NewBeauty gave it a name last week: the GLP-1 mommy makeover. The weight comes off on semaglutide or tirzepatide, the skin stays behind, and the next call is to a plastic surgeon for the tummy tuck, the lift and the BBL. I wasn’t quoted in the piece, so here is the part I’d have added, from the med spa side of my practice at Southwest Plastic Surgery, where a lot of these patients start.
The surgery is the last step. The skin has six to nine months of work to do first.
Why the skin does not know how you lost it
“Obviously the GLP-1s have changed everything, but weight loss has been happening for ages, with bariatric surgery or diet and exercise. 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. It depends on the amount of weight you lose, how fast you do it, and how you take care of yourself during that time. Are you taking protein? Are you doing weightlifting and building muscle?”
What the face does first
“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. That’s usually the first thing they notice in the early stages of the weight loss.”
“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, and there we have a combination. 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.”
What a moisturizer can do during the weight loss, and where it stops
“Topicals definitely have a place in weight loss. We’re having less fat consumption, and fat is an emollient that helps with barriers in the cell membranes. We’re taking less protein, which generates collagen. And we’re usually taking a lot less fluid, so we’re dehydrated. All three decrease the moisture in the skin, which makes it look older a lot quicker. The topicals have two functions: barrier and attracting moisture, and then the antioxidants, which keep the skin looking younger, and retinoids, which can speed up turnover.”
“You’re pretty honest about the topicals: it’s not going to remove the excess skin. But we have to do everything we can to make the process the best possible and to try to minimize how much surgery we’re going to need.”
“Skincare is part of any surgery I do. Even for a breast augmentation or a tummy tuck, I put my patients on a special moisturizer, because when there’s inflammation and recovery you lose that moisture, and that really hurts you in the end.”
More on this in skin care during weight loss.
The order I do things in
“I would start with the topicals early on to give the skin the foundation and help it recoil as much as possible. As we’re losing weight, the first thing patients notice is the face, usually at two months. That’s when we start using fillers or Sculptra and radiofrequency treatments like microneedling with radiofrequency for skin tightening, just to get them through to the later stages. If you’re losing 40 pounds, I think you’re going to need a surgical procedure.”
| Month on the medication | What I usually see | What we do at Southwest Plastic Surgery |
|---|---|---|
| Month 0 | The plan, the labs, protein and lifting set up | Medically supervised GLP-1 program, barrier moisturizer, retinoid at night |
| Month 2 | The face deflates first | Fillers, Sculptra or donor fat for volume; Morpheus8 Cool for the skin |
| Months 3 to 9 | Breast, buttock, arms and tummy loosen | Keep the skin moving: QuantumRF where the laxity is mild, protein, weights |
| Plateau plus 3 months | The weight stops moving | Surgical consult on the Agullo Plastic Surgery side |
What radiofrequency can and cannot do
Morpheus8 Cool and QuantumRF tighten skin that still has some elastin left in it. Here is where that ends:
“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. That doesn’t mean that in the future we may not have different tools. But as of this writing, that is the recommendation.”
“Younger patients are going to retract better. Everybody retracts some, probably not as much as we would want, and it’s also sooner than people think. It really happens in the early stages, and I think at a maximum of a year it’s all done.”
When it is time for the surgeon
“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.”
“You do have to stop the GLP-1 two weeks before surgery.”
“For the GLP-1, you can go back as soon as about five days.”
Why the weight has to stop moving first, how loose skin changes the operation, and what I use for the buttock when there is no fat left to graft are all in the full post on Agullo Plastic Surgery. My read on the trend itself is on drworldwide.com.
Why Choose Dr. Agullo
I am a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and a Clinical Associate Professor of plastic surgery at Texas Tech University Health Sciences Center. The weight-loss program, the skin treatments and the surgery are all under one roof in El Paso.
Ready to talk?
On a GLP-1 now? Then the skin work starts now.
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. Find me @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
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