GLP-1 Agonists in Body Contouring Surgery: What the Evidence Shows

Abstract

Study at a Glance

Study Snapshot

Study Facts Table

What Researchers Actually Did

Collaco and colleagues at the Division of Plastic Surgery, Mayo Clinic Jacksonville, searched PubMed, Embase, and the Cochrane Library through August 10, 2025, for studies comparing adults undergoing body contouring procedures with and without GLP-1 RA exposure. From 1,479 screened records, four studies met inclusion criteria: three retrospective cohorts and one prospective comparative study with historical controls. The combined population comprised 8,944 patients, the overwhelming majority of whom were female and predominantly in the obese BMI range. Semaglutide accounted for more than 99% of all GLP-1 RA prescriptions across included studies, driven largely by the Lewis et al. 2025 cohort, which enrolled 4,157 matched non-diabetic post-bariatric patients exclusively treated with semaglutide.

Binary outcomes were synthesized using Mantel-Haenszel random-effects models, with between-study heterogeneity further characterized via restricted maximum likelihood estimation and I² statistics. Risk of bias was assessed using ROBINS-I across seven domains. Leave-one-out sensitivity analyses were performed for outcomes with four contributing studies; outcomes with only three contributing studies were excluded from LOO analysis given interpretability constraints. Publication bias assessment was not performed, given the limited study count.

Key Findings: Primary Outcomes

• Wound dehiscence: Significantly higher in GLP-1 RA users on pooled analysis across all four studies (5.2% vs. 2.9%; RR 1.62; 95% CI 1.09–2.42; p=0.017; I²=0%). LOO sensitivity analysis removing Lewis et al. 2025 attenuated the effect to non-significance (RR 1.02; 95% CI 0.46–2.26).
• Seroma: No statistically significant difference across three studies (9.2% vs. 12.3%; RR 0.78; 95% CI 0.30–2.05; p=0.613; I²=62.7%).
• Hematoma: No statistically significant difference across three studies (4.6% vs. 2.6%; RR 1.74; 95% CI 0.72–4.24; p=0.220; I²=0%).
• Surgical site infection: No statistically significant difference across three studies (5.3% vs. 3.3%; RR 1.16; 95% CI 0.48–2.77; p=0.746; I²=65.6%).
• Composite SSO: No statistically significant difference across all four studies (13.9% vs. 9.2%; RR 1.31; 95% CI 0.90–1.90; p=0.164; I²=80.7%); heterogeneity was high throughout.

Key Findings: Secondary Outcomes and Subgroup Analyses

• Lewis et al. 2025 reported higher rates of nausea, vomiting, diarrhea, delayed wound healing, hypertrophic scars, and surgical site pain in GLP-1 RA users, and recommended cautious perioperative planning, potential drug discontinuation, and nutritional optimization. These secondary outcomes were not pooled across all studies due to inconsistent reporting.
• Koenig et al. 2025 restricted analysis to panniculectomy and reported lower wound dehiscence in GLP-1 RA users (1.2% vs. 2.4%), in contrast to Lewis et al. 2025.
• Liang et al. 2025 reported wound dehiscence rates of 8.3% (GLP-1 RA) vs. 7.0% (controls), with a longer mean discontinuation interval of 9.6 weeks (range 0–100 weeks).
• Albanese et al. 2025 was the only study to follow the ASA protocol, discontinuing GLP-1 therapy one week preoperatively.
• Formal subgroup analyses by procedure type, agent, dose, or discontinuation interval were not performed; the authors cite this as a key limitation.
• VTE events were infrequently reported and not pooled; no consistent differences were identified between groups.

Results: Adverse Events and Safety Profile

Gastrointestinal adverse events — nausea, vomiting, diarrhea — were reported as secondary outcomes by Lewis et al. 2025 at higher rates in GLP-1 RA users, but were not systematically captured or pooled across all four studies. Hypertrophic scarring and surgical site pain were also noted by Lewis et al. in GLP-1 RA users. The authors note that GLP-1 RAs may delay gastric emptying and increase aspiration risk during anesthesia, citing relevant anesthesiology guidance. Venous thromboembolism was infrequently reported and no consistent between-group differences were identified.

