As the popularity of GLP-1 agonists for weight loss surges, we explore strategies for providers to successfully integrate these medications into their services, address potential side effects, and enhance overall aesthetic outcomes through complementary treatments
Aesthetic practices worldwide have likely encountered people on or asking about glucagon-like peptide-1 (GLP‑1) agonists, such as exenatide, liraglutide, dulaglutide, semaglutide and tirzepatide.
Increasing research, popular news stories and social media have elevated these medicines to mighty multitaskers, capable of helping people shed pounds, reduce cardiovascular risks, control glucose, and so much more. But while these medications could offer health in a pill, like most drugs, they have side effects, sometimes no efficacy, and might do more harm than good for those who take them.
Recent research1 examining the drugs’ benefits and risks found: ‘Compared to usual care, GLP-1RA use was associated with a reduced risk of substance use and psychotic disorders, seizures, neurocognitive disorders (including Alzheimer’s disease and dementia), coagulation disorders, cardiometabolic disorders, infectious illnesses and several respiratory conditions. There was an increased risk of gastrointestinal disorders, hypotension, syncope, arthritic disorders, nephrolithiasis, interstitial nephritis and drug-induced pancreatitis associated with GLP-1RA use compared to usual care.’
Weight loss wins
Johnny Franco, MD, a plastic surgeon in Austin, Texas, US, knows the power of GLP-1 agonists personally and professionally. He started taking the medicine in 2022 and lost 90 pounds in the first year. He has since stabilised but chooses to stay on the medicine, potentially for heart health benefits.
After experiencing what GLP-1 agonists could do for him, Dr Franco started offering the medicines to patients and, today, he sees about 1,500 weight loss patients a month at his plastic surgery practice.
Key to success #1: Commit
‘You really have to make a decision that this is going to be part of your practice, and you are going to be involved in it,’ Dr Franco told PRIME.
Knowledge about the benefits and drawbacks of GLP-1 agonists is in its infancy. Aesthetic practices need a physician champion or other provider who understands the data, available medications and investigational drugs, as well as how to safely and optimally help patients along their weight loss journeys, according to Dr Franco.
Patients also have to commit, planning to be on the medication for at least 6 months, according to Dr. Franco. Additionally, experts say this is not for the patient who wants to be on a GLP-1 agonist to lose a quick five or ten pounds.
‘The medication has been so impactful because it can actually change an individual’s relationship with food. It has for me, personally,’ Dr Franco said.
Key to success #2: Learn best practices
Sometimes it is better for patients when providers don’t adhere to GLP-1 agonist manufacturers’ dosing regimens, according to Dr Franco.
‘Now we realise that we don’t necessarily need to keep pushing people up on dosage just because they hit a timeframe,’ he said. ‘This is where we have seen a lot of patients being sick, having nausea. Like most medications, we just want to get them to an effective dose.’
Some believe that patients have to be sick with side effects for the drugs to be effective. That is simply not true, according to Dr. Franco. Rather, patients experiencing side effects might be in the small percentage of people who cannot tolerate GLP-1 agonists or might need a reduced dose adjustment, he said.
Key to success #3: Prepare for an uptick in demand for core services
When used for weight loss, GLP-1 agonists, like Wegovy (semaglutide, Novo Nordisk), can result in undesirable aesthetic effects, such as facial volume depletion and skin laxity. Because of this, they are typically combined with treatments like dermal fillers and body contouring procedures (such as cryolipolysis, high-intensity focused ultrasound (HIFU), and radiofrequency (RF)) to address these concerns and optimise overall aesthetic outcomes, according to Diala Haykal, MD, a cosmetic doctor and laser expert in private practice at the Centre Laser Palaiseau, Palaiseau, France.
‘A commonly favoured approach is to pair dermal fillers (hyaluronic acid, poly-l-lactic acid (PLLA)) for volume restoration with energy-based devices … like RF or HIFU for skin tightening. This combination addresses both volume loss and skin laxity, which are significant post-weight loss concerns, providing patients with a more comprehensive and long-lasting rejuvenation,’ said Dr. Haykal, author of the recent paper, The Role of GLP-1 Agonists in Esthetic Medicine: Exploring the Impact of Semaglutide on Body Contouring and Skin Health.
Aesthetic practitioners should be aware of these changes and anticipate the need for comprehensive interventions to address facial and body concerns. Monitoring psychological impacts, such as body image dissatisfaction or emotional distress, is important, Dr Haykal noted.
Nearly half of the members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) reported a noticeable rise in patients seeking procedures to mitigate the cosmetic effects of these medications, according to the AAFPRS 2024 Annual Trends Survey2.
