GLP-1 Weight Management Program – Managing Excess Weight Prior to Plastic Surgery & Beyond
Dr. Fiala has long been a proponent of helping patients lose excess weight prior to the planned plastic surgery procedure. Not only does it help the results look better, the risks of anesthesia complications and surgical complications are reduced.
In the past, in addition to sensible diet and exercise plans, we often used an FDA-approved weight-loss medication called Qsymia, especially prior to a tummy tuck. We have had many patient successes with this approach, and some wonderful results with the combination of pre-operative weight loss and excellent body contouring surgery.
The exciting news is that we now have even more powerful treatment options: semaglutide and tirzepatide, which are injectable medications that have been FDA-approved for use in both diabetes and for weight loss. These are a whole new category of weight loss medications, unrelated to previous stimulant-type medications. The amount of weight that patients can lose is much more impressive than our previous standard medications. Semaglutide and Tirzepatide belong to a class of medications called GLP-1 agonsists. The help manage your blood sugar by triggering your pancreas to release more insulin. Semaglutide is a single receptor drug, while Tirzepatide has effects on both the GLP-1 and GIP receptors. Tirzepatide has been more effective in recent studies.
In addition to improving surgical body contouring results, GLP-1 medications have been shown to improve cardiovascular risks, such as elevated cholesterol and blood pressure, diabetes, sleep apnea, non-alcoholic fatty liver disease, and chronic kidney disease. GLP-1 medications have clearly shown us that it is biology, rather than willpower, that controls our ability to lose weight and to keep it off. It is our goal to help our patients learn not only how to take the weight off, but also how to maintain that loss for a lifetime!
Summary of Our GLP-1 Program
- An initial assessment will be performed by one of our trained nurses. This will include a review of your personal health and weight loss history to determine if you can safely receive the medication, and a review of medical reasons to make sure you don’t have a situation where this medication might not be appropriate for you. Vital signs will be checked, and a body composition analysis, performed with the InBody 520 analyzer, will be performed.
- A set of pre-treatment blood tests will be performed, for patients who wish to proceed. You will also be given an extensive Health & Weight Loss History form to complete. All results will be reviewed by Dr. Fiala to make sure that they are within normal limits, and that you are an appropriate candidate for GLP-1 medications.
- Weekly doses of compounded (i.e. pharmacy created) semaglutide or tirzepatide will be prescribed from our office. Of note, this is a compounded drug, obtained from a US-based supplier and licensed compounding pharmacy. Ozempic, Wegovy, Zepbound or Mounjaro, the name-brand medications, while excellent, are still very expensive, and are out of the financial reach of many patients at this time. (Patients who do desire the brand name products can receive a prescription for these, but will have to source the medications themselves.)
- We will teach you the correct method for self-injection of these medications. Alternatively, we can have one of nurses perform this for you (service fee applies).
- We will follow-up with you for monthly weigh-ins and repeat body analysis. Nutirtional guidance and coaching will be provided if needed.
- We will be available to help you manage common side effects from medication.
- We will, as time progresses, gradually increase your medication dose, provided that your side effects are minimal and well-managed.
Who is a Candidate for Treatment with Semaglutide
The standard FDA-approved indications for treatment are:
a) BMI >30, or
b) BMI >27 with at least one of the following:
– Increased blood pressure (hypertension)
– Elevated cholesterol
– Sleep apnea
– Cardiovascular disease
– Non-alcoholic Fatty Liver Disease
– Diabetes (Type I or Type II). These patients are best managed by a diabetologist / endocrinologist, due to their complexity.
c) Don’t have any of the contraindications.
Do I Still Need to Diet and Exercise?
Yes. You should aim for a “calorie deficit” of about 500 calories each day. This means you consume 500 calories less than your estimated energy expenditure. Sticking to a low-carb, low-fat diet will also help you avoid side effects from the medication.
As for exercise – yes, this is also important. Aim for about 150 minutes of activity every week.
The amount of weight you lose will really depend on your dietary and exercise habits. Most people on GLP-1 medications lose about 15%-20% of the body weight. Remember, you are not alone on this journey, your nurse/weight loss coach is here to listen, advise and to help you to discover your best self…
Program Prices:
Initial consult – $100
Pre-treatment laboratory testing – $75, repeat every 6 months or as needed
Medication – prices vary with the dose level
Semaglutide:
- 0.25 mg: 4 weekly doses for $225
- 0.50 mg: 4 weekly doses for $250
- 0.75 mg: 4 weekly doses for $300
- 1.0 mg: 4 weekly doses for $350
- 1.5 mg: 4 weekly doses for $450
- 2.0 mg : 4 weekly doses for $550
- 2.4 mg: 4 weekly doses for $600
Tirzepatide:
- 2.5 mg: 4 weekly doses for $145
- 5.0 mg: 4 weekly doses for $290
- 7.5 mg: 4 weekly doses for $425
- 10 mg: 4 weekly doses for $565
- 12.5 mg: 4 weekly doses for $710
- 15 mg: 4 weekly doses for $850
Follow-up weigh-in’s, body analysis and follow-up with nurse: $100
Nurse injection fee, if requested: $25 per session
There is no monthly “membership” fee.