How GLP-1s Are Changing Plastic Surgery

Announcer (00:00):
You're listening to The La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:05):
One in seven Americans plans to use a GLP-1 in 2026, and that's already changing plastic surgery. Today, we're talking with our chief operating officer, Janelle, who's seeing this shift from every angle as a leader inside plastic surgery practice and as someone who personally has used the GLP-1 medications and is using them. So we're going to chat about that today and welcome Janelle.

Janelle (00:30):
Thank you. Happy to be here.

Monique Ramsey (00:33):
Yeah. So this article came out, and I'll put it in the show notes, but it's that one in seven Americans plans to use a GLP-1 soon. So why do you think this interest has exploded?

Janelle (00:46):
Well, I think everyone's seen it working. That is a huge testament to the efficacy of the medication. So you see a lot of people out there who have lost weight and it works. And I think too, there's a lot of people that are coming right out and talking about it on social media. And really in general, I think people are more comfortable talking about. And if you do have a significant weight loss, you probably can't hide that now everybody knows there's this option. And so I think a lot of people are just owning up to it and they feel great and they want to share it more.

Monique Ramsey (01:33):
So tell me, are you using it currently and why did you decide to go down that road? What's that story?

Janelle (01:39):
Yeah. It's interesting because being here for nearly 20 years, we always felt like we needed some component of a weight loss option for people. There was either the patient that maybe had a little bit of weight to lose before they got to their surgery or people once they went through the financial and the whole emotional investment to help them really support them and maintain their results. And so for me, having surgery five years ago, I felt like a million dollars. It just made such a difference. And I thought, I have to do everything to keep this because I finally felt good in close and some things after having kids that I didn't want to lose those results. So I had created really my own regimen, became really disciplined, motivated, worked out. And one day I broke my knee and couldn't exercise. And so I had already really achieved my weight goal where I was, but having that knee injury, I had gained a couple of pounds and heard about this as an option as I was kind of getting ready for a girl's trip, and I thought, hmm, I'll maybe just give that a whirl. Why not?

(03:06):
And it really worked. I mean, it got me back off of those couple of pounds and I only did it for maybe four to six weeks just to shed those pounds after my injury. And then went back to my disciplined regimen and was working out again after I got back from my injury. And then I thought to myself, "Gosh, this is like torture sometimes having to really go, I can only eat this much or managing my caloric intake." And then we got it within the practice here and I thought, "I'm just going to go back on this at a really low dose to help me more sanely manage this weight that I had worked so hard to achieve." And not just from, of course, the surgical work that I had put into it, but also the work afterwards.

(04:06):
And so for me, I just feel like I'm doing what I already did in terms of the food and the intake and everything. I'm not really changing that, but it's just not as much of a struggle. I'm just on the lowest dose and you can do so many different things where you even maybe just take it every other week or go on the lowest dose. Because what I like about the lower dose is I still have an appetite. I still have to resist things on my own. And then that way, if later down the road I'm not using this medication, I'm going to be okay to take off the training wheels.

Monique Ramsey (04:53):
I was just going to say the exact same thing. The training wheels can come off, but I like what you're bringing up about kind of the struggle. It's very hard to maintain a good weight even when you're doing all the right things, and especially as we age, and I hate to say it since we all are. And as a woman, I just turned 58. It's hard post-menopause, even the perimenopause, but you could do the same exact thing as you did in your 30s and it doesn't work. You could think, "Oh, I'm just going to be really good for a couple weeks and I won't drink and I'll take off five pounds." No, no. You could do all those things and be completely killing it in the gym and doing all the ... And you don't make any progress. And so there's so many different changes going on in people's bodies as they age. And you're right, it is like a lot of mental stress. And if you can do what ... And I hear the term micro dosing and is that kind of what you're alluding to?

Janelle (05:56):
Yeah, just a really low dose and it helps you maintain where you're at. So somebody maybe who's looking to lose weight would have a little higher dose that might curb their appetite a little bit more, but it really just reduces your cravings. You just don't crave things like ... Even alcohol, you don't crave that as much. And so it's nice because if you are at a restaurant or at a party and there's all these wonderful, tempting options, it's like you might have some of it, but just a little bit because you're not wanting to just gorge. And I always think that's an important balance. I don't want to deprive myself from having those delicious things and enjoying the wonderful foods that are out there. I just am not going to eat a lot of it. And I think that's what it comes down to is it helps you maintain not just your caloric intake, but your portions or maybe just not even putting some things in your mouth in the first place.

Monique Ramsey (07:02):
There's a funny ... I'm going to put this in the show notes too, because Amber, I think, made a really funny video, Amber or Gretchel where we have those, somebody had brought in those crumble

Janelle (07:13):
Crumble cookies. Yes.

Monique Ramsey (07:15):
And she's kind of from the point of view of the person passing the cookies and people are like, "No, I'm good. I'm good."

Janelle (07:23):
Or you have a- No, we laugh because we've had potlucks and people bring in food all the time here over the years, it used to get devoured and now this stuff sits around and we're like, "This is the skinny shot here." Nobody's eating anymore and they're eating just not like ... I mean,

Monique Ramsey (07:45):
You just don't need the whole thing. And it's nice. You could just cut it in fourths and have a fourth and you feel like I'm participating, I'm celebrating and I'm enjoying to your point of it doesn't take away the-

Janelle (07:59):
The fun. Yeah. T

Monique Ramsey (08:01):
he fun and the yumminess. Right. So it's been interesting to watch. I've seen in the media things shift over time. And when these GLP-1s first came out, and maybe it was like Sharon Osborne was taking them and Kelly and her daughter, and there were some kind of, I think Oprah, there was some high visibility people who were taking that and there was a lot of backlash at first. But over time, I think people have been more open and even the advertising you see from these big companies, trying to sort of take the shame away from it. It's like, it's okay to use a tool. And I feel like it's a little more mainstream now.

Janelle (08:45):
Yeah. And we were talking earlier, it's like how you feel on the outside affects your inside so much. And you had said, "Don't let it take up your mental space." And it's true. I mean, we're going to have a little extra pep in our step that day that when we put on our clothes and we feel good and yes, and I think some of the people that have maybe given some negative comments about it too is not just the thin people, but sometimes the heavier people who want to say they're comfortable in their skin and that's okay. They might be, but I think none of us can deny that it doesn't ... It's like shopping and finding clothes that fit and all of those things just make life easier and we feel better and we're going to be a better mom or a better wife or husband, you're just going to be the best version of yourself.

Monique Ramsey (09:41):
Right, right. Well, it's kind of like when you go get your hair and makeup done for a big event, you put on a beautiful dress or a great outfit and you know you look great and you have that like extra, like you say, pepping your step or that edge and having that extra weight not be part of your mental conversation, I think is very liberating and freeing. And I'm glad that more people are talking about it and saying, "Yeah, that's what I'm doing."

Janelle (10:10):
Well, and think about the people that are in the media maybe that have gotten really thin. Those might be extreme cases where people are kind of thinking and more of a negative because you see that too with cosmetic procedures, people who've overdone their faces, their lips, and that's the representation that they think this medication or that procedure is. And there's probably a lot of people walking around that are taking these at a very reasonable dose and doing it responsibly and you would never know. You wouldn't look at them and say, "Oh, they must be on a GLP." But the people that are maybe allowing themselves to waste away or get too thin and not doing it in a healthy way would be someone that people would have a negative perception on.

Monique Ramsey (11:06):
True. And I think that's something that really makes the skinny shot at the surgery center that we've developed this program and now it's been more than two years and we've had hundreds and hundreds of patients and probably thousands of pounds lost. I don't know how many pounds we've had collectively lost. But Dr. Haas is our director of the Skinny Shot program and sort of the health and wellness side of our practice. And the fact that you have somebody who's going to help manage and not let you get too thin and make sure ... We've got Lauren who checks in with you every week, every couple weeks as you are using these medications and making sure that you're not wasting away, that you're not losing muscle, that you're eating the right things, especially when you're on it at first, you really ... I mean, it's a big difference in how hungry you are and you want to make sure, because you're not hungry, that you might not be eating enough.

