GLP‑1 Medications, Ozempic Face & Fat Transfer Surgery for breast with Robert Whitfield MD

Good morning, everyone. I wanted to hop on here and do a live because I was sent an article this morning and it's something I've discussed in both my books and on podcasts that I've done. And I've made guest appearances on in CNN Style section this morning. And today is July 30, 2025. The article in Style, specifically the beauty section says osipic face may be driving a cosmetic surgery. Boom. It's written by Oscar Holland. So we want to give him credit for this. You know, on today's show, I just want to talk a little bit about GLP1 medications, Ozempic, face and fat transfer surgery. I'm Dr. Whitfield. I'm plastic surgeon who concentrates mostly on performing explant surgery and then perform holistic transformations with fat transfers. And now in the day and age of GLP1 medications, I have to be very, very careful with patients were discussing this with because many patients are using or have used these medications. There's implications for this. So we'll go go through this. So once again, Oscar Holland reported this in the CNN Beauty section online today. You can find it there. Ozempic phase maybe driving a cosmetic surgery. Boom. So in this CNN report, it talks about the GLP1 receptor agonists like Ozempic or Wegovy and the dramatic changes you see in facial volume due to the fat loss. So when you look at a youthful face, it's usually rounder full than an aging face. And there's certain things you have to key into. Certainly as we age, we lose bone and that's probably not well understood, but that's been reported for a long period of time. We use bony support in the face and then we have and can have fat atrophy or fat loss in the face and then we can have skin laxity. So those are kind of, I would say, the three main tenants that I'm looking at all the time now. You don't want to lose fat in your face. And part of the reason the aging face is becoming, you know, I guess if you want to say now the Ozempic phase is because this drug, which is very effective at burning fat, is causing this more rapid onset of fat loss. So, you know, when I'm thinking about fat transfers, especially if someone who's having an explant procedure or who just doesn't want to use implants and wants to use their own fat for their breasts or buttocks, then they have to be able to take fat from the places we normally store fat that May be in the trunk area. So think of abdomen, the love handles, the waist, and then the inner outer thighs. A lot of people store fat there. They think of kind of the, the hip area as a common area. And for those procedures, which, you know, granted, from a technical standpoint, we're very good at doing the procedure. We have a lot of experience with the procedure. What we can't control for, honestly, is the microdosing or macrodosing or of GLP1s. And so for the fat to survive long term in your body, obviously it has to heal. So the minute you take something out of one area and place it into another, it has to heal in the area it's not alive anymore. So we disrupt the fat that you take it out and then transpose it back into the desired or the target area, whether that's breast or buttocks. So those cells have to heal. If you look at models, traditionally in flap surgery, it takes about 21 days for something to revascularize. In this case, we want to do everything we can to support that. So the way these traditionally would work is you transpose the fat. It's in the target area. The target area is the subcutaneous fat layer in augmentation around the breast. It's not in the breast and it's not in the muscle. It's in the scutaneous fatty layer, which is beneath the skin and above the breast tissue. So if we're actively engaged in losing weight, so we're taking either ozempic or other GLP1 drugs, the metabolism that I'm assuming is stable is actually not stable anymore. And so this is a problem that the provider, in my instance, runs into. So your body is in a fat burning mode, not a fat preservation mode, because even though you think you're in a, say, microdosing state, no one has any data to support what that looks like for you in particular. And I can't then, you know, decide or guide you on what to think about that. And it's not a safe procedure in that as well. And there's already been instances of patients that have been operated on in different surgery centers and hospitals around the United States where their cases have been canceled because they have been found to have a full stomach, even though they've stopped using the GLP1s, we'll say two weeks before surgery, because it delays your stomach from emptying. And that's one of the main ways that the feedback loop to your brain tells you, oh, don't eat anymore, your stomach is still full. So that, but you know, as an aside for us who operate and work with anesthesia and patients who undergo general anesthetic, they can't have a full stomach. That's a dangerous situation for them because they could aspirate the contents of the stomach. So it used to be two weeks, it's probably going to be three and four weeks, you know, longer for me personally, I don't want anybody on a GL1P agonist who I'm going to see for a fat transfer. They need to be off that because you can't understand their metabolism if they're, they're on those medications. And we don't want to, you know, prevent somebody who from a metabolic standpoint needs