Glucagon-like peptide-1 receptor agonists and aesthetic surgery: perioperative safety, timing, durability and body composition

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual incretin agonists have transformed the management of obesity and type 2 diabetes and are rapidly reshaping the population seeking aesthetic surgery. By producing double-digit percentage weight loss, these agents expand eligibility for elective procedures while generating new patterns of skin redundancy, soft-tissue laxity, and facial volume depletion that drive demand for body contouring and facial rejuvenation. At the same time, incretin therapy introduces distinct perioperative considerations: delayed gastric emptying with possible pulmonary aspiration in symptomatic patients, gastrointestinal adverse effects that peak during dose escalation, loss of lean mass with rapid weight reduction, nutritional inadequacy during profound appetite suppression, and frequent weight regain after drug discontinuation, which threatens the durability of surgical results. This mini-review synthesizes current evidence on the mechanisms of GLP-1 RAs relevant to the reconstructive surgical patient, summarizes the evolving guidance from anesthesia societies, moving from blanket preoperative withholding to individualized risk stratification, reviews emerging outcome data on body contouring in GLP-1 RA users, and discusses body composition, sarcopenia risk, and nutritional optimization. We propose a pragmatic framework, anchored in weight stability and symptom burden, for timing elective aesthetic procedures relative to GLP-1 RA initiation, escalation, and maintenance, along with a multidisciplinary perioperative algorithm that links the endocrinologist, plastic surgeon, and anesthesiologist. As incretin-based pharmacotherapy expands globally, coordinated endocrine–surgical–anesthetic care will be essential to maximize safety, functional recovery, and patient satisfaction in the GLP-1 era.