Researchers at the Mayo Clinic conducted the analysis in accordance with the Cochrane Collaboration Handbook and the PRISMA reporting guidelines, registering the protocol prospectively in PROSPERO. Their search of PubMed, Embase, and the Cochrane Library yielded 1,479 records, which were screened independently by two reviewers down to just four eligible studies: three retrospective cohorts and one prospective cohort, together encompassing 8,944 adult patients undergoing body contouring procedures. Notably, semaglutide dominated the treatment landscape, accounting for more than 99 percent of prescriptions across the included studies, a detail that reflects how thoroughly one molecule has come to define the pharmacologic weight loss revolution.

The investigators focused their primary analysis on surgical site occurrences, a composite category capturing wound dehiscence, surgical site infection, seroma, and hematoma, the complications that most concern reconstructive surgeons operating on reshaped tissue. Secondary outcomes included readmission, emergency department visits, and gastrointestinal complications. Pooled risk ratios were calculated using random-effects models, with between-study heterogeneity quantified by the I² statistic, and leave-one-out sensitivity analyses were used to test whether any single study was driving the pooled results. Risk of bias was evaluated with the ROBINS-I instrument, and the certainty of evidence was graded using the GRADE framework.

The headline finding concerns wound dehiscence, the partial or complete separation of a surgical incision. Across the four studies, patients exposed to GLP-1 receptor agonists experienced wound dehiscence at a rate of 5.2 percent, compared with 2.9 percent among non-users. The pooled analysis produced a risk ratio of 1.62 with a 95 percent confidence interval of 1.09 to 2.42 and a p-value of 0.017, with no detectable heterogeneity, a statistically significant elevation in risk that carries real clinical weight. Dehiscence can prolong recovery, inflate healthcare costs, and undermine the aesthetic outcomes that motivate contouring surgery in the first place, so a 62 percent relative increase, if genuine, would matter to surgeons and patients alike.

Yet the story becomes considerably more complicated under scrutiny. When the researchers performed leave-one-out sensitivity analysis, the removal of a single large retrospective cohort by Lewis and colleagues, a study of nondiabetic post-bariatric patients treated exclusively with semaglutide, caused the wound dehiscence association to collapse to non-significance, with the pooled risk ratio falling to 1.02. In other words, the entire statistical signal appears to rest on one study. That cohort also reported higher overall complication rates than the other included trials, encompassing delayed wound healing, infections, nausea, vomiting, diarrhea, hypertrophic scars, and surgical site pain, and its authors had already recommended cautious perioperative planning, potential drug discontinuation before surgery, and nutritional optimization for patients on semaglutide undergoing post-bariatric contouring.

For every other outcome, the meta-analysis found no convincing signal of harm. Seroma formation showed no significant difference between users and non-users, with pooled rates of 9.2 percent versus 12.3 percent and a risk ratio of 0.78 that actually favored drug exposure. Hematoma rates were similarly indistinguishable, at 4.6 percent versus 2.6 percent, and surgical site infection showed no significant elevation at 5.3 percent versus 3.3 percent. Even the composite surgical site occurrence outcome, pooling all four studies, failed to reach significance, with rates of 13.9 percent versus 9.2 percent and wide confidence intervals. However, heterogeneity was high for seroma, infection, and composite outcomes, with I² values reaching 80.7 percent for the composite analysis, a statistical warning sign indicating that the underlying studies differed so substantially in populations, procedures, and definitions that pooling them may obscure more than it reveals.

Those differences are far from trivial. One included study restricted its analysis to lipoabdominoplasty, another to panniculectomy, while others spanned a broad range of contouring operations across the face, breast, trunk, and limbs. Treatment durations ranged from roughly 4.7 months to nearly four years, and perioperative discontinuation practices varied wildly: one study adhered to the American Society of Anesthesiologists protocol and stopped therapy one week before surgery, another reported an average discontinuation interval of 9.6 weeks with a range from zero to 100 weeks, and the remaining studies did not report discontinuation practices at all. Given that GLP-1 receptor agonists delay gastric emptying and raise theoretical aspiration risks under anesthesia, the absence of standardized perioperative protocols is itself a finding that should concern clinicians.

Physiologically, several mechanisms could plausibly link rapid pharmacologic weight loss to impaired wound repair. Aggressive weight reduction can precipitate relative malnutrition, depleting the protein stores and micronutrients essential for collagen deposition and tissue remodeling. There is also emerging evidence that GLP-1 receptor agonists may modulate inflammatory pathways and collagen synthesis, potentially affecting the mechanical integrity of healing incisions. Conversely, in diabetic patients, the improved glycemic control these drugs deliver may actually enhance wound healing and reduce infection risk, since obesity and hyperglycemia are well-established risk factors for postoperative complications. This inverse logic may explain why the study restricted to nondiabetic patients reported the worst outcomes, while studies with more metabolically diverse populations found neutral or even favorable effects. Prior bariatric surgery adds a further confounder, independently associated with nutritional deficiencies and impaired healing, and a separate comparison study found that bariatric surgery patients not taking GLP-1 drugs actually showed higher wound dehiscence and surgical site occurrence rates than matched drug users, hinting that the feared signal may partly reflect patient mix rather than the medication itself.

The quality assessment tempers optimism further. Using the ROBINS-I tool, the reviewers rated all included studies at moderate or serious risk of bias, with persistent problems in confounding, classification of interventions, missing data, and outcome measurement. Drug doses and timing were incompletely captured, outcome definitions were not standardized, and none of the studies had preregistered protocols, raising concerns about selective reporting. The authors themselves conclude that routine discontinuation of GLP-1 receptor agonists before body contouring surgery cannot yet be universally recommended, but that selective withholding may be appropriate, and that perioperative management should emphasize nutritional optimization, meticulous wound closure technique, multidisciplinary coordination with anesthesiologists and endocrinologists, and close postoperative surveillance for wound breakdown in active users.

What emerges is a portrait of a field racing to catch up with a medication revolution. With the population of patients on GLP-1 therapy expanding exponentially and body contouring demand rising in parallel, surgeons urgently need evidence-based guidelines for this new patient profile, yet the current evidence base consists of just four observational studies, none randomized, all carrying at least moderate bias risk. The investigators call for larger prospective studies with standardized protocols, ideally randomized controlled trials, that separately analyze patients with and without prior bariatric surgery, evaluate individual agents, doses, and treatment durations, and define optimal discontinuation strategies. Until such data arrive, the practical message for the millions of patients contemplating skin-removal surgery after their own pharmaceutical weight loss journey is one of measured reassurance: no consistent elevation in infections, fluid collections, or overall surgical complications has been demonstrated, but a possible, unconfirmed signal for wound dehiscence means the decision about when, whether, and how long to pause these drugs before going under the knife should be made deliberately, with a surgeon and endocrinologist at the table.

Subject of Research: Perioperative safety of GLP-1 receptor agonist therapy in patients undergoing body contouring surgery

Article Title: Safety of GLP-1 receptor agonists in body contouring surgery: a systematic review and meta-analysis

Article References: Safety of GLP-1 receptor agonists in body contouring surgery: a systematic review and meta-analysis. (n.d.). https://doi.org/10.1186/s44452-026-00024-w

Image Credits: AI Generated

DOI: 10.1186/s44452-026-00024-w

Keywords: GLP-1 receptor agonists, semaglutide, body contouring surgery, wound dehiscence, systematic review, meta-analysis, plastic surgery, weight loss medications, surgical site occurrences, perioperative outcomes, wound healing, obesity