2023 brought with it many medical advances, including the “skinny shot” for weight loss, known in its various formulations as the brand names Ozempic, Wegovy, Mounjaro and others.

Popularized by celebrities (it seems everyone is admitting to losing weight because of these drugs), semaglutide medications (GLP-1 agonists) were designed to help lower blood sugar in diabetics but were found to have the benefit of weight loss as well.  Semaglutide and its chemical cousins (tirzepatide, liraglutide, Jardiance, etc – see a complete list below) work by promoting insulin production and lowering blood-sugar levels, which often makes you feel full for hours to days after eating and causes you to eat less.

Our patients who are taking semaglutides say these medications help to quiet their “food noise” – preoccupation with eating or snacking that haunts them from the moment they wake up in the morning to when they fall asleep.  They consequently eat less overall and have more healthy and regulated eating patterns, rather than obsess about food.

Ozempic has proven behavioral changes related to eating such as decreased (or astonishingly zero) cravings for sugary foods and alcohol, and aversions to former favorite comfort foods or “guilty pleasures”.  This often leads to significant weight loss which is often noticed dramatically in the cheeks – hence the trendy name “Ozempic face” – facial wasting (fat loss) that occurs with precipitous weight loss from any cause.

Despite all the benefits, there are also very real side effects from semaglutides such as nausea, abdominal pain, bloating, diarrhea and constipation, which often go hand-in-hand with slowing down your gastrointestinal tract, and can even lead to malnutrition, Ozempic overdose and even death.

Medications like these are heavily marketed “off label” for weight loss, rather than just for diabetes treatment, and are now offered online without being seen and examined by a Physician – or being provided important professional counseling about all available weight loss options, the importance of balanced nutrition and potential medication-related adverse effects – before selling you this expensive injectable shot.

There has been a worldwide shortage of these drugs, with many companies offering compounded versions (mixed by an independent pharmacy and adding other components such as vitamins) versus getting the FDA-approved medication directly from the manufacturer.  This has led to pharmacies and companies selling their own versions of this medication.  Just this week, there was a report from the FDA of “fake” (counterfit) Ozempic being sold even by reputable sources.  Five illnesses have been linked to the fake shots, but none have been serious, the FDA said on 12/21/23.

Why should patients exercise caution with Ozempic-like medications if considering Plastic Surgery?

If a patient is on one of these medications, it is well-known that food passes more slowly through their stomach into their intestines.  Since these drugs are relatively new and we are still learning about all their effects, surgeons and anesthesiologists have not had guidelines for management of these medications around surgery until recently.

At Plastic Surgery professional conferences I attended this past year, scientific panels focused on semaglutides, describing the pathophysiology of how these drugs work on the body and brain, with two of my Plastic Surgery colleagues sharing their own personal experiences with weight loss (up to 80 pounds) on these magical medications.

Several Plastic Surgeons in the audience publicly shared their concerns regarding concerning incidents in their patients – witnessing undigested food retained in the stomach from meals eaten two or three days prior despite a 12-hour period of fasting and stopping Ozempic days to a week before surgery!  The consequence was either a precarious intubation or the decision to cancel surgery altogether.  Having food still present in the stomach even after a period of fasting before surgery due to GLP-1 agonist medications puts patients at serious risk of aspiration pneumonia during intubation.

Upon induction of general anesthesia, all muscles (including the stomach) are relaxed by a paralytic medication to allow for a breathing tube to be inserted without trauma to the airway.  If there are any stomach contents present during intubation, they can come up the esophagus, end up in the trachea and travel into the lungs, leading to a life-threatening lung infection.  This is why we have a rule of being “NPO” (nil per os in Latin, meaning nothing to eat or drink) from midnight the night before.

The American Society of Anesthesiology (ASA) proposed GLP-1 agonist guidelines in the fall of 2023, and recommended stopping these medications one week before surgery requiring general anesthesia.  However, our understanding of semaglutides and how they affect the body is still accumulating and incidents of undigested food being present in the stomach from days to weeks prior even after stopping these medications a week before surgery have been reported.  I suspect the guidelines will evolve to become more strict with time.  This is why my practice has gone one step further to avoid retained gastric contents from harming our patients on semaglutides or related medications.

We are requiring our patients to stop all weight loss medications such as semaglutides one month before surgery for absolute safety.  Plastic Surgery is elective, and the body should be optimized to ensure the smoothest surgery and best healing before proceeding.  And of course, your weight should be optimized and ideally stable for six months to a year before surgery to ensure a consistent and enduring aesthetic outcome from surgery.

The following is a list of currently available medications that act as GLP-1 agonists and that should be stopped ONE MONTH prior to surgery:

Our office does not prescribe GLP-1 agonists for our patients.  We are not recommendating against taking semaglutides – rather, we are not weight loss counselors or endocrinological specialists.  Instead, we are happy to cheer our patients on as they achieve a more healthy weight and maintain it after they have finished their course of medication.  Injections or pills are not always the answer, but for some patients they seem to be helpful.

For more information on preparing for Plastic Surgery when on Ozempic or other weight loss drugs, contact my office at 415-923-3067 or email info@drkarenhorton.com.