Poster Presentation New Zealand Association of Plastic Surgeons Annual Scientific Meeting

Implications of GLP-1 Agonists in Plastic and Reconstructive Surgery – a Literature Review (1762)

Priyal Patel 1 , Jessica Vlok 2
  1. Surgery, CDHB, Christchurch, New Zealand
  2. Plastic Surgery, CDHB, Christchurch, New Zealand

Background:

Glucagon-like peptide-1 (GLP-1) agonists are medications that mimic the action of GLP-1, a hormone involved in the regulation of glucose homeostasis and appetite.1 These agents are increasingly utilised in the management of type-2 diabetes and obesity, with growing relevance for surgical practice following Medsafe approval.1

Aim:

This review will provide an overview of the plastic surgical and perioperative considerations related to the use of GLP-1 agonists.

Method:

A literature search was performed using PubMed and ClinicalKey medical databases.

Findings:

Current literature on the impact of GLP-1 agonists on wound healing is limited and somewhat conflicting. Nevertheless, improved glycaemic control and cardioprotective effects may indirectly enhance surgical outcomes through reduced inflammation and enhanced vascular function. Additionally, evidence suggests that these agents may improve flap viability via autophagy and the inhibition of oxidative stress.2 However, there is a theoretical risk of malnutrition and sarcopenia due to weight loss, which may impair wound healing.1

The phenomenon of “Ozempic face,” characterised by facial aging from reduced fat deposits and skin composition changes, is emerging as a concern in facial plastic surgery.2 It is relevant to highlight these side effects and the potential impaired skin barrier function.

GLP-1 agonists can facilitate preoperative weight loss, potentially allowing for higher BMI thresholds for surgery at time of referral. It is essential to ensure that patients maintain a stable weight by the time of surgery, with consideration given to possible weight gain if the medication is discontinued.2

Due to delayed gastric emptying and the associated risk of aspiration, the American Society of Anesthesiologists recommends withholding daily-dosed GLP-1 medications on the day of surgery and weekly dosed agents one week prior.2

Conclusion:

GLP-1 agonists offer potential benefits in optimising postoperative outcomes but further research is needed to fully define their perioperative role in plastic surgery.

  1. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity.New England Journal of Medicine. 2021;384(11):989-1002.
  2. Stanton EW, Manasyan A, Banerjee R, et al. Glucagon-Like Peptide-1 Agonists: A Practical Overview for Plastic and Reconstructive Surgeons. Annals of Plastic Surgery94(1):p 121-127, January 2025.