October 24, 2026 | Patient Safety, Plastic Surgery Consultation, Weight Loss
Should you stop your GLP-1 before a tummy tuck or a lift?
Yes. Two weeks before. Here is why, and what this week’s two-million-record headline does not change.
What the Study Found, and What It Did Not
Newsweek reported it October 18. UTHealth Houston, American Society of Anesthesiologists meeting, 2,028,601 elective inpatient surgeries in the Epic Cosmos database, 2016 through 2024.
| The study | The number |
|---|---|
| Patients on a GLP-1 | 145,610, about 7 percent |
| Major cardiac event (heart attack, heart injury, stroke or death) | 1.0 percent against 1.1 percent, 11 percent lower odds |
| Infection after surgery | 4.9 against 5.3 percent, 8 percent lower odds |
| Cause and effect | No, observational |
| When the last dose was taken | Not recorded |
| Aspiration under anesthesia | Not studied |
Safer is a fair word for the headline. It is not the same word as ready.
Why I Hold the Drug for Two Weeks
“Our practice really hasn’t changed because of the increase in GLP-1 weight loss patients. We still do our complete workup and consultation prior to surgery. The financing is done in the same terms. I think the most important thing with GLP-1 patients is to stop the GLP-1 medication two weeks prior to surgery. Otherwise, it’s like any other patient, with the same high-grade attention to detail.”
The stomach first. These drugs slow gastric emptying. A stomach that is not empty under general anesthesia is an aspiration risk. The anesthesiology societies said hold a weekly dose for a week in 2023, then case by case in 2024. I take two weeks. Elective surgery can wait.
The gut after surgery is the second reason, and my pre-op nurse says it at the two-week visit:
“I’m gonna need for you to stop taking it 2 weeks before the surgery and 2 weeks after. The reason why, they slow down your intestinal motility, as well as the surgery, and we do need for you to have bowel movements right after surgery.”
Is My Weight Stable?
“The most important thing is for the patient to be stable at their weight. If they continue to lose, or go up and down, they may need more procedures in the future.”
“With GLP-1s, it’s a little bit less clear, because the weight loss usually happens in a period between three to nine months, sometimes a year. But the patients seem to plateau a little bit quicker, and they seem to be ready a little bit faster after they plateau, usually about three months.”
Three months at one weight, then we plan. A tummy tuck removes the skin you have today. Lose 30 more pounds and a new fold shows up. Timing: body contouring after weight loss. The face: face after weight loss.
“I am always an advocate for patients to continue their weight loss journey to get to a healthier weight and BMI to decrease complications. But the fact of the matter is that some patients have just plateaued and are no longer able to lose more weight. They continue to diet and exercise and use GLP-1s, or they may have already had a bariatric procedure. But the fact that they are not moving the scale is frustrating and sometimes causes psychological distress, resulting in bounce backs and weight gain, almost a vicious cycle of a yo-yo effect.”
“At this point, if the patient agrees that the benefits will outweigh the risks, and it gets them motivated to a healthier weight and lifestyle, I agree to proceed.”
| Where you are | What I usually say |
|---|---|
| Still losing on the drug | Not yet. Keep going; we plan the sequence now |
| Plateaued, under three months | Consult now, book for the three-month mark |
| Weight stable three months, BMI under 35 | Book. Off the drug two weeks before and two weeks after |
| Stable, BMI over 35 | Case by case; the BMI post is the honest version |
The Workup Does Not Change. The Labs Matter More.
“There are unique risks in this population, and the post-bariatric patients are still at higher risk for wound complications than the GLP-1 patients. This has been seen in recent studies, and it’s not surprising, because the bariatric patients do have more nutritional deficiencies, and they often have a much higher percentage of body weight loss.”
“We also see that GLP-1 patients are healthier than bariatric patients, because bariatric patients also have the nutritional deficit; we’re taking out intestinal parts that absorb nutrients. So the complications are lower and the healing is better.”
“So we have to look at the protein levels and protein intake before the surgery. And another thing we like to look at is the hemoglobin levels, to make sure the patient’s not anemic.”
Two weeks out, iron starts for anyone having liposuction or a tummy tuck. The nurse’s reason: “The reason why, we do lose a little bit of blood during surgery. So if you lose a little bit of blood and it’s high, it’ll go to normal levels other than having it normal and dropping to anemia.” The protein target goes up (the protein after surgery post has the numbers), and the diet pauses:
“The first week after surgery is not a time for dieting. We want you to have a good intake of protein, because your body is working overtime and burning excessive calories in order to repair the incisions and your tissues.”
Will I Gain the Weight Back When I Stop It?
“The timing is shorter now with the GLP-1s, but it’s still cooking. We don’t know exactly how it’s going to work. And the main thing is not to bounce back. When you stop taking it, if we have a bounce back, that can pretty much destroy everything we did, and the fat is not going to come back in the right places necessarily.”
“I don’t think there’s a huge health hazard or urgency. With the weight loss you got healthier. If you gain it back, some of your other problems might come back, like blood pressure or glucose intolerance. But the skin will keep stretching.”
Four weeks off around surgery is not the bounce back. Stopping for good with no plan is. Settle that with the prescribing doctor first.
More: GLP-1 consults, the planning post, the med-spa options on the Southwest Plastic Surgery post, the commentary on drworldwide.com.
Why Choose Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. About a third of his consults are now post-GLP-1 patients.
Ready to Talk?
On a GLP-1 and thinking about a tummy tuck, a lift or a mommy makeover? Bring the drug, the dose and the date of your last injection to the consult. I will tell you whether the answer is now, three months, or wait.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
