GLP-1 Receptor Agonists in Aesthetic Surgery: A Narrative Review on Perioperative Safety, Sarcopenic Morphologies, and Adapted Body Contouring Strategies.

BACKGROUND

GLP-1 receptor agonists (GLP-1 RAs) are increasingly used for obesity and for weight management in individuals seeking aesthetic improvement. Their pharmacologic effects (delayed gastric emptying and reduced appetite) and the rapidity of weight loss may create perioperative and morphologic challenges for aesthetic and body contouring surgery.

METHODS

A targeted narrative review of perioperative safety considerations, body-composition studies, and aesthetic/body contouring literature relevant to GLP-1 RA users. Classical massive weight-loss (MWL) body contouring principles were integrated to develop a practical conceptual framework for surgeon-facing perioperative assessment and surgical planning.

RESULTS

Emerging evidence in aesthetic/body contouring cohorts signals higher wound complication rates in GLP-1 RA users, including increased wound dehiscence in semaglutide users versus matched controls (5.19% vs 2.78%). Perioperative data from mixed surgical populations suggest that some GLP-1 RA users may have retained gastric contents despite standard fasting, supporting individualized risk assessment, symptom screening, and multidisciplinary planning. GLP-1-associated weight loss may also coincide with clinically relevant lean-mass reductions, potentially influencing tissue quality and contouring strategy.

CONCLUSIONS

Aesthetic surgeons are encouraged to anticipate perioperative and morphologic implications of GLP-1 RAs, incorporate multidisciplinary, individualized perioperative planning in coordination with anesthesiology and institutional policies, and adapt timing and contouring strategies, while prospective aesthetic-specific data remain limited.

LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .