Plastic Surgery in the Ozempidemic: Considerations for the Timing of Body Contouring Surgery in Patients with Semaglutide-Associated Weight Loss.

BACKGROUND: Many patients seek body contouring surgery (BCS) to address excess skin following significant weight loss (WL), including from GLP-1 receptor agonists such as semaglutide. Optimal BCS timing is crucial, as postoperative weight fluctuations can distort outcomes. While weight stabilizes 12-18 months after bariatric surgery, the timeline for semaglutide-associated WL is less clear, particularly with weight recurrence (WR) after drug discontinuation METHODS: A systematic review of MEDLINE, Embase, Web of Science, and PubMed was performed. Randomized controlled trials (RCTs) and prospective observational studies measuring weight change over time with semaglutide use were included. Time to weight loss plateau (WLP), defined as ≥1 month with WL <3%, was calculated. WR, defined as ≥25% WL regained, was calculated for studies including drug discontinuation, and meta-analysis was performed RESULTS: Of 555 studies, 12 met inclusion criteria (n=13,947 patients). WLP occurred at 53.0±8.2 weeks at 16% (±3.1%) WL, deviating from greatest on-treatment WL by 2% (±0.7%) and end-of-treatment WL by 1% (±1.2%). Two studies assessed WR following drug discontinuation. WR occurred at 12 weeks and 24 weeks post-discontinuation. By the end of the observation period, participants regained 62.7 and 74.3% of greatest on-treatment WL, respectively CONCLUSION: This systematic review and meta-analysis suggests weight stabilizes after 8-12 months of semaglutide use, at which time BCS may be appropriate. This timeline is slightly earlier than post-bariatric surgery. However, given initial data indicating weight recurrence exceeding 50% after drug discontinuation, surgeons should approach BCS cautiously until further research clarifies the impact of WR on surgical outcomes. NO LEVEL ASSIGNED: 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 .