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The Body Lift Era: What the 2025 Global Numbers Say About the Weight Loss Patient

Black and white photograph of four women of different backgrounds in dark fitted clothing standing in a line against a dark studio wall, faces shown, lit by a single hard light. Illustrative image, not patients. Frank Agullo, MD, FACS.

Liposuction is the number one surgery in the world, and in 2025 it fell 11.4 percent. Upper body lifts rose 38 percent. Buttock lifts rose 39. Lower body lifts rose 22. Arm lifts rose 13. That is the International Society of Aesthetic Plastic Surgery’s survey of procedures performed in 2025, published at the end of September. It never mentions weight loss medication. It does not have to.

We used to only talk about massive weight loss after bariatric surgery, like a Roux-en-Y or a gastric sleeve. But nowadays, massive weight loss also happens with GLP-1s. There is a rapid amount of weight loss, and the loss of volume deflates the skin that was previously stretched out. This ultimately sags and creates contour irregularities.

The Fat Is Already Gone

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. So the body loses muscle mass plus the fatty content, and then we have the sagging in the buttock. Some patients have it in the inner thighs, the arms, the back. It’s a 360 thing. It’s the whole body, not just the tummy like most people expect.

Once the skin has been stretched out to a certain degree, it loses its elasticity and really doesn’t react to radiofrequency energy the same way healthy skin would. When the skin laxity is significant, the only option at this point is excisional.

What a Body Lift Actually Is

I think the gold standard for massive weight loss is usually performing an abdominal procedure, which entails a tummy tuck. But more often than not, because of the massive weight loss, this tummy tuck has to be extended circumferentially, so that we can lift the buttock and the lateral thigh, reduce the lower back, and fix the abdomen at the same time.

After a full consultation, we can determine whether you can undergo all the procedures at once, which usually entails an overnight stay and possible blood transfusion, versus breaking them up into parts. I think the most convenient way to break them up is to do the upper body, and then do the lower body.

The Part Nobody Posts

Body contouring surgery does entail surgical scars, but most of them can be hidden by normal clothing. The circumferential body lift can be hidden by swimwear or underwear. There are some procedures whose scars are a little harder to hide, like the arm lift, or brachioplasty.

Oftentimes the patients are willing to have these scars because of the amount of excess skin in these areas, and ultimately they will feel better in clothing than not doing anything at all.

The timing, the staging and the screening are in the full post on the Agullo Plastic Surgery site.

Why Me

Double board-certified, Mayo Clinic trained, Clinical Associate Professor of Plastic Surgery at Texas Tech, Castle Connolly Top Doctor 2014 through 2026. ISAPS says one surgeon in five performs an upper body lift. I am one of them.

Ready to Talk?

Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful

Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

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The Next Wave in Weight Loss

Woman in a long robe standing on a bathroom scale in window light, black and white

There is a molecule Americans search for hundreds of thousands of times a month that has not reached a pharmacy shelf. Not because it is banned. Because it has not finished the process.

What it actually is:

“Retatrutide is a triple hormone receptor agonist that targets three pathways: GLP-1, GIP and glucagon receptors.”

“At this time, there is no FDA-approved branded retatrutide product available.”

Where it sits in the family:

“The GLP-1 originally came out as a medication for diabetics. There are receptors in the stomach that make us feel full, and that same signaling helps lower blood sugar, which is how it helps diabetics control their sugar. It also communicates with the brain so your appetite goes down, you feel fuller and more satisfied, and it slows the intestine so your portions naturally get smaller. You eat the same way but smaller portions, and certain foods, like very greasy or very sugary foods, stop appealing to you.”

“Semaglutide was the first one and has just one component, GLP-1. Tirzepatide has two components, GLP-1 and GIP. It helps more with inflammation, helps with more weight loss, and has fewer side effects like nausea, heartburn, and vomiting.”

One receptor. Then two. Retatrutide makes three.

On how I dose the approved ones:

“We start with the smallest dose, which is 2.5 milligrams, for four weeks, and I see how you feel. If you are doing well I increase the dose depending on how you feel. If you are losing a good amount of weight, I keep you at that dose until you stop losing, then we go up again.”

