Abdominoplasty After Bariatric Surgery and GLP-1 Receptor Agonists: Independent vs Combined Complication Risks

Abstract Background Rising obesity has surged demand for weight loss interventions and body contouring procedures. The independent and combined effects of prior bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) on abdominoplasty outcomes remain unclear. Objectives To estimate the independent and combined associations of prior BS and recent GLP-1RA use with 90-day postoperative complications after abdominoplasty. Methods This retrospective cohort study used TriNetX network data on adults undergoing abdominoplasty (January 2004–June 2025). Patients were grouped into no prior interventions, BS only, recent GLP-1RA use only, and both. Propensity score matching controlled for confounders and 90-day surgical complications were compared. Results Included were 4776 patients with prior BS, 2253 recent GLP-1RA users, and 465 with both. Bariatric surgery increased the risks of hematomas (RR = 1.55; 95% CI 1.11-2.17) and seromas (RR = 1.55; 95% CI 1.19-2.02), lowered hypertrophic scarring (RR = 0.74; 95% CI 0.62-0.87) and systemic infections (RR = 0.78; 95% CI 0.64-0.93). Glucagon-like peptide-1 receptor agonists use heightened hypertrophic scarring risk (RR = 1.79; 95% CI 1.374-2.352), a finding confirmed in a sensitivity analysis against DPP-4 inhibitors (RR = 2.40). Glucagon-like peptide-1 receptor agonist use in BS patients increased wound dehiscence risk (RR = 1.92; 95% CI 1.12-3.38) and constitutional symptoms (RR = 1.69; 95% CI 1.164-2.461). Conclusions Bariatric surgery is associated with higher hematoma and seroma risks but lower hypertrophic scarring and systemic infections. Glucagon-like peptide-1 receptor agonists are independently associated with hypertrophic scarring risk. When combined, these interventions are associated with significant wound dehiscence and increased constitutional symptoms, underscoring the need for tailored perioperative management and preoperative counseling. Level of Evidence: 3 (Therapeutic)