The Ozempic boom is turning into a gold mine for plastic surgeons

Patients taking Wegovy, Zepbound and other new weight-loss drugs are finding that after losing about 25kg, their skin sags over their stomachs, arms and buttocks. In the face and chest, the loss of elasticity can make someone look much older than they actually are or give a hollowed-out appearance that’s been dubbed “Ozempic face”.

This has turned into a gold mine for plastic surgeons.  

From 2022 to 2023, there was an 8% increase in face lifts, likely fuelled by people who have taken weight-loss shots, according to a report from the American Society of Plastic Surgeons published on Tuesday. The group, which represents 92% of board-certified plastic surgeons in the US, also found that tummy tucks and lower body lifts increased 5%. Arm lifts, thigh lifts and breast lifts were also up, according to the report. 

Following weight loss, “all of those people potentially are going to have issues with how they look afterwards,” said Steven Williams, president of the American Society of Plastic Surgeons who is based in Dublin, California.

And the number of weight-loss drug users is only expected to rise as more options become available. Eli Lilly & Co.’s Zepbound, for example, only launched in December, so many of these patients may not have been captured in the ASPS report. 

Also read: The rise of Ozempic: how surprise discoveries and lizard venom led to a new class of weight-loss drugs

As more of the estimated millions of people taking GLP-1 weight-loss shots from Eli Lilly and Novo Nordisk A/S or copycat drugs sold by companies like Hims & Hers Health begin to consider plastic surgery, doctors are now faced with ethical questions. What happens if these patients continue to lose weight — or gain it all back?

It’s clear that many of the people who laid out more than $1,000 a month for weight-loss drugs are also prepared to spend time fine-tuning their bodies after shedding the weight. Few of these reshaping operations are covered by insurance, and a full-body makeover can cost upwards of $80,000, experts say.  

“That’s a whole new category of patients,” said Michele Shermak, an ASPS member and plastic surgeon who specialises in body contouring. At her practice in Baltimore, about 20% of patients are on weight-loss drugs, she said, including herself. “We’re all just so excited to be able to fit into a size 8 again.”

The GLP-1 craze hasn’t only been a boon for plastic surgeons, it’s also driving business for medical spas that offer services like Botox and filler. Botox and similar injections were up 9% in 2023, according to the ASPS report, and fillers were up 8%. For some, these non-invasive options or exercise can help. But for patients who have shed a significant amount of their body weight, plastic surgery may be the only way to tighten the loose skin. 

“You can’t put pants in the dryer to make them shorter, the only way to do that is to hem them,” said Alan Matarasso, a plastic surgeon based on New York City’s Upper East Side. It’s the same with excess skin, he said: “Plastic surgery is the only way to address that.”

That was the case for 45-year-old Allison Rhodes who has now lost a total of 67kg on Ozempic and Mounjaro, diabetes drugs that are frequently used for weight loss. The Missouri resident was left with folds of sagging skin around her torso that were constantly getting infected. And despite losing almost a third of her body weight, Rhodes’ clothes still didn’t fit around her waist. The area was constantly sweaty and raw, she said, and had a foul odour no matter how many times a day she showered.

In March, she got skin removal surgery, called a panniculectomy, which was paid for by her insurance. The surgeon ended up removing about 3kg of skin and tissue, she said.

Insurers may be more willing to cover panniculectomies, dubbed “apron tucks”, which remove loose skin from the lower abdomen. The procedure can be seen as medically necessary if a patient’s skin hangs at or below the level of the pubis bone or if there’s evidence of a rash that has not gone away despite topical treatments. In contrast, insurance typically doesn’t cover the cost of a tummy tuck, a procedure often marketed to women after pregnancy, since it’s seen as a more aesthetic choice that can also include suctioning away fat and tightening abdominal muscles.

Rhodes says all her surgeries — she also got a breast reduction and lift — have “absolutely” been worth it. “I don’t hurt all the time now.”  

Also read: The problem with belly fat — and what to do about it

In the last year, Matarasso has seen a two-fold increase in the number of his patients who have reported using weight-loss shots. But it’s not the first time he’s seen a new weight-loss treatment bring in waves of new customers. Two decades ago he noted the rise in “bariatric plastic surgery” from patients who’d lost large amounts of weight loss after procedures that reduce stomach or intestine sizes to limit the amount of food consumed or absorbed. 

Research from that earlier wave of weight-loss patients show that in general, health and confidence improves for weight-loss patients after plastic surgery to remove excess skin. But some patients may have unrealistic expectations of the end results, said Jane Ogden, a professor of health psychology at the University of Surrey, who surveyed patients for a study. 

“The body at the end isn’t necessarily the body they thought they were going to get,” Ogden said. Scarring can be an issue, and self-esteem issues can be lingering, she said. And patients who regained weight after having the plastic surgery expressed regret and concerns of “being on the wrong journey,” she said.

It’s common for patients to gain back some weight after body-contouring plastic surgery, according to a study published last year in the journal of the American Society of Plastic Surgeons. Researchers followed 121 patients who had surgery to remove skin folds and fat, and half had previously had bariatric surgery. The latter group saw their weight rise an average of nearly 12% from their thinnest points, compared with an average gain of 7.6% for those who had not had bariatric surgery.  

Some of the regained weight may end up at other parts of the body, at least in the case of patients who also get liposuction, researchers showed in a 2011 study. Once fat cells are removed from one area, the body looks to store excess calories as fat elsewhere, so liposuction on thighs could lead to more fatty arms.

Because of these issues, some doctors are taking a more cautious approach with weight-loss drug patients. “We don’t have a crystal ball, and anyone we operate on could potentially gain or lose weight in the future,” said Nora Nugent, vice president of the British Association of Aesthetic Plastic Surgeons. “We would want to be reasonably certain that someone’s at a steady rate before undertaking this surgery.”

Beth Lazarus had bariatric surgery at just 19 and dropped about 90kg. She “had skin everywhere” that really affected her health, marriage and confidence, she said. Eventually, she got a tummy tuck, thigh lift and breast implants.

She lost another 32kg on a copycat version of Mounjaro in the last year and her body changed again. Her breast implants had to be moved behind muscle tissue, since her skin was no longer strong enough to hold the implants in place. She also got a revision on her thigh lift. Insurance didn’t pay for any of this. All in all, the 40-year-old Cincinnati mom said all the procedures, including the earlier ones, cost around $90,000. She’s incredibly happy with the results. 

“It’s the completion of the journey,” Lazarus said. “You don’t run a marathon and stop halfway through.”