Your patient lost weight on a GLP-1. Now they’re back with all new concerns. Here’s how to respond
Industry Buzz
It’s also important to recognize that patients who experience significant weight loss may face psychological challenges, including body dysmorphia. Identifying these concerns and setting realistic expectations is key to achieving a good outcome and avoiding dissatisfaction.
—Viktoryia Kazlouskaya, MD
I reframe the conversation: Fat loss and skin contraction are not the same biological process. GLP-1s are powerful, but they don’t rewrite skin elasticity... The key is helping them choose what matters more: tightness or scar burden? That tradeoff is the entire game.
—Gina Maccarone, MD
GLP-1 therapy produces rapid weight reduction. Many patients reach a weight range they have never experienced. What follows next are unexpected clinical issues for patients like body image, excess skin, and a whole new set of functional concerns.
A new—but different—body
Patients report difficulty adapting to a new body size. Ramtin Kassir, MD, a board-certified plastic surgeon, founder and CEO at Kassir Plastic Surgery, said, “GLP-1 weight loss often creates what I describe as a deflation effect. Patients lose volume first, and the skin does not always adapt accordingly. In the face, this can accelerate the appearance of aging, with patients often looking older rather than younger.”
Related: Patients are worrying about 'Ozempic breasts'Catherine Hannan, MD, a board-certified plastic surgeon from Washington, DC, tells MDLinx, “I do occasionally see patients with features consistent with body dysmorphia, but in this particular demographic it more commonly presents as overuse of GLP-1 medications. These patients may present with a BMI in the 17 to 19 range, which is not a healthy starting point for a cosmetic surgery journey.”
Some patients describe a persistent “obesity identity” despite weight normalization. Viktoryia Kazlouskaya, MD, dermatologist at the Circle PLLC, said, “It’s also important to recognize that patients who experience significant weight loss may face psychological challenges, including body dysmorphia. Identifying these concerns and setting realistic expectations is key to achieving a good outcome and avoiding dissatisfaction.”
Related: Patients with anorexia are misusing Ozempic prescriptions—but how are they getting the Rx?Managing complications of physical changes
Excess skin leads to intertrigo, hygiene issues, and physical discomfort.
As board-certified plastic surgeon Paul Pearce, MD, from Pearce Plastic Surgery, explains, “Folds of skin tend to trap moisture, and trapped moisture combined with body heat can increase the risk of infection. Rashes, abscesses, and fungal infections can all develop in patients with excess skin and poor hygiene.”
Related: Will GLP-1–associated weight loss drive demand for abdominoplasty?In selected cases, therefore, these symptoms support the medical necessity for surgery. Abdominoplasty done for clinical concerns may also qualify for insurance coverage, according to Ronald Rosso, MD, a plastic surgeon in the South Bay area of Los Angeles.
Counseling approach
It is best to use direct language in speaking to patients about how their body will change following weight loss. Before initiating GLP-1 therapy, explain that they should expect certain physical changes, and normalize the resulting loose skin as a biological consequence of weight loss.
Hygiene measures
Dr. Pearce says, “I discuss with my patients who have excess skin after GLP-1 weight loss that they need to keep the areas where skin folds over clean and dry. Showering daily with soap and water, along with thorough drying of the skin, can help decrease the risk of developing these issues.”
Frame surgery as one option, not a requirement
Gina Maccarone, MD, a triple board-certified cosmetic surgeon and founder of The Surgeonista, approaches counseling like this: “I reframe the conversation: Fat loss and skin contraction are not the same biological process. GLP-1s are powerful, but they don’t rewrite skin elasticity. I walk patients through the spectrum: time (some recoil improves), non-invasive options (often modest), and surgery (definitive but with scars). The key is helping them choose what matters more: tightness, or scar burden? That tradeoff is the entire game.”
For appropriate candidates, provide structured referral. Plastic surgeons with experience in post–weight-loss patients offer better outcomes.
Board-certified plastic surgeon Rachel Ford, MD, says, “During a consultation with a GLP-1 weight loss patient, I recommend maintaining a stable, goal weight for at least several months prior to surgery, ideally longer. Skin retracts to varying degrees after weight loss and differs from person to person.”
Non-surgical interventions
For patients unsuitable for surgery, emphasize non-surgical strategies, such as the following:
Exercise should be framed as a proactive option before weight loss sets in.
Resistance training improves muscle tone, but once laxity is set in, exercising won’t make much of a difference. Skin elasticity shows limited recovery but improves with gradual weight loss and time.
Dr. Ford adds, “Not everyone who loses weight with GLP-1 medications will require surgical body contouring. However, once the skin has retracted as much as possible and weight has stabilized, that is the appropriate time to evaluate whether surgery is indicated. I tell patients that there is no exercise that can tighten skin. While exercise is excellent for overall health, strength, and weight management, surgical excision remains the most effective option for removing significant excess skin.”
Maintaining nutritional status is just as important. Dr. Hannan adds, “I recommend they focus on optimizing protein intake and incorporating resistance training to build muscle mass, so that when they are ready for surgery, they can expect a safer and more straightforward recovery.”