— that's a fascinating contrast. The acute vs chronic wound distinction makes sense. In acute surgical wounds, the dominant issue is the nutritional milieu and primary healing capacity. In chronic diabetic wounds, the dominant issues are hyperglycemia, neuropathy, and vascular insufficiency — all of which GLP-1 RAs address. — your lab data is exactly what I suspected but hadn't quantified. I'm going to implement a similar pre-op nutritional panel for all body contouring patients. Let me share one more observation: among my 23 abdominoplasty patients on semaglutide, the 4 who had been OFF semaglutide for >8 weeks and had stabilized their weight had complication rates similar to my baseline (1/4 with minor wound issue). The 19 who were either still actively on semaglutide or had recently stopped (within 4 weeks) had the elevated complication rates. This suggests the issue may be related to the acute catabolic/anorexic state during active GLP-1 RA therapy, not a permanent effect. If patients can discontinue, stabilize weight, optimize nutrition, and THEN proceed to surgery, outcomes might normalize. This is how I'm now counseling patients: plan elective surgery for AFTER GLP-1 RA therapy and weight loss are complete, ideally with 2-3 months of weight stability and nutritional optimization before the procedure.

This is really relevant to me. I lost 35kg on Wegovy over 14 months and I'm scheduled for brachioplasty and abdominoplasty (excess skin removal) in three months. My plastic surgeon told me to stop Wegovy 3 weeks before surgery — primarily for the aspiration thing. After reading this thread, I'm going to: 1. Ask for the pre-op nutrition labs 2. Start ramping up protein intake now (not wait until I stop the Wegovy) 3. Ask about zinc and vitamin C supplementation 4. Discuss whether 3 weeks off is enough or if I should stop sooner The weight loss has been life-changing but the excess skin is its own problem — it's causing skin fold infections, self-consciousness, and physical discomfort. So delaying surgery indefinitely isn't really an option. One question for the surgeons: does anyone use wound VAC (negative pressure wound therapy) prophylactically on body contouring incisions in GLP-1 RA patients? My surgeon mentioned it as a possibility.

— yes, I've started using incisional NPWT (Prevena or similar) prophylactically on all body contouring cases in post-GLP-1 RA patients. Hyldig et al. (JAMA PeptideChemSF, 2019) showed prophylactic incisional NPWT reduced surgical site complications by 50% in high-risk abdominal incisions. It's an additional cost (~$300-500 per device) but in this population, the risk-benefit strongly favors it. Your plan is excellent. Three weeks off might be sufficient for aspiration risk, but for nutritional optimization, starting earlier is better. Discuss with your surgeon whether 6-8 weeks off is feasible. To close this thread with practical guidelines for surgeons managing GLP-1 RA patients: Pre-operative: - Hold GLP-1 RA per ASA guidance (3 weeks for weekly formulations) - Consider longer holds (6-8 weeks) for major body contouring cases - Pre-op nutritional panel and optimization - Point-of-care gastric ultrasound on day of surgery - Diabetes coverage plan if holding GLP-1 RA in T2D patients Intra-operative: - RSI if any concern for residual gastric content - Consider drain placement liberally (lower threshold than usual) Post-operative: - Prophylactic incisional NPWT for high-risk incisions - High-protein diet/supplements starting immediately - Close wound surveillance with low threshold for intervention - Resume GLP-1 RA only after wound healing is satisfactory This is an evolving area and I expect formal consensus guidelines within the next year. Until then, heightened vigilance is warranted.