to be on that medication. So that's pre op. You know, if we've performed a fat transfer and somebody feels like they need to go on a weight loss journey, these medications are extremely effective and currently they're not as specific. So they burn both fat and muscle. So we don't want any of our patients post op doing this. The, the whole point of doing a fat transfer is for an enhancement, whether it's breast or buttock. And our practice, so we want to preserve that fat, we want to provide as much balance in the metabolism through hormonal adjustment if necessary, and then improving sleep, improving diet, supporting the fat as it heals and then maintaining that over time. We certainly, in my practice, because I deal with patients who are both premenopausal, perimenopausal and postmenopausal, want to preserve, preserve muscular strength. We want to avoid anybody becoming more frail, losing resiliency. So we're constantly working hard with our patients to support them, you know, nutritionally and guide them on postoperatively what we feel will be the best way for them to exercise. The other more like problematic issue here that's not being discussed in this article that we see a lot is patients. I particularly care for women. They're under immense pressure socially around body image and this constant issue with weight loss or, you know, appearing a certain way and that is not a healthy way to, you know, function. So let's just say this is not going to get any, any better. The, the advent of AI and all these different images you see of, of perfection. So there's absolutely, obviously no perfect person. And if you go throughout time, the image of body changes throughout time. If you go back through different periods of time, the, the, the, the portraits, if you will, are changing in terms of males and females and body dimensions. And in our country, in the 50s, there became more and more emphasis on size of breast. And through different media outlets and magazines, you saw this kind of image and you know, it's created a really false sense of what is the norm. So let me pause here and take a question. It said, how long should someone stay off GLP1 once surgery is completed? So, you know, if I'm performing a fat transfer, that's forever. So thank you for your question, but I don't want anybody who I do a fat transfer on to go back onto a GLP1 inhibitor because it's going to work. And the newer GLP1 inhibitors are going to work even more effectively. They're not going to be less effective. What you want to do is always preserve muscle mass and you know, the, the preservation of muscle mass is going to prevent you in terms of long term health and wellness issues. So say, for instance, I have someone show up to the office. This recently happened. They were in their 90s and they stumbled coming into my office and hurt themselves. And when I interviewed them and helped them with, they'd cut their forehead. Essentially they were completely cognitively with it so they could answer all my questions. They didn't have a loss of consciousness. They were completely able to converse with us, carry on our conversation. So that is somebody who from a mental standpoint is totally there. And for instance, if you go read the book Superagers by Eric Topol, he talks about this group that he studied called the welderly. And these are people who never developed chronic diseases. And they lived into, I believe, the 80s, 90s and into the hundreds in his study. And it took him seven years to find this group. But the point of it is you can live a long period of time and not develop chronic disease. So in his study population, he looked at patients and they had a lot of sense of an activity in community. They exercised. Some of them even, you know, smoked, which we don't obviously support. But there were specifics, you know, from when I think a bit like, okay, you got to stay active, you got to stay involved in community. You can't be isolated. And then, you know, you're more apt to, you know, maybe age in a different way because all of us have parents and we inherit our genes from our parents. And the expression of those genes can be modified by our exposures. And Dr. Eric Topol was recently interviewed on Dr. Hyman's podcast and they discussed some of these exposures because Dr. Hyman's talked about toxicity for a long period of time. He's very prominent in the world of functional medicine. And to that matter, he started a company called Function Health to increase our accessibility to biomarkers. And so when it comes to how we're going to function in a world where we have all these new GLP1s coming and the ones that exist already and, you know, what, what is our, what's the right, you know, body image? So preservation of muscle mass will help you live longer. Okay. And then I always support the following. When I am talking to patients who are interested in fat transfers, I don't want patients involved in activities that are going to increase, we'll say fat burning. So things like high intensity cycling, running long periods, things that are just going to be like high interval type training. That's not to say someone can't participate, where they do short bursts of sprinting, things like that. When you're trying to improve VO2 max, or if you're, your, your goal is, you know, more bent that way. But these, you know, cycling, running long distances, those don't correlate with what we're trying to