Janelle (12:08):
Then maybe they need to reduce your dose because you have to be eating a certain number of calories. You have to be doing a certain amount of protein. And so they're really on top of that. And I think too, there's a lot of programs that just automatically do a monthly increase. And if it's working and you're losing weight, then why increase? And so I think-

Monique Ramsey (12:33):
Why increase.

Janelle (12:34):
That's what I love about the team's approach with the Skinny Shop because-

Monique Ramsey (12:39):
Yeah. And making sure it's safe.

Janelle (12:40):
Yeah. Exactly. And you can even, with our program customized, you don't even have to go up to the full next dose. You can do something in between and really take baby steps or do one shot every 10 days instead of every week. And there's so many things that can be customized to the person's goals.

Monique Ramsey (13:03):
So you're taking it now still, right?

Janelle (13:06):
Yep.

Monique Ramsey (13:07):
Can you give us an idea of how often you take it?

Janelle (13:09):
So I've done different maintenance doses 0.25 for the semaglutide, which is the lowest starting dose, or I'll do it less frequently. So maybe two syringes a month or two shots per month, like every other week, or just that super low dose every week, just kind of depending on how things are going. But yeah, I just use it to stay right where I'm at. I'm not looking to lose weight.

Monique Ramsey (13:38):
Well, and I think there's all kinds of studies coming out there. They're really studying these drugs because it's such a new thing. And I guess there's like hundreds of gut hormones technically that ... So they're testing different gut hormones. So the GLP-1 works on one gut hormone and then the GIP that works on a different ... So the tirzepatide works on two different gut hormones, the semaglutide on one gut hormone. So they're studying more and more and seeing what things work. And I noticed a TV ad the other day, there's a pill form. And so there's like different things that science is coming up with, which I think is great because then you're not feeling like, "Well, God, what are the long-term implications if I'm taking this high dose forever, but I feel like I can't go off of it? " So it's nice that our program lets you really customize it and just do the minimum you need to stay where you want to be.

Janelle (14:35):
Not try to fall in a bucket that everyone else, the average person might need. It's really what they need.

Monique Ramsey (14:44):
Yeah. So what surprised you most when you started this medication or when you took it, what surprised you about it?

Janelle (14:52):
I've always loved food and had a really hard time resisting it. And some people are not big foodies, I am. And so it was always harder for me and it just was a big relief to not have that struggle. And it's weird because you look around sometimes and you see people gorging and you're like, "Gosh, it's weird because I don't have that desire." And then you almost feel full just looking at them. And I would say the other thing was just how good I felt. And you do have some adjustments sometimes on energy levels and things like that, but I love that it forces you to eat good. You have to have your protein and not have too much sugar and things like that because that will maybe have some of the side effects more prevalent. And so you really do have to still have some discipline.

(15:52):
And I like that you still have to have that conscious eating. And I just felt good if it was nice to be able to go about other things and not have to worry about, "Oh my gosh, what's for lunch today?" And just ... Yeah.

Monique Ramsey (16:10):
Well, it's impossible if you work at the surgery center because there's

Janelle (16:13):
Always

Monique Ramsey (16:14):
Food.

Janelle (16:14):
Yes, yes.

Monique Ramsey (16:15):
People bring in so many wonderful little treats and our patients give us treats. And so it's like you can't escape it. At least I work from home. So I only have to deal with what's in my house.

Janelle (16:27):
I would eat so much better if I wasn't here every day. That is a huge-

Monique Ramsey (16:32):
Yeah. If you can't resist, I mean, I guess for people who can resist temptation, it's not a big deal, but

Janelle (16:38):
Most people, most people can't.

Monique Ramsey (16:40):
Right, exactly. And I think that's why these are so popular, why one in seven is thinking about taking one, because it is hard. And I think that's everybody acknowledging, but you want to be healthy. And I think if you're overweight, there's a lot of things that come down that road at you. If you're overweight, there's heart issues, there's inflammatory problems, there's diabetes or pre-diabetes and a whole lot of stuff that can happen. And so it's like, not only are you taking control of what you eat and how you're feeling mentally, but you're also then your physical body, you're at less risk for some of these other- Well,

Janelle (17:24):
I think that's why a lot of the stigma has gone away from it too, because people are looking to improve their health and you can't argue with that. It's not just a weight thing, it's what the weight loss can do for your overall health.

