Jennifer Witherspoon can’t stop sharing photos of her new body. After losing more than 100 pounds with a slimming drug, the 47-year-old in Austin had a tummy tuck and breast lift to get rid of the loose, loose skin she was left with. Now, she’s flaunting abs in a bikini for the first time in 20 years.
“I’m literally living my best life,” she said.
Patients taking Wegovy, Zepbound and other new weight-loss drugs find that after losing 50 pounds, the skin hangs over their stomachs, arms and buttocks. In the face and chest, loss of elasticity can make someone appear much larger than they actually are, or give a hollow appearance that has been called an “Ozep face.”
This has turned into a gold mine for plastic surgeons.
From 2022 to 2023, there was an 8 percent increase in facelifts, likely fueled by people getting slimming shots, according to a report by the American Society of Plastic Surgeons released Tuesday. The group, which represents 92 percent of board-certified plastic surgeons in the U.S., also found that tummy tucks and lower body lifts increased by 5 percent. Arm lifts, thigh lifts and chest lifts were also up, according to the report.
After losing weight, “all of these people are potentially going to have problems with how they look afterward,” said Steven Williams, president of the American Society of Plastic Surgeons based in Dublin, California.
And the number of people using weight loss drugs is only expected to increase 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.
As more of the estimated millions of people who receive GLP-1 weight-loss vaccines from Eli Lilly and Novo Nordisk A/S or generic drugs sold by companies such as Hims & Hers Health begin to consider plastic surgery, doctors are facing now ethical questions. What if these patients continue to lose weight—or gain it all back?
It’s clear that many of the people who used to spend more than $1,000 a month on weight loss pills are also ready to switch to improving their bodies after losing weight. Few of these makeovers are covered by insurance, and a full-body makeover can cost upwards of $80,000, experts say.
“This is a whole new category of patient,” said Michele Shermak, ASPS member and plastic surgeon specializing in body contouring. At her Baltimore practice, about 20 percent of patients take weight-loss drugs, she said, including herself. “We are all so excited to be able to fit into a size 8 again.”
The GLP-1 craze has not only benefited plastic surgeons, but also medical spas offering services such as Botox and fillers. Botox and similar injections are up 9% in 2023, according to the ASPS report, and fillers are up 8%. For some, these non-invasive options or exercise can help. But for patients who have lost a significant amount of body weight, plastic surgery may be the only way to tighten loose skin.
“You can’t put pants in the dryer to make them tighter, the only way to do that is to twist them,” said Alan Mataraso, a plastic surgeon based on New York’s Upper East Side. It’s the same with excess skin, he said: “Plastic surgery is the only way to deal with it.”
This was the case for 45-year-old Allison Rhodes who lost more than 80 pounds on Ozempic and Mounjaro, diabetes drugs often used for weight loss. The Missouri resident was left with folds of drooping skin around her torso that kept getting infected. And despite losing almost a third of her body weight, Rhodes’ clothes didn’t fit her waist. The area was constantly sweaty and raw, he said, and it smelled bad no matter how many times a day he showered.
In March, she underwent skin removal surgery called a pannicolectomy, which was paid for by her insurance. The surgeon ended up removing six pounds of skin and tissue, he said.
Insurers may be more willing to cover pannicectomies, called “apron tucks,” which remove loose skin from the lower abdomen. The procedure may be considered medically necessary if the patient’s skin hangs at or below the level of the pubic bone, or if there is evidence of a rash that has not resolved despite topical treatments. In contrast, insurance usually does not cover the cost of a tummy tuck, a procedure often marketed to post-pregnancy women as considered a more cosmetic option that may also include liposuction and tightening of abdominal muscles.
Rhodes says all of her surgeries – she also had a breast reduction and lift – were “absolutely” worth it. “I don’t hurt all the time now.”
In the last year, Mataraso has doubled the number of his patients who have reported taking weight loss shots. But it’s not the first time he’s seen a new slimming treatment bring in new waves of customers. Two decades ago he noted the rise of “bariatric plastic surgery” by patients who lost large amounts of weight after procedures that reduced the size of the stomach or intestine to limit the amount of food eaten or absorbed.
Research from that previous wave of weight-loss patients shows that overall, health and self-confidence improve for patients who lose weight after plastic surgery to remove excess skin. However, some patients may have unrealistic expectations of the end results, said Jane Ogden, professor of health psychology at the University of Surrey, who surveyed patients for a study.
“The body at the end is not necessarily the body they thought they were going to get,” Ogden said. Scarring can be a problem and self-esteem issues can remain, she said. And patients who regained weight after plastic surgery expressed regret and concerns that they were “on the wrong journey,” he said.
It’s common for patients to regain some weight after plastic surgery for body contouring, according to a study published last year in the Journal of the American Society of Plastic Surgeons. The researchers followed 121 patients who underwent surgery to remove skin folds and fat, and half had previously undergone bariatric surgery. The latter group saw their weight increase by an average of almost 12% from their thinnest points, compared to an average increase of 7.6% for those who had not undergone bariatric surgery.
Some of the regained weight may end up elsewhere in the body, at least in patients who also undergo liposuction, researchers showed in a 2011 study. Once fat cells are removed from an area, the body looks to store the excess calories as fat elsewhere, so liposuction on the thighs could lead to more fatty arms.
Because of these issues, some doctors take a more cautious approach with weight loss medication 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 Cosmetic Plastic Surgeons. “We would want to be reasonably sure that someone is in a stable rhythm before we perform this surgery.”
Beth Lazarus had bariatric surgery at age 19 and lost about 200 pounds. “She had skin all over” which really affected her health, marriage and self-confidence, she said. Eventually, she had a tummy tuck, thigh lift and breast implants.
She lost another 70 pounds on a copy of Mounjaro in the last year and her body changed again. Her breast implants had to be moved behind the muscle tissue after her skin was no longer strong enough to hold the implants in place. She also got a revision to lift her thighs. Insurance didn’t pay any of it. In total, the 40-year-old Cincinnati mom said all the procedures, including the previous ones, cost about $90,000. She is incredibly happy with the results.
“It is the completion of the journey,” said Lazarus. “You don’t run a marathon and stop halfway.”