Demand for Dr Franco’s core services, including surgical and nonsurgical options, has risen thanks to GLP-1 agonists.
‘It has changed our practice. We see so many more excisional surgeries than we did before and in very young patients,’ he said. ‘Facelifts have gone up, circumferential body lifts, thigh lifts.’
Key to success #4: Beware, GLP-1 agonists are associated with suboptimal outcomes
Timing is crucial in optimising aesthetic outcomes for patients taking GLP-1s. Many recommend that providers begin nonsurgical treatments, like dermal fillers and RF, after weight loss stabilisation — ideally once the weight is maintained for 3 to 6 months, Dr Haykal told PRIME.
‘Injectables such as dermal fillers should be performed once the patient’s weight is stable, but in some cases, early intervention may help reduce complications. Using biostimulatory agents (like calcium hydroxylapatite (CaHA) or PLLA) could be started in the earlier phases of weight loss to help stimulate collagen production,’ Dr Haykal said. ‘Body contouring procedures like cryolipolysis or HIFU may be initiated when the patient has achieved a significant portion of their weight loss but before the skin has begun to sag severely. Timing these procedures around the weight loss phase helps prevent further skin laxity.’
Patrick Byrne, MD, MBA, facial plastic and reconstructive surgeon and president of AAFPRS, told PRIME that based on his experience, both significant weight gain and significant weight loss can negatively impact the long-term results of facelifting and neck lifting procedures.
‘Small weight fluctuations don’t typically make much of a difference, but when patients gain or lose more than 10 to 15 pounds, an initially excellent surgical result may start to lose some of its effect over time,’ Dr Byrne said. ‘For any facial fat grafting procedures, I would be cautious about performing them on patients still actively losing weight, as their facial fat distribution is still changing. Similarly, minimally invasive skin-tightening treatments may not provide the desired long-term results if significant weight loss continues.’
Plastic and cosmetic surgeons should also be aware of surgical complications that can arise in patients taking weight loss medications. Italian plastic surgeons authored a paper3 of two case reports that showed delayed wound healing and fat necrosis in patients undergoing breast surgery while receiving GLP-1 receptor agonists for weight management. These complications, they wrote, had not been previously described in the literature.
New York City-based facial plastic surgeon Jennifer Levine, MD, said cosmetic surgery plays an important role in the effective treatment of skin laxity.
‘Whether patients are having general anaesthesia or even sedation, the risk of aspiration can increase on the medication, which is why we have the patient stop the medication [2 to 4 weeks] before the surgery,’ said Dr Levine, adding she keeps many off the medication for 6 weeks post-op.
More research needs to be done to determine whether poor healing in some surgical patients is a direct result of the medication or because patients on the medication can become nutritionally depleted.
Dr Levine reasoned that suboptimal outcomes might also occur in nonsurgical patients who are nutritionally deficient.
Key to success #5: Look holistically to achieve the best outcomes
Dr Haykal and coauthors wrote that a holistic approach addressing physical and psychological outcomes is critical to ensuring patient satisfaction and long-term well-being.
Physical exercise, particularly weightlifting, can play a significant role in improving muscle tone and skin elasticity, especially when combined with weight loss medications like GLP-1 agonists. Weightlifting helps build muscle mass, which can prevent excessive sagging of the skin, especially in areas like the arms, abdomen, and thighs, according to Dr Haykal.
‘Nutritional support is equally important, focusing on protein-rich foods to support muscle maintenance and collagen production (which can be supported by supplements like vitamin C, amino acids, and omega-3 fatty acids). Offering advice on micronutrition and the role of supplements can complement aesthetic interventions, particularly when considering the accelerated ageing process due to rapid weight loss,’ Dr Haykal said.
Dr Levine added that the goal is for patients to be healthy and stay healthy.
‘We have the Inbody scan in our office that lets you know how much fat you have, muscle distribution and how much visceral fat. We monitor that on a monthly basis. If the patient is losing muscle, we take steps to make sure they maintain their muscle mass,’ Dr Levine said.
For patients who might not lift enough weight to improve muscle mass, Dr Levine offers treatment with the Emsculpt NEO (Body By BTL), which can help them maintain muscle in the trunk, pelvis or buttocks.
In the big picture of aesthetic medicine, these drugs are a useful tool that work effectively. But they’re not for every patient who wants to lose weight.
‘You have to be judicious in your use of GLP-1 agonists in practice, and you have to use them responsibly,’ Dr Levine concluded.
Written by Lisette Hilton, contributing editor
