Marc McKee lost 126 pounds on Mounjaro. Two years in, he still had questions about his skin. So he asked me all of them, on camera, for 28 minutes.
The episode went live this week on his podcast, This Is My Journey. It is the GLP-1 show out of the UK that people on these medications actually listen to, because Marc is one of them.
Watch it here, then read on for what we got into.
The line Marc could not stop thinking about
He opened with something I had said before, and asked me to explain it. The skin doesn’t know you lost the weight the healthy way.
“It’s true, the skin doesn’t know how you did it. Patients lose the weight, the envelope stays, and some patients feel ashamed of it, like they did something wrong. That’s not the fact. It’s just the way things work. Skin stops producing elastin after puberty, so it just doesn’t contract like it does during puberty.”
“You shouldn’t feel bad if you have excess skin. It’s part of losing weight, and everybody’s different. Even with pregnancy, some women spring right back and it looks like nothing ever happened, and some don’t.”
That is the whole episode in two answers. The rest is detail.
Why the face goes first
Marc wanted the deflation story for the whole body, not just the tummy. Here is the part that surprises people.
“The biggest surprise patients see is the change in their face. The face doesn’t have a lot of fat, but the fat it does have is the good fat, the baby fat, what makes you look young. In the face you see the loss of the fat under the eyes, the temporal areas, temporal wasting, the buccal fat. We see the face just melt down because it’s lost all that volume.”
I wrote a full post on that face last week, what deflation does and why the fix is fat. The episode is the spoken version.
And it is not only the face.
“The breast loses its fat content, and this is for both men and women, which is also surprising. You suddenly have saggy breasts, and that can affect a lot of patients mentally. The same thing happens in the buttock area. A lot of these patients losing weight fast are not taking in enough protein, so they’re also losing muscle. About a quarter of the weight loss is going to be muscle mass.”
“It’s a 360 thing. It’s the whole body, not just the tummy like most people expect.”
The timing question, answered out loud
This is the question I get in every consult now, and Marc asked it plainly. How stable does the weight need to be?
“We had everything standardized for bariatric surgery. They would lose weight for a year or a year and a half, stabilize, and then we would wait six months. With GLP-1s, patients are losing the weight a lot faster, getting to goal faster, and plateauing faster. What I’ve been seeing is about a six to nine month weight loss and then about a three month stabilization until we’re ready for surgery.”
“If you’re losing 40 pounds, I think you’re going to need a surgical procedure.”
And the one thing that undoes all of it:
“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.”
What the before-and-after photo leaves out
Near the end Marc asked what before-and-after culture online hides. I have opinions.
“I would stay away from anybody that has one or two or three amazing before and afters and that’s it. You want to see a surgeon that’s posting before and afters every day, and they’re all consistent.”
“The before and after doesn’t tell the whole story. It doesn’t tell you about the patient’s psychology, if they’re happy or not. It doesn’t tell you about the recovery, everything they had to go through, or any complications there could have been. The before and after is a quick fast-forward through all of that.”
Who should watch
Anyone on a GLP-1 who has started to notice their face before their waistline. Anyone at goal weight wondering whether the skin will tighten on its own if they wait. And anyone whose family keeps saying “you look great” while they are quietly avoiding mirrors.
Marc is 37, two years in, and still on the road. He asked the questions the way a patient asks them. I answered the way I do in the exam room.
Why me, and why this show
I am a double board-certified plastic surgeon, Mayo Clinic fellowship trained, and a Clinical Associate Professor of Plastic Surgery at Texas Tech’s Paul L. Foster School of Medicine. Massive weight loss surgery has been part of my practice since before the pen existed. Marc built This Is My Journey for people who could not find straight answers, and that is the same reason I started filming surgery in 2014. We were always going to get along.
Watch the episode, then send me the question he did not ask.
Ready to talk?
If you have lost the weight and want a surgeon’s read on the skin, call (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.