Ten years ago, the patient who had lost a great deal of weight and wanted surgery was a rare visitor at Southwest Plastic Surgery. Today, that patient is roughly one in three.
Dr. Frank Agullo was recently asked a set of questions about what the GLP-1 wave has done to a plastic surgery practice. His answers are below, in his own words, because the numbers are his and the patients are his.
How Big the Shift Is
What share of your consults today involve a patient who has lost weight on a GLP-1, and what was it before?
Dr. Agullo: “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.”
Three times the volume. And the operation those patients ask for first is not the one most people would guess.
What They Book Most
Which procedures do they book most?
Dr. Agullo: “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 face leads. The practice covered why in its face after weight loss post, and the body contouring after weight loss post covers the lower body side.
Has the GLP-1 wave changed your overall case mix, and has BBL volume dropped?
Dr. Agullo: “About 30 percent of the fraction of volume is now post-weight-loss work. 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.”
“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.”
| Before the GLP-1 era | Now |
|---|---|
| Post-weight-loss work about 10 percent of the practice | About 30 percent |
| Most common post-weight-loss procedure: lower body lift | Most common: deep plane facelift, deep neck lift, or the ponytail lift |
| Augmentation work: implants and fat grafting | Unchanged, because lost volume still needs replacing |
| BBL | Still in very high demand, less volume, more natural silhouettes |
What Changes in the Operating Room
The same procedure on a GLP-1 patient versus a patient who never lost major weight: how much more time, and what does that do to the price?
Dr. Agullo: “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.”
About an hour. More skin, more tissue, more time. That is the whole reason the number moves.
Why Combining Procedures Costs Less
How do you decide what goes in one session versus two, and what does combining save the patient?
Dr. Agullo: “Combining surgeries is very common in my practice, and of course safety is the number one priority. The surgery length has to be predetermined to be safe, usually under six to eight hours. Depending on the complexity and invasiveness of the procedures, an overnight stay and blood products on standby might be necessary.”
“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.”
One recovery. One block of time off work. One first hour instead of two.
What Has Not Changed
Have you changed anything in the practice because of this: pricing, scheduling, workup, staff?
Dr. Agullo: “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.”
Two weeks off the medication before surgery. Patients in the practice’s medically supervised GLP-1 program hear this early, so the surgery date and the medication schedule are planned together.
Are GLP-1 patients paying differently, or facing a “second bill” after the weight loss?
Dr. Agullo: “I see the makeup of the GLP-1 patients, in terms of how they pay for their surgeries, being very similar to any other person. I think most patients still finance their procedure through one of our lenders. 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.”
Stable weight first. Surgery second. That order protects the result and the budget.
Where Demand Is Headed
The price cuts on Wegovy and Ozempic and the self-pay tiers. What do you expect them to do to demand?
Dr. Agullo: “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 medication, more patients reaching goal, more loose skin to correct. The practice’s retatrutide post covers the next compound in the pipeline, and an upcoming post on the Everyday Health Saxenda feature covers how access and monitoring work in the clinic.
Restoration or Transformation
ASPS describes a shift from transformation to restoration. Is that what you see?
Dr. Agullo: “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.”
Why 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. Southwest Plastic Surgery runs the medically supervised GLP-1 program and the surgery that follows it under one roof.
Schedule a Consultation
Whether the weight loss is finished or still under way, the planning can start now. Call Southwest Plastic Surgery at (915) 590-7900, text 1-866-814-0038, or book at swplasticsurgery.com. #StayBeautiful
Find Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