“I give you the four injections for the whole month, and you inject yourself once a week. The injections are like an insulin shot, a tiny drop, usually in the abdomen, alternating sides each week.”

In trial, retatrutide started at 2 mg weekly and stepped up every four weeks.

Why the body fights you in the first place:

“As estrogen starts to drop, the other hormones start to change, the thyroid, insulin, and cortisol, and women tend to start gaining around the middle.”

“Insulin makes you very hungry and tired and causes you to store more fat. The metabolism slows down and cortisol rises, and that is part of why we gain weight.”

“Even if you exercise a lot and eat well, sometimes we need some kind of help.”

On whether the new molecule is the better choice:

“Retatrutide, being a triple agonist targeting GLP-1, GIP, and glucagon receptors, may offer greater weight loss potential than semaglutide and tirzepatide. Semaglutide is a GLP-1 receptor agonist, whereas tirzepatide is a dual GLP-1 and GIP receptor agonist.

“Patient selection should be individualized rather than based on one peptide. Patients with obesity or overweight accompanied by metabolic complications such as prediabetes, insulin resistance, metabolic dysfunction-associated fatty liver, or cardiometabolic risk factors may all be appropriate candidates for any of the GLP forms.”

May. That word is doing real work and I am not going to pretend otherwise. There is no completed head to head trial against tirzepatide.

Why anyone cares this much

Lilly published Phase 3 TRIUMPH-1 in May. At 80 weeks, participants on 12 mg had lost an average of 28.3 percent of their body weight, about 70 pounds. Forty five percent lost at least 30 percent. Two thirds finished with a BMI under 30. A smaller group who ran to 104 weeks averaged 30.3 percent, roughly 85 pounds.

I have spent my career operating on people after weight loss like that. Until recently the only reliable route to those numbers was a surgeon.

The results carried a cost. At the top dose, 42 percent nausea, one in eight reporting abnormal skin sensation, about one in nine quitting over side effects. The lowest dose studied delivered 19 percent weight loss with fewer dropouts than placebo, which tells you the ceiling is not the target for everyone.

Where it stands

Lilly hinted it might file with the FDA before the end of 2026. In July it moved that to the first quarter of 2027, citing manufacturing and quality control data still being assembled. Then the review clock starts.

On sourcing, which is the part that keeps me up:

“An important safety consideration with GLP-1 based therapies and other peptide treatments is the importance of ongoing evaluation, treatment, and follow-up by a qualified licensed medical professional. Patients should undergo appropriate screening before treatment.

“Appropriate clinical oversight and sourcing medication through legitimate, appropriately licensed pharmacies can also help reduce the risk of obtaining counterfeit, contaminated, improperly compounded or otherwise unsafe products from unverified sources.

“Patients should be educated to obtain their medications only through authorized and reputable channels and to avoid products purchased from unverified websites, social media, or any other unauthorized sellers.”

Unverified websites, social media, unauthorized sellers. That is where a great many of those searches end up, and there is no approved product waiting at the other end of any of them. I wrote recently about what the word peptide actually means and why I now ask every surgical patient what they have been injecting. Same problem, newer name.

What I tell people instead

The approved medications work. What I say to patients on them has not changed:

“Your appetite will go down. Many patients stop eating and only eat at mealtime, but I do not want you to do that, because if your blood sugar drops you will feel tired. I want you to eat small amounts during the day, snacking on something like a fruit, so your blood sugar stays more stable. I also want you to eat more protein so you do not lose as much muscle and we burn more fat.”

“Walk twenty to thirty minutes a day. Once you feel a little better, add light weights while you walk. That helps the muscle grow and burns more fat.”

A better obesity medication does appear to be coming. On the optimistic reading it is about a year from a pharmacy. Nothing about that timeline improves by buying a vial from someone who will not tell you where it came from.

For the full trial breakdown, dosing as it was studied, and what to do in the meantime, read the complete guide on the Southwest Plastic Surgery site. The version I wrote for my surgical patients is at agulloplasticsurgery.com, and body contouring after major weight loss is the surgical side of this story.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

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Breast Reduction, Off the Record: Relief, Real Limits, and the Weight Question

Black and white editorial portrait, soft studio light. Breast reduction commentary by Dr. Frank Agullo, MD, FACS.

