Saturday, March 25, 2023

A surge in the number of people using slimming jabs to lose weight could lead to a rise in patients travelling abroad for tummy tucks or other surgery to remove excess skin, surgeons have said.

Drugs such as liraglutide and semaglutide, which could help people reduce their weight by more than 10%, have been approved for use on the NHS for certain groups of people with obesity, although supplies of the latter under the brand name Wegovy have yet to arrive in the UK.

It is also possible to access the drugs through online pharmacies, however, meaning many people hoping to lose weight have sought a private prescription.

Surgeons have raised concerns that people using the jabs may not realise they could be left with excess skin.

“Whilst the newly introduced weight-loss drugs are not likely to produce comparable weight loss to bariatric surgery there is always the possibility that accompanying weight loss, a patient might be left with a degree of deflation and redundant skin. If this persists, then plastic surgery would be indicated to address the area,” said Marc Pacifico, the president of the British Association of Aesthetic Plastic Surgeons, noting that factors such as the degree of weight loss as well as the patient’s age and genetics can all affect how the skin behaves.

A package of injection pens for semaglutide medication Wegovy.
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The Joint Council for Cosmetic Practitioners said any significant or rapid weight loss could cause problems with excess skin and that patients should be told of the risk.

“Liraglutide and semaglutide are prescription-only medicines and as such the patient must be fully informed of all side-effects, including excess skin, before agreeing to commence treatment,” it said.

Mark Soldin, a consultant plastic and reconstructive surgeon based in London, said he had seen rising numbers of patients seeking procedures to remove excess skin after using slimming jabs. “They were rare and are becoming more frequent,” he said. “I anticipate a significant increase over the next few years.”

Soldin said skin tended to become loose on particular parts of the body after substantial weight loss, including the inner thighs, breasts, arms and sometimes back folds and buttocks if the weight loss had been significant.

Pacifico, however, said access to surgery on the NHS to remove excess skin was limited. “Most areas of the NHS do not fund post-weight loss plastic surgery any more, so on the whole this plastic surgery would need to be undertaken in the private sector,” he said.

According to the NHS, it costs about £4,500 to £6,000 to have a tummy tuck in the UK, plus the cost of any consultations or follow-up care, although Soldin said it could cost £7,000 to £10,000.

As a result, Pacifico said there was concern patients might seek cheaper procedures abroad.

“I would strongly warn against this as there might not be the safeguards and assurances that the drugs being used are of the same quality and provenance as those being prescribed in the UK,” he said.

Pacifico said that among the risks of plastic surgery abroad after weight loss was the inability to undertake proper research on a surgeon, as well as the risks associated with flying straight after significant surgery – such as blood clots.

He also warned of a lack of structured and accessible follow-up with the surgeon and clinic. “Particularly as these forms of surgery carry a higher risk of wound healing problems, and post-operative wound infection issues than non-weight loss plastic surgery,” he said.

Soldin said guidelines on eligibility for procedures such as tummy tucks on the NHS differed across the UK.

“Getting body-contouring surgery after weight loss is part of a postcode lottery,” he said, noting that in south London patients wanting a tummy tuck after non-surgical weight loss must meet effective commissioning initiative criteria such as a BMI of 27 or lower, being a stable weight for 18 months and be experiencing significant problems associated with the excess skin – for example recurrent infections.

“Therein lies part of the problem because after losing weight, patients are going to want to have the body contouring surgery and realise that the NHS is not going to fund this unless they meet multiple criteria.”

Soldin echoed Pacifico’s concerns about cosmetic procedures abroad, adding that while the NHS would treat patients with life-threatening complications after such surgery, it would not tackle issues such as patients being left unhappy with how they looked.

Soldin advised that weight loss jabs were still new and said there needed to be a greater communication about who they were suitable for, as well as monitoring of patients using the drugs through primary care. But he said greater awareness of the potential impact of weight loss jabs also mattered.

“Perhaps it just needs to be emphasised that you may not be happy with your body after you’ve lost weight and then to fix that is not necessarily going to be available on the NHS that is currently struggling to look after the health of the population,” he said.