The trade press has a new word for what patients want, and the word is restoration. Not a new face. The old one back.
I was asked recently to put numbers on what the GLP-1 wave has done to my practice. Here they are.
“About 30 percent of my patients involve a patient who has lost weight on GLP-1s. Before the GLP-1 era, my post-bariatric weight loss surgery practice was about 10 percent.”
Ten to thirty. In a few years. And the first thing that changed was not the operation I expected.
“The most common procedure after GLP-1 weight loss right now is a deep plane facelift, a deep neck lift, and/or an endoscopic deep plane facelift, also known as the ponytail lift. This is surprising, because in the post-bariatric patients the most common procedure was a lower body lift, which addressed the abdomen, the buttock and the thighs.”
The bariatric patient came for the body. The GLP-1 patient comes for the face. I have written about why; the short version is that the face is where a fast loss shows first and hides worst.
Now the obituary everyone keeps writing for the BBL.
“My BBL volume has not dropped in my practice. It’s still an essential part of almost every mommy makeover in order to shape the hip area and buttock area. We’ve seen a transition to less volume and more natural silhouettes, but it’s still in very high demand.”
“Augmentation-type work is still really untouched, because the weight loss patients also need augmentation of lost volume in the breast, buttock and face, whether it’s with implants or fat grafting.”
Weight loss does not respect the areas you liked. It takes from the cheek and the hip along with the waist. So the patient who “just wants the loose skin gone” almost always also needs something put back. Less of it than five years ago. Still put back.
Does the surgery cost more? A little, and for an honest reason.
“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.”
And the reason I push these patients toward one combined session rather than two.
“Combining multiple procedures does have its advantages, because the patient only has to recover once and take time off work once. It also has an economic advantage, because the first hour of surgery is the most expensive. That first hour is the one that pays for all the supplies, the medications, the preoperative time. So there is a cost savings component to it.”
Within a limit.
“The surgery length has to be predetermined to be safe, usually under six to eight hours.”
What has the wave changed inside my practice? Almost nothing, which I consider a feature.
“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.”
“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.”
Now the word. Restoration. The ASPS says the field has shifted from transformation to restoration, and here is where I agree and where I do not.
“The ASPS is describing a shift from transformation to restoration, and I do believe this is true, for some procedures and for some patients. For example, most rhinoplasty patients, which is one of the most common procedures that we perform, are looking for a transformation. They’re not trying to get back to something they were before; they want to optimize their facial aesthetics. I see the same thing with young patients seeking transformations in their face, their jawlines, their brows and their breasts. So I think young patients are still looking for transformation.”
“More mature patients, and weight loss patients, especially the GLP-1 patients, are looking for a type of restoration. I still feel that the overall majority of patients would like to obtain a better version of themselves, even a better version of themselves before they had their changes through weight loss, aging or pregnancy.”
Read that last sentence again. A better version of themselves than before the weight, the years or the pregnancies. That is not a return to a photograph. Nobody in my exam room wants the old face exactly. They want the old face, edited.
Where is this going?
“As the cost of GLP-1s has decreased, I’ve seen more patients on GLP-1s, more patients successfully losing weight and getting toward their ideal weight, and an increase in patients seeking correction of the loose skin and loss of volume. I foresee a continued increase in demand for these surgeries.”
Cheaper drugs, more goal weights, more loose skin. Retatrutide is next. Thirty percent is not the ceiling.
The full Q&A, with the table and every answer, is on the Southwest Plastic Surgery site. The surgical planning side, OR time and the two-week rule, is on agulloplasticsurgery.com.
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