Most of my patients do not cry in a consultation. The breast reduction ones sometimes do, and it is not sadness.

It is relief, arriving early. They have been carrying this for years. Back, neck, and shoulder pain. Grooves carved into the shoulders by bra straps. Breasts that just kept growing no matter what they did. And the first time someone tells them the pain is fixable, the weight does not have to stay, the body softens a little. I get it. This is one of the most satisfying operations I do, precisely because it solves a physical problem and not just a cosmetic one.

But it comes with honest limits, and I would rather hand them to you up front than have you discover them later. Here is the candid version, from real consultations, anonymized.

It Is a Lift as Much as a Reduction

People picture this operation as scooping volume out. It is more than that. You are getting a lift and a reduction in the same sitting.

The scars trace a familiar pattern: one around the areola, one running down from the areola to the fold, one along the fold itself. Working through them, I lift the breast up where it belongs and take tissue out, usually a few hundred grams a side for most women. Before any of that, a simulation lets you stand in front of a screen and see the smaller, lighter version of yourself, with less load hanging off your neck and back. That drop in weight is the thing that does the heavy lifting on your pain.

There Is a Ceiling, and Blood Supply Sets It

Here is the limit nobody wants to hear, so I will not dress it up. I cannot take out an unlimited amount.

The nipple and areola have to stay alive, which means they have to stay connected to their blood supply. Take too much and the blood does not reach the nipple, and that is a far worse outcome than landing a cup size above your dream. So I work within a safe middle ground and chase the most relief I can responsibly give you. For most women that is still dramatic, still life-changing. But if you came in picturing a very large chest shrunk to tiny in one operation, your anatomy may not cooperate, and I would rather say so to your face than pretend otherwise.

The Weight Question, Answered Straight

Patients ask me constantly whether they should drop weight first. The answer is often yes, and the reason is more interesting than most people expect.

A breast is built from two different tissues, glandular and fat, and they could not behave more differently from each other.

Tissue Type What It Does With Weight Loss
Fat tissue Shrinks; this is the part that responds to diet and weight loss
Glandular tissue Does not shrink with weight, and is sometimes still growing

If your BMI sits in the obese range, dropping weight first will help you feel lighter up top and can trim the breast a little. But if yours run mostly glandular, the scale barely touches their size, and that is precisely why surgery, not dieting, is the real answer for so many women. One more piece of timing advice: if you have a big weight-loss goal, get close to it before we operate. Reduce first, then shed a lot of weight, and things can sag all over again.

Yes, I Can Usually Do the Arms Too

This request comes up often, and the answer is usually yes. For arms I lean on liposuction with BodyTite to tighten the skin, frequently feathering it into the side of the chest and the back so you do not end up looking heavy on top once the breasts are smaller. Healthy skin responds beautifully, and the whole upper body finally reads as one result instead of a reduced chest bolted onto an unchanged frame.

The Two Risks I Never Skip Over

I put both of these on the table every single time.

The first is losing some nipple sensation. Under ten percent, but real. The second is more serious and far rarer: a small chance the nipple and areola do not get enough circulation, in which case some of that tissue can be lost. That one sits under one percent, very low, but you deserve to know it exists before you sign anything. I would rather you carry the small risks knowingly than be ambushed by them later.

“Will I Still Be Able to Breastfeed?”

You keep breast tissue connected to the nipple, so in theory it should remain possible. Here is the honest caveat, though. Even women who have never had a single operation do not always know in advance whether they can nurse, so I cannot hand you a clean percentage. What I can promise is that the connection is preserved, not cut.

The Credential Behind the Honesty

I am a double board-certified plastic surgeon, certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, with a plastic surgery fellowship from the Mayo Clinic. Breast reduction changes lives, but it has real anatomic limits, and I would rather you walk in understanding the trade-offs, the weight question, and the small risks than walk out surprised.

For the full patient walkthrough, see the breast reduction page at agulloplasticsurgery.com, and for the El Paso practice details and recovery support, see the version at swplasticsurgery.com. If a lift is more what you need, that lives on the breast lift page.

Ready to Talk?

If the weight of your breasts is wearing on your back and neck, relief is a real option, with honest limits attached. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.