Ozempic & Co: When the number on the scale is right, but the image in the mirror isn't quite there yet.
There are moments in medicine when a success brings a new problem to light. GLP-1 agonists represent such a moment. Semaglutide, tirzepatide—drugs originally developed to treat type 2 diabetes—have, in just a few years, achieved something that decades of nutritional medicine failed to do: they enable sustained, substantial weight loss for people who previously could not achieve it despite their best efforts. This is a genuine medical breakthrough. And it raises a follow-up question that is still far too rarely discussed. People come to us who have lost twenty, thirty, sometimes forty kilograms in a year and a half. People who, for the first time in their lives, are no longer bothered by their weight in their daily lives or in their self-image. And yet they are still not satisfied when they look at themselves in the mirror. Because: there is still a lot of sagging skin that, after many years of stretching, no longer retracts on its own. Skin is not an infinitely elastic material that adapts at will. It has limits—limits that depend on age, genetics, the pace of weight loss, and the initial situation. Those who lose a lot of weight in a short time also lose volume—in the chest, face, and arms. The skin that once enveloped this volume remains. It sags. It hangs. And GLP-1 agents do nothing to change this. They affect metabolism. Not skin structure.
A phenomenon that medicine is only just beginning to understand
The numbers paint a clear picture: Searches for body contouring treatments surged by more than 2,000 percent in 2025. Surgeons worldwide report a new, growing group of patients with a specific profile: successful, motivated, physically healthier than ever before—and deeply unsettled by what they see in the mirror. The image we have of ourselves influences how we move in our bodies, how we interact with others, and what we believe we are capable of. The connection between body image and mental well-being is well established. And it doesn’t end with the scale showing a certain weight. What happens to the body when weight is lost rapidly is not a malfunction. It is a physiological consequence that no one deserves and for which no one is to blame. Anyone who fails to communicate this clearly is making a mistake—regardless of whether they have a treatment plan to offer afterward or not.
When surgery is appropriate—and when it isn't
That’s the question we’re asked most often. And the honest answer is uncomfortable, but important: In many cases, the time isn’t right yet. Surgery following weight loss—whether it’s a body lift, breast reduction, or liposuction to remove stubborn pockets of fat—requires a stable foundation. Your weight must have been stable for at least six months. Anyone who is still in the process, who is still adjusting or dosing medications, whose body is still readjusting: they should wait. A procedure performed on an unstable foundation will not yield lasting results. This is not a cautious practice policy. It is medical logic. What may be appropriate in the meantime—non-invasive skin tightening, regenerative procedures, or accompanying diagnostics—depends on the individual situation. There is no standard answer. There is only a thorough medical history and an honest conversation.
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