Semaglutide – “The Skinny Shot”

Semaglutide – Managing Excess Weight Prior to Plastic Surgery

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.  And we had many patients be very successful with this approach, and get some wonderful results with the combination of pre-operative weight loss and excellent body contouring surgery.

Now, we have new and more powerful treatment options, in the forms of 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 medication.

Therefore, Dr. Fiala is bringing this advancement to our practice, beginning January 2024.  While it is primarily designed for our patients who are preparing for body contouring surgery, we will make it available to any patient that meets the requirements for use.

Summary of Our Semaglutide Program

1.  An initial assessment will be performed by one of our trained nurses.  This will include a review of whether you can safely receive the medication and a double-check 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.
2. A set of pre-treatment blood tests will be performed, for patients who wish to proceed.  Dr. Fiala will review these, and make sure that they are within normal limits.
3. Weekly doses of compounded semaglutide will be prescribed from our office.  Of note, this is a compounded drug, obtained from a US-based supplier and licensed compounding pharmacy.  It is not brand-name “Ozempic” or “Wegovy”.  The brand-name 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.)
4. 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).
5. We will follow-up with you for monthly weigh-ins and repeat body analysis.
6. We will be available to help you manage common side effects from medication.
7. As time progresses, we will gradually increase your medication dose, if 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

–  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 semaglutide lose about 15%-20% of the body weight.

Program Prices:

Initial consult – $100

Pre-treatment laboratory testing – $75, repeat every 6 months or as needed

Medication – semaglutide price varies with the dose level

• 0.25 mg – 0.75 mg:  4 weekly doses for $180
• 1.0 mg – 1.5 mg:  4 weekly doses for $250
• 1.75 mg – 2.4 mg:  4 weekly doses for $500

Follow-up weigh in’s and body analysis:  included

Nurse injection fee: $25 per session

There is no monthly “membership” fee.

Is Terzepatide Available?

Yes, but it is more expensive.  It will be available later in Q1 of 2024.

Can I Still do EON or CoolSculpting?

Yes – the EON and CoolSculpting machines are designed for the treatment of subcutaneous fat.  They can’t treat the internal visceral fat, whereas Semaglutide can.  It’s a great 1-2 combo!