do. When someone comes in and asks for or desires a fat transfer, that's just, it doesn't make a lot of sense if in fact you're interested in, you know, your body composition. And then if you want to think of it like redistribution of body composition, you actually have to make sure you're on point with your sleep and your diet. And then your exercise pattern should be more about preservation of muscle mass, not so much about burning fat, especially if you're trying to use that fat to augment another area, whether it's the breast or buttocks. So we don't want you on a roller coaster, if you will, of getting on and off GLP1s. We want you to basically start with a very pragmatic approach to just health and wellness. So I always start with sleep. If you could do one thing, you got to start with getting better. Better. I'm sorry, better and better sleep. So think of, you know, the sweet spot is between seven and nine hours. So I think in Eric Topol, Topol's book, he talks about eight hours being like, oh, that's almost optimal if you can do that. So there are wearables and not to give anybody wearable anxiety, but you can track this. And devices that are very, very good that I've used personally and talked about professionally to my patients are whoop straps, ultra human rings. A Polar H10 strap is very good to measure HRV, but obviously not something you wear around all the time. And that's not something used to measure sleep. It's more for hrv. So those are good wearables that we support the use of. And then from a dietary standpoint, you know, we'll just say 70 to 100 grams kind of is a goal of protein per day and we ramp it up around the times of surgery. And that's not just a unsupported notion throughout the literature really. In care of critically ill patients, the demands of recovery increase the amount of protein that you not just need, but then you'll be able to utilize. So that's very rooted in that. I don't support high carbohydrate diets. I think those are challenging for patients. So we concentrate, concentrate on higher protein and of course, healthy fats in the diet. That just allows you honestly to be able to cope with, you know, what's going to happen in the body. And then you can see my books behind me. The short method is based on what I've discussed, plus additional things like leveraging your, you know, you want to leverage your body's lymphatic drainage system. So we have ways to support that. But having a, a diet that is very high in nutrient ranch as well as protein and healthy fats is going to be, you know, paramount in recovery. If you want to have a surgical procedure and then just from day to day wellness, you can use the methodology to support that as well. So I think in closing, GLP1s are going to get better and better in terms of targeting just fat. Now as we age, our skin is going to get looser and our skeletal structure, our facial skeleton will resorb a little bit and you want to preserve your fat. So you have to have that discussion before you ever go in and start these medications. Now, primary care providers are not going to be probably extremely well versed in discussing the implications of GLP1s long term on your facial skeleton, your facial fatigue, and you know, how to preserve that. If you want to have one of those discussions, you're going to need to engage with either a dermatologist, a plastic surgeon, a facial plastic surgeon, people who are more well versed in the skin, the face, facial fat, you know, possible surgical, you know, interventions if needed. Those are all things that are going to be hard for your primary care provider to discuss. So that is basically one that I wanted to go into about this article in cnn. Olympic face may be driving a cosmetic surgery boom. So for certain patient populations, this is definitely going to drive cosmetic surgery. The younger patient who doesn't have skin laxatively won't really fall into this category. But as we age, and if we're talking about women going through a perimenopausal period, hormones are changing, the laxative, skin is changing. That makes them uniquely susceptible. And if you're macro dosing these drugs, like, if they're putting you on them for weight loss, you're going to experience weight loss. The drug works. So you have to be extremely cognizant of that. All right, I'm going to take some questions and see if we can't clear up any confusion about these drugs. So if you have questions, put those in the chat, and once we get some of those rolling, we will have a discussion regarding more like, specific responses in base questions. So one thing that I get asked, you know, routinely about fat transfers is, you know, do they last? Right. That's one of the main things. Everybody's on the Internet is undefeated. So they constantly want to know in their situation, is fat going to last? So the fat is the original filler. And of course, fat can be moved from one place to another and heal. Now, its ability to be moved from one place to another will depend upon, is there enough fat in the area that you're moving fat from? And then two, is the recipient side the area where you're moving it to healthy enough? Does it have a good blood supply? And, you know, three, you know, I always think of, like, how much volume can you move? So there is the donor site, which is where you're taking fat from. There's the recipient site where you're going to put the fat, and if you will, the health