Beyond Skin Laxity: GLP-1 Receptor Agonist-Induced Lean Mass Depletion and Surgical Tissue Quality in Aesthetic Surgery: A Narrative Review.

The aesthetic surgery literature on GLP-1 receptor agonists (GLP-1 RAs) has focused predominantly on facial volume depletion and perioperative anesthetic risk. Less attention has been paid to lean soft tissue changes accompanying rapid GLP-1-induced weight loss. For procedures dependent on structural tissue quality-superficial musculoaponeurotic system robustness in facelift, fascial integrity in abdominoplasty, and adipose viability in fat grafting-this is clinically relevant and underexamined. The aim of this study was to characterize GLP-1 RA-associated lean mass loss, distinguish it from age-related sarcopenia, examine the surgical domains where tissue-quality effects are most plausible, and propose a preoperative framework and research agenda. Narrative review combining GLP-1 RA trial body composition data with mechanistic and surgical outcome literature. A targeted literature search was performed using PubMed, Embase, and Web of Science (inception to March 2026). Direct outcome data in GLP-1 RA aesthetic surgery patients are limited to 2 case reports and 1 small cohort; surgical implications remain inferential. Lean soft tissue loss comprising ∼25% to 30% of total weight lost is consistently reported across GLP-1 RA trials. This loss is pharmacologically distinct from age-related sarcopenia, occurring with reduced systemic inflammation and potential reversibility. Current evidence does not support modifying surgical technique in GLP-1 RA patients as a class. Increasing prevalence mandates that surgeons consider body composition-not simply weight-preoperatively. A subgroup with rapid weight loss, inadequate protein intake, and absent resistance training may warrant structured preoperative consideration. For fat grafting, cessation timing and metabolic rebound represent bidirectional uncertainties requiring prospective investigation. Level of Evidence: 5 (Therapeutic).