Statistical Approach and Rigor

The authors used Mantel-Haenszel random-effects models with REML for variance estimation, which is a defensible and commonly applied approach for heterogeneous observational data. I² was used as the primary heterogeneity metric, with pre-specified thresholds. LOO sensitivity analyses were correctly limited to outcomes with four contributing studies. The decision to forgo funnel plot and Egger’s test given the small number of studies is methodologically appropriate, though it leaves publication bias unquantified. Meta-analysis was conducted on event-level, unadjusted data because adjusted estimates were not consistently available across studies — a meaningful constraint that increases residual confounding in the pooled estimates. No formal assessment of small-study effects was performed.

Clinical Takeaway

Clinicians counseling patients on GLP-1 RA therapy who are pursuing body contouring procedures should be aware that the current pooled data suggest a possible but fragile signal for increased wound dehiscence. That signal is carried almost entirely by one large matched cohort of non-diabetic post-bariatric patients (Lewis et al. 2025), and disappears entirely in sensitivity analysis. No other wound-healing complication — seroma, hematoma, SSI, or composite SSO — reached statistical significance. The evidence is insufficient to mandate universal perioperative discontinuation, but coordination with anesthesiology and endocrinology, attention to nutritional status, and meticulous wound closure technique remain sound individualized management steps in the absence of higher-quality data.

Why This Matters Clinically

The intersection of GLP-1 RA use and body contouring surgery represents one of the most rapidly expanding clinical scenarios in plastic surgery. Millions of patients are losing weight on semaglutide and related agents and subsequently presenting for panniculectomy, abdominoplasty, brachioplasty, and thighplasty. Until this systematic review, no rigorous synthesis existed to guide clinicians. The findings do not establish that GLP-1 RAs are clearly unsafe in this setting, but they identify wound dehiscence as the outcome most plausibly affected — a complication associated with prolonged recovery, increased cost, reoperation, and impaired aesthetic outcomes. Equally relevant is what the data do not show: no consistent elevation in infection, seroma, hematoma, or overall SSOs. The heterogeneity across studies, the dominant influence of a single cohort, and the observational design of all included studies mean that confident perioperative guidance cannot yet be derived from this evidence base alone.

CED Clinical Relevance

At CED Clinic, patients commonly use GLP-1 receptor agonists for weight management, metabolic optimization, and as adjuncts to comprehensive cannabis-based and integrative care plans. When these patients are also pursuing or have undergone surgical procedures — including body contouring — the perioperative safety of their GLP-1 RA regimen becomes a direct concern. This review reinforces the importance of individualized preoperative assessment, nutritional screening, and interdisciplinary coordination with surgeons and anesthesiologists when GLP-1 RA therapy is part of a patient’s active medication regimen. The absence of a robust composite SSO signal is reassuring, but the wound dehiscence data warrants a specific conversation about wound monitoring and postoperative follow-up protocols.

Fits What We Already Know

This meta-analysis situates within a sparse but emerging literature. The authors cite Wilding et al. (NEJM 2021) establishing semaglutide’s weight-loss efficacy, and several prior case series and single-center reports on GLP-1 RAs in aesthetic contexts. The ASA consensus guidance on perioperative GLP-1 RA management, referenced by the authors, focuses primarily on aspiration risk from delayed gastric emptying, not wound healing. Prior work in other surgical specialties — including spinal fusion and total knee arthroplasty, cited by the authors — has suggested either neutral or beneficial effects of GLP-1 RAs on perioperative infection rates, which is consistent with the non-significant SSI finding here. A separate, non-included cohort by Khong et al. 2025 comparing GLP-1 RA users to post-bariatric patients without GLP-1 exposure found higher wound dehiscence and SSO rates in the bariatric group, suggesting that post-bariatric surgery status itself — not GLP-1 RA use — may be the primary driver of elevated complications in Lewis et al. 2025.

What This Study Teaches Us

In plain terms: using a GLP-1 medication like semaglutide around the time of a body-reshaping surgery does not clearly raise the overall risk of wound infections, fluid collections, or bleeding. There is a possible — but fragile — signal that wounds may be more likely to open up (dehisce) in patients on these medications, but that signal is almost entirely produced by a single large study, and vanishes when that study is removed from the analysis. The takeaway

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