of the recipient site and indirectly the health of the patient. So those are things that I have to consider in every single patient. And so let's take them, if you will. Let's take a stepwise approach to this. And because I am able to answer ongoing questions in the chat, I'm just going to take my chat into different windows so I can see that. Okay, there we go. All right. So this is a conversation that I like to have, and it revolves around, you know, philosophically. Things work better when we're younger. So what do I mean by that? So if you were to take fat out of a person in their 20s, we'll say, love handle fat. That's an easy place. People accumulate fat. And you transferred that fat to in a woman, breast or buttock, and into a male, you say they you want a buttock transfer. For argument's sake, would that fat heal? What percentage of that fat would heal? Would it cause A visible change. And so logically, the more space you have meaning from donor to recipient. So do you have the product in the donor side? That's where you're taking the fat from. And then the recipient side, that's where you're putting the fat. So donor site is important. And donor sites, typically abdomen, if you want to think of like love handle area and then inner and outer thigh area, those are like the dominant donor sites. And then recipient signs, we'll say are for this discussion, we'll just say breast and buttock. So typically in the younger patient, we'll say we can take fat out. And then what happens at the donor site? Well, in a younger patient, the skin elasticity is higher, meaning it will tighten up more easily versus an older patient because we're losing collagen as we age. And that's one of the main components in, if you want to think of the strength of the skin or the elasticity of the skin, another component is called elastin. And that's one of the main things we lose over time as well. All right, so we take that out and those areas all heal. We'll say in that person who's in their, in their 20s and you can't tell a difference. Right. The skin quality is the same before and after, relatively speaking. Now, where you can put the fat varies. And then using that same thought process, why is that varying? Now that varies because typically the younger patient has not gone through a significant weight gain, weight loss. So the skin hasn't stretched out in the, in the female, it would be from breastfeeding or pregnancy, typically. And in a male, once again, there's not typically a weight gain, weight loss experience that's happened in that age group. All right, so then let's go to a different age group and try to compare them. In the, in the 30s, we'll just say in the case of female, they've gone through pregnancy, there's been weight loss, weight gain, breastfeeding, all these things. So now the breast has changed. Now there's a little bit of skin laxity. So maybe there's not been a big volume change, but now the skin seems looser. And that's very common. And that's why patients undergo something that's commonly referred to as a mommy makeover. All right, so that's where they would get a tummy tuck, a breast augmentation with or without a mastopexy, which is called a lift. All right, so that's a lot to unpack. You went from 20s, 30s, you went from being Able to take fat and not have a lot of space to put fat back into a 20 something year old patient, male or female, because they haven't gone through weight loss, weight gain, and in females, pregnancy or breastfeeding or something like that. Now you jump to the 30 year old patient and it's probably super simple in a fat transfer in a woman who's breastfed. Why? Because the breast has went up and down in size, the patient's weight has changed. And I just recently did a case where we just transferred fat for breast augmentation into body contouring in association when we were taking the fat to better shape the waist and thighs, but restore volume in the patient's breast because they did not want a breast implant. And so in that patient who is in their 30s, how should that work? What should the outcome of that be? Well, the outcome should be very well, you know, as close to, we'll say 80 to 100% take as possible. Why? Why do I say that? So fat transfers work better when you're younger and when your hormones are in balance and something that's not probably well understood, which is your toxicity level. So toxins can be the things that we breathe in air, eat on our food or along with our food and in the fluids we drink. I know that seems probably a little bit different, but think of like tap water. So tap water can be, you know, if you want to think of something like arsenic is a common contaminant in tap water. If you think of food, everybody's heard of the product Roundup, which has glyphosate, that's the herbicide. So there's a lot of talk obviously about avoiding this in our food supply so that we don't intake glyphosate. The other, you know, common thing in air, you know, especially where I live in Austin, Texas, is mold spores or pollen from oak or cedar. So those are just common examples of things that can get into our system. Now how those affect each person is going to vary based on their genetics and then how they eat, sleep and all the other things they put in their system. So think of like topical application of skincare products. Skincare products can have things like parabens, in them, BPAs, all sorts of things can come into