other patient, with the same high-grade attention to detail.”
A GLP-1 slows the stomach. That is the mechanism, not a side effect. A full stomach under anesthesia is how people aspirate; the anesthesia societies said a one-week hold in 2023, case by case in 2024. I hold two weeks. My nurse gives the second reason better than I do:
“I’m gonna need for you to stop taking it 2 weeks before the surgery and 2 weeks after. The reason why, they slow down your intestinal motility, as well as the surgery, and we do need for you to have bowel movements right after surgery.”
Nobody writes a headline about the first bowel movement after a tummy tuck. Everybody who has had one remembers it.
“Everybody’s expecting the midsection to get smaller and to have some skin laxity there. We know a lot about it, because pregnancy is the number one reason we do tummy tucks, and weight loss has been a big reason as well, both bariatric and GLP-1 and even diet and exercise. The skin envelope has been stretched out. It’s lost those connections with elastin, and you can’t make any new elastin. Once you deflate, just like a balloon, the outside wrinkles. We’re going to get some contracture, it’s just not as much as we would want.”
Three Months at the Same Weight
“With GLP-1s, it’s a little bit less clear, because the weight loss usually happens in a period between three to nine months, sometimes a year. But the patients seem to plateau a little bit quicker, and they seem to be ready a little bit faster after they plateau, usually about three months.”
“The most important thing is for the patient to be stable at their weight. If they continue to lose, or go up and down, they may need more procedures in the future.”
Not safety. Geometry. I remove the skin that exists on the day of surgery; thirty pounds later there is new skin and I did not get a vote. More: body contouring after GLP-1 weight loss, the BMI read.
The operation itself is different too:
“For a massive weight loss patient, the traditional tummy tuck or breast lift or buttock lift may take a little bit longer, maybe an hour, because there is a lot more skin and tissue to be removed versus a patient that has not lost weight. Of course, more time in the OR and anesthesia can increase the overall cost of the surgery. The difference is usually going to be in the two to three thousand dollar range.”
“So we have to look at the protein levels and protein intake before the surgery. And another thing we like to look at is the hemoglobin levels, to make sure the patient’s not anemic.”
The Bounce Back
“The timing is shorter now with the GLP-1s, but it’s still cooking. We don’t know exactly how it’s going to work. And the main thing is not to bounce back. When you stop taking it, if we have a bounce back, that can pretty much destroy everything we did, and the fat is not going to come back in the right places necessarily.”
“I don’t think there’s a huge health hazard or urgency. With the weight loss you got healthier. If you gain it back, some of your other problems might come back, like blood pressure or glucose intolerance. But the skin will keep stretching.”
Four weeks off is not a bounce back. Quitting with no plan is. The study measured weeks. I am measuring the next thirty years.
The consult version is on agulloplasticsurgery.com, the face while the scale moves is on the Southwest Plastic Surgery post, and one in three is how these consults took over my week.
Why Choose Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026.
Ready to Talk?
Safer is a word for a headline. Ready is a word for a consult. Bring the drug, the dose and the date, and we will figure out which one you are.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
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