October 10, 2026 | Body Contouring, Plastic Surgery News, Weight Loss Surgery
We used to only talk about massive weight loss after bariatric surgery, like a Roux-en-Y or a gastric sleeve. But nowadays, massive weight loss also happens with GLP-1s. There is a rapid amount of weight loss, and the loss of volume deflates the skin that was previously stretched out. This ultimately sags and creates contour irregularities.
The International Society of Aesthetic Plastic Surgery released its survey of procedures performed in 2025 at the end of September, and the body numbers tell that story without saying the words. Liposuction, the number one surgery in the world, fell 11.4 percent. Every lift rose.
| Body procedure, worldwide 2025 | Procedures | Change vs 2024 | Change vs 2021 |
|---|---|---|---|
| Liposuction | 1,849,828 | minus 11.4% | minus 2.8% |
| Abdominoplasty | 1,039,808 | plus 0.3% | plus 4.9% |
| Brachioplasty (arm lift) | 240,232 | plus 13.2% | plus 71.4% |
| Lower body lift | 146,246 | plus 22.2% | plus 51.8% |
| Thigh lift | 139,854 | plus 2.4% | plus 23.5% |
| Buttock lift | 112,004 | plus 38.9% | plus 77.2% |
| Upper body lift | 87,067 | plus 38.0% | plus 92.6% |
| Non-surgical fat reduction | 406,286 | minus 42.2% | minus 44.4% |
Source: ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2025. The report does not mention weight loss medication anywhere. The reading is mine.
Why the Lifts Are Rising
This loss in volume also creates breast ptosis, both in men and women, and buttock ptosis. Sometimes it affects other places like the arms, the inner thighs, or the outer thighs if you’re prone to saddlebags. So all these places that now have excess skin can only really be addressed with surgical intervention.
Once the skin has been stretched out to a certain degree, it loses its elasticity and really doesn’t react to radiofrequency energy the same way healthy skin would. When the skin laxity is significant, the only option at this point is excisional. That doesn’t mean that in the future we may not have different tools. But as of this writing, that is the recommendation.
Massive weight loss patients may not be candidates. If we see a lot of stretch marks on the skin, or large folds with loss of collagen and dermal tears, the likelihood that the skin will contract is lower, and this would require excisional plastic surgery procedures.
Why Liposuction Fell
A lot of these patients losing weight fast are not taking in enough protein, so they’re also losing muscle. About a quarter of the weight loss is going to be muscle mass. So the body loses muscle mass plus the fatty content, and then we have the sagging in the buttock. Some patients have it in the inner thighs, the arms, the back. It’s a 360 thing. It’s the whole body, not just the tummy like most people expect.
The fat left on its own. What is left is skin, and liposuction has nothing to take from it.
When the Patient Is Ready
This has been standardized in bariatric surgery. After a bariatric surgery, most patients take about a year or a year and a half to get to their goal weight or plateau, and we usually wait six months after they plateau before doing the body contouring or post-bariatric body work.
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.
What Gets Done, and in What Order
I think the gold standard for massive weight loss is usually performing an abdominal procedure, which entails a tummy tuck. But more often than not, because of the massive weight loss, this tummy tuck has to be extended circumferentially, so that we can lift the buttock and the lateral thigh, reduce the lower back, and fix the abdomen at the same time. Another common procedure is a monsplasty.
And often we do some sort of breast procedure, which usually entails a lift. With massive weight loss, it’s usually a full breast lift with an anchor-type incision. For males, the breast procedure is often a gynecomastia reduction. Oftentimes we combine procedures such as a brachioplasty, or arm lift, a medial thigh lift, and excision of back rolls or lateral chest rolls.
After a full consultation, we can determine whether you can undergo all the procedures at once, which usually entails an overnight stay and possible blood transfusion, versus breaking them up into parts. I think the most convenient way to break them up is to do the upper body, and then do the lower body.
ISAPS says 82.3 percent of surgeons perform abdominoplasty but only 31.1 percent perform a lower body lift and 20 percent an upper body lift. The lifts are rising faster than the number of surgeons who do them.
Recovery and Risk
A lot of times these procedures are a lot more invasive than just a tummy tuck. Usually a tummy tuck requires about two weeks for recovery. When we combine more procedures, we usually need at least three weeks to return back to normal activity, and it can be six to eight weeks before we can return to any exercise.
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.
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.
The Scars
Body contouring surgery does entail surgical scars, but most of them can be hidden by normal clothing. The circumferential body lift can be hidden by swimwear or underwear. There are some procedures whose scars are a little harder to hide, like the arm lift, or brachioplasty.
Oftentimes the patients are willing to have these scars because of the amount of excess skin in these areas, and ultimately they will feel better in clothing than not doing anything at all. So some of it is balancing pros versus cons, benefits versus risks and scars, and this requires a full consultation with a conversation about expectations.
Why Choose Dr. Agullo
I am certified by the American Board of Plastic Surgery and the American Board of Surgery, trained in plastic surgery at the Mayo Clinic, and teach as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has named me a Top Doctor every year from 2014 through 2026. Body contouring after weight loss, bariatric and GLP-1, is a large part of my practice, and I do the lifts the survey says fewer surgeons offer.
Ready to Talk?
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. Pricing is on the fees page. #StayBeautiful
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