contact with our skin and then it'll be absorbed into our system. So there's lots of things that can build up in someone's system and you wouldn't know that. You wouldn't necessarily be able to ascertain like what's going on in every Single situation. And that's part of why I think there's variability in patient outcomes. With fat transfers. We try to be extremely careful in terms of patient selection. So, one, I won't do a fat transfer on somebody who's been on a glp, one who wants to go on one in the future. I just tell them that's not practical. Two, for me to do a fat transfer, I want to know about hormonal balance and toxicity levels. How are they, you know, sleeping? What is their gut health like? Those things are important to help us better prepare a patient for a fat transfer. So that's how we think about it. And then you can extrapolate into later and later years in life. But you're always trying to use kind of the same playbook, if you will. You're trying to make sure that you're helping the patient in all those different areas to support them so that regardless of what you're doing, you're. You're putting them into a position for success. All right, so we're going to go over some FAQs. I got some questions in the chat. All right, why do I need to stop GLP1s before surgery? Obvious one is you don't want to trigger ongoing fat loss. You don't want to jeopardize the fat that's being transferred. You want to reduce your risk of delayed gastric emptying or having a full stomach under anesthesia. So, you know, the most common one, like I said, how long does the fat last after it's transferred? Obviously we want to set this up for long term success based on what I'd already spoke about. How can I help fat survive post surgery? Certainly, like I said, I don't want patients interested in fat burning activities. So you don't go have a fat transfer if in fact the next day or the next month or the next year. You want to lose 20 pounds or 10 pounds or whatever it is. You want to be comfortable at your weight, because that's what we need to know in order to give you the best guidance. And you want to preserve it by maintaining your diet, your exercise, your sleep, all the things that outside of adjunctive mortalities like lymphatic massage and red light therapy and hyperbaric or peptide support, things that are separate, you don't want to have to factor it. So the areas of treatment with fat transfer. So we concentrate on breasts in my practice, but you can use it for the face, the breast and the buttocks. Is the fat transfer better than fillers or implants? Obviously, it's your own tissue, it's genetically biocompatible, so you're not going to reject it. It just has to heal. And it heals based on those factors we mentioned previously. So it's my go to. What is the recovery like for fat transfer? Well, we leverage a lot of things in my practice to promote early recovery. If you look at my book, Sharp Behind My Shoulder, basically the whole system is set up to help you recover sooner by preparation. So I don't like to react to problems, I like to take them on early, address them by identification through toxicity testing, genetic testing, gut health testing, hormone testing, metabolism. We're trying to get as much information about the patient to really help them succeed by knowing up front and not responding to a problem. So I like to have engagement, you know, with patients as early as possible in the process to give them plenty of Runway to prepare for any kind of treatment. I often get asked, can I combine fat transfer with other procedures? And the answer will vary on the, on the patient. I get asked a lot with explant surgery, of course, because that's what I do predominantly. And it goes back to my program and the Sharp method pre op once again, starting that as soon as possible because that helps support you and get you prepared for surgery, not just a fat transfer. Can you do it with skin tightening procedures? We do do that, of course, and other facial rejuvenation, rejuvenation procedures. So I'm very careful about the face and I've tabled in my practice doing facial fat grafting. All fat typically you put in the face will have a high degree of success due to the blood supply of the face and the very small quantities you need to transfer to for effect. So you just have to be very careful about those opportunities. Now, once again, anything to do with surgery or body contouring or fat transfer, you want to have a very good feel for what you want and then get yourself in the best possible position. And we work with patients now around the globe. We have a whole program that's based on Sharp, you can access it. And I can't operate on everyone, you know, there's a issue, you know, I can only do so much surgery. So we're training other surgeons to run my methodology. And then we have Sharp that runs as a group program to help repair patients before and after surgery with other practices. We just want to, you know, know I want to improve the level of preparation and recovery for surgery around the world. And this is why we, we published our methodology in Sharp and that's why we created a group program and have supplement, support and ongoing education and testing about our program. All right, any other questions that I can answer here? I'm looking in the chats and I don't see anything else. So we're going to end the stream. Thank you all for coming. Till next time.