Outcomes of Body Contouring Surgery After Bariatric Surgery vs. GLP-1 Receptor Agonist-Induced Weight Loss: A Propensity Score Matched Analysis.

BACKGROUND: Body contouring surgery (BCS) addresses excess skin following significant weight loss. While bariatric surgery has been the primary intervention for massive weight loss, the rise of GLP-1 receptor agonists (GLP-1 RAs) introduces a new patient population seeking BCS. Limited data exists on how GLP-1 RA-associated weight loss impacts BCS timing, procedure preferences, and complication rates. METHODS: This retrospective study used the TriNetX database to identify adults who underwent BCS following bariatric surgery or long-term GLP-1 RA therapy (≥6 prescriptions). Propensity score matching adjusted for differences in sex, age, comorbidities, and nutritional markers. Kaplan-Meier analysis evaluated the timing of BCS. Additional outcomes included differences in BCS location and complication rates between weight loss methods. RESULTS: Among those undergoing BCS, GLP-1 RA users more commonly underwent breast-focused procedures than post-bariatric patients (56.9% vs. 21.7%, OR 4.772, p<0.001), while post-bariatric patients more often received abdominal procedures (84.8% vs. 42.1%, OR 0.131, p<0.001). GLP-1 RA users had more variable BCS timing, with a greater proportion undergoing surgery within the first year of weight-loss therapy. Post-bariatric patients delayed BCS with a notable increase around 500 days post-surgery. GLP-1 RA users had lower intraoperative hemorrhage rates (0.07% vs. 0.74%, OR 0.09, p=0.021). Postoperative infection, wound dehiscence, and thromboembolic events were similar between cohorts. CONCLUSIONS: Reduced intraoperative bleeding during BCS suggests potential benefits from anti-inflammatory properties of GLP-1 RAs compared to bariatric surgery weight loss. Variability in BCS timing highlights the need for standardized guidelines to optimize patient outcomes as GLP-1 RA use continues to expand. LEVEL OF EVIDENCE III: 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 .