Body Contouring Surgery in the Era of GLP–1 Receptor Agonists: A Narrative Review

Abstract GLP-1 receptor agonist (GLP-1 RA) pharmacotherapy has emerged as a transformative approach to obesity management, producing mean weight reductions of 14.9% with semaglutide and up to 20.9% with tirzepatide in pivotal randomized controlled trials. The resulting skin laxity across the abdomen, upper arms, breasts, and medial thighs has driven a measurable increase in demand for body contouring procedures; however, the evidence base guiding surgical decision-making in this population remains limited and largely extrapolated from postbariatric surgery literature. This narrative review synthesizes current evidence on patient selection, perioperative management, and surgical outcomes in patients undergoing body contouring following GLP-1 RA-induced weight loss. Preoperative requirements include weight stability of 6 to 12 months, BMI below 30 kg/m2, and correction of protein-calorie and micronutrient deficits; available data indicate that BMI at surgery and metabolic status—rather than weight loss modality—are the primary independent predictors of postoperative complications, with diabetes history conferring an odds ratio of 1.62 for adverse outcomes. Perioperative GLP-1 RA management is addressed through two divergent guideline frameworks: the 2023 ASA consensus recommends elective drug cessation before surgery, while the 2025 ADS/ANZCA/GESA/NACOS recommendations explicitly advise against cessation, prioritizing glycemic stability. In the wholly elective body contouring context, the authors favor the ASA approach. Propensity-matched data demonstrate overall complication rates comparable to non-GLP-1 RA controls, with a statistically significant reduction in postoperative cellulitis potentially attributable to anti-inflammatory effects of GLP-1 RAs. Patient-reported outcomes data demonstrate significant improvements in psychological, physical, and social functioning following body contouring, though no validated instruments exist for the pharmacologically treated cohort. Critical knowledge gaps include the absence of prospective multicenter registries, dedicated primary histological data, functional muscle assessments, and outcomes data from non-North American surgical populations. This review provides a structured clinical framework to guide practice while these gaps are addressed.