GLP-1 weight loss drugs like Ozempic, Wegovy and Zepbound keep Long Island plastic surgeons busy

With the help of exercise, a better diet, a lot of determination, and a GLP-1 medication, Jeanne Erland lost 164 pounds over two years.

She felt great. But no matter how hard she hit the gym, Erland couldn’t tighten the loose, excess skin on her stomach, arms and legs. It made it difficult to wear certain clothing, and the hanging skin hindered her workouts. She decided to seek out plastic surgery and have it removed.

"I lost this weight and I gained muscle, but there’s only so much you can do and I had this skin hanging," said Erland, 64 of Central Islip. "I just hated it."

Plastic surgeons on Long Island said they are busier than ever with patients who lost weight on GLP-1 medications like Ozempic, Wegovy and Zepbound. The most commonly discussed skin-sagging side effect is "Ozempic face" — a gaunt, jowly visage that can happen if certain patients lose volume in their face through rapid weight loss. But dropping weight can also result in excess skin around the abdomen, breasts, thighs and arms. And while many seek out procedures to look better, there are some that are considered medically necessary.

"It's like deflating a balloon," said Dr. Kevin Kresofsky, a plastic surgeon with NYU Langone Plastic Surgery Associates in Patchogue. "Once the skin gets expanded so much, it loses the ability to recoil and tighten."

About 20% of people taking GLP-1 medications for weight loss have undergone a plastic surgery procedure, while 39% are considering it and 41% are mulling non surgical procedures, according to an American Society of Plastic Surgeons report released last year.

Dr. Kevin Small, director of plastic surgery for the New York Bariatric Group, said his wait list has grown from a week to a month due to the increase in patients losing weight with GLP-1 medications. He has performed two procedures on Erland — so far — to remove the excess skin on her stomach and arms.

In some cases, female patients who have gained and lost weight due to pregnancies have even more trouble bouncing back.

"Those bodies have gone through a significant yo-yo," said Small, who works out of an office in Roslyn. "The belly is the most common request not only from an aesthetic standpoint but a functional standpoint. That fold of skin is prone to irritation and fungal rashes. The weight can impact back pain and shoulder pain."

GLP-1 drugs, or Glucagon-like peptide-1 receptor agonists, were originally used to treat people with diabetes. But they also can lead to dramatic weight loss since they slow digestion and make people feel full for longer periods of time.

The first GLP-1 medicines specifically approved for weight loss were released in 2021 and "transformed the obesity treatment landscape," one scientific review explained. A November 2025 tracking poll from the health policy group KFF found one in eight adults said they were currently taking a GLP-1 drug to lose weight or treat a chronic condition.

Small said a person’s center of gravity changes with the significant weight loss and the overhanging skin causes strain of the shoulder and back. Additionally, rapid weight loss can result in muscle wasting and loss of core strength.

'From the face down to the knees'

Dr. David Pincus, a plastic surgeon with offices in Smithtown, New York and Boca Raton, Florida, said most patients he currently sees are on some sort of GLP-1 medication.

"I’m seeing a lot of weight loss, even in patients who we would consider skinny," he said. "That comes with a lot of skin issues from the face down to the knees."

For the patients whose weight loss led to sagging breasts, the result has been neck and back pain. Pincus said the remedy is usually a breast lift or even augmentation.

"A lot of patients that I operated on within the last 5 or 10 years come back for touchups because of this weight loss," he said.

Kresofsky said he often sees patients who lost weight through bariatric surgery, regained it and then lost even more weight after taking GLP-1 medications.

"Body contouring surgery after massive weight loss ... I would consider it reconstructive, not even cosmetic," he said.

Kresofsky said a procedure deemed medically necessary, is often covered by insurance. 

One example is a panniculectomy, which removes hanging skin from the lower abdomen.

Because of possible complications during surgery, people on GLP-1 medications need to stop taking them for two to three weeks before undergoing procedures that use anesthesia.

Good nutrition, working out

Erland, an insurance risk analyst for a major corporation, said as she began taking Zepbound, she also started counseling to address why she had gained weight and working with a physical therapist to exercise correctly. After her latest procedure in May, she resumed workouts with her personal trainer. She's looking forward to playing tennis, skiing and jumping back into the dating pool — which she had avoided during the years she was heavy.

"It's a work in progress but I feel amazing both physically and mentally," said Erland, who plans to have one final surgery in November to address the extra skin on her legs. "I went a little overboard and brought all these bathing suits and new clothes."

Kresofsky, Pincus and Small agreed that any weight loss program needs to include exercise and good nutrition to be healthy and effective.

"Anyone can help themselves by doing resistance training, by having good protein intake. That maximizes the elasticity and keeps your muscle content," said Dr. David Pechman, director of bariatric surgery at South Shore University Hospital in Bay Shore.

Pechman pointed out that if people don’t eat enough protein while losing weight, their body will eat away at its muscle, not the fat.

Pincus likened healthy bones and muscle as a "scaffold" for the skin, and said GLP-1s by themselves are not a cure-all.

"If there's no lifestyle modification with GLPs, then really what you're doing — it's almost detrimental," he said.