Monique Ramsey (17:39):
Being in charge of everything there at the surgery center, you're in on a lot of the decision making. And so how has your personal experience using the skinny shot helped you decide on how to work with this program for our patients and how you make decisions about it?

Janelle (17:57):
Yeah, it has. I mean, it definitely has because I can understand what the patient is looking for. And being 46 years old and having your metabolism change as you get older, and that's, I think, a big portion of the patients that we're having come to us are women in their 40s or 50s going through menopause and really having their metabolism come to a screeching halt and struggle with it. And that's a big portion of our patients. And what's also interesting too is I'm finding a lot of people are just like me. There's a lot of patients who really aren't coming that have a lot to lose. They're just looking for those last 10 to 20 pounds. And sure, we've had some people that have had an upward of 40 or 50 pounds to lose, but it's really, it's just, I think reaffirming to what my experience is seeing, who is coming and contacting us, but also us developing messaging and things based on what I know is huge.

(19:14):
And it's really like, who doesn't want to just be able to resist some of those temptations? Or even if you can do it on your own, could I do it on my own? Absolutely. And I think a lot of these people could, but the reason why people fall off so easily is because it's hard. And so if you can get there and it'd be more saying, why not? And yes, there is a cost associated with it. Obviously, that can be a barrier for people, but truthfully, you will save money on food. You will. It's true. Yeah. And so it all balances out and you might even not have to buy a new wardrobe if you can get back into some things that you used to wear. So there's- This is true. It's girl math. You can figure out a way to justify the investment.

Monique Ramsey (20:11):
Exactly. Is there anything that you didn't understand about the GLP-1s until you used it?

Janelle (20:19):
I'm not sure because I was such an early adopter when it was-

Monique Ramsey (20:23):
True.

Janelle (20:23):
... early on and I actually didn't even know where this would take us. And once it did really kick off, we thought the management team, we need to do this because this is the solution for our patients that we've been missing. And so we have so many surgery patients who come in for a consult, have 10 or 15 pounds to get them maybe to their goal weight or where it would make most sense to do the surgery. And now we have an option for them. And before losing only 10 or 15 pounds, sometimes those are the hardest few pounds to lose and they would be discouraged because they're like, "I don't know if I can do this unless I can get there." And so now that we've got this option, it's just, we have so many of our surgery patients doing it before or doing it after, or some people that just contact us because they want something that's really managed by a doctor, high touch, high follow up, which doesn't always happen in some of the other programs.

Monique Ramsey (21:37):
Right. And I think that's really where the value of what we bring, not only the experience of helping hundreds of patients, but helping you manage it as you're coming off of it or as you want to sort of do a more personalized or customized micro dose to keep the results that you've got. So I love that the surgery center offers this tool and so many of our staff have partaken and our doctors and they really, it's like until you experience it, I guess it's hard to know, but it really is a game changer. And I think that's why that article was talking about one in seven Americans and people want to feel confident, people want to feel healthy and that they're their best version of their self.

Janelle (22:24):
Well, I think when the microdosing concept came out, when you're doing a low dose, that also kind of made it trend a little bit more socially acceptable because it was like-

Monique Ramsey (22:37):
True.

Janelle (22:38):
"I'm just doing a little bit."

Monique Ramsey (22:40):
It's like having a mini face lift. Yeah. Nobody wants a full face lift. They want a mini. And okay, we'll call it a mini. I don't need the full thing.

Janelle (22:49):
Right. So I think that also made a difference. And then the other thing that I was going to say, a lot of our patients too, you have to be at a safe wait to do surgery. So there are people who need to get down into a safe BMI so that they don't have increased risks from having general anesthesia. So there's lots of different reasons why this just is a natural path for people before or after.

Monique Ramsey (23:22):
And what are the procedures that people are most curious about after they lose weight?

Janelle (23:28):
I would say anything where they might have some excess skin, which could be from their face, face and neck lift, people lose that facial volume. And so a facelift will help with some of the laxity in their skin. And then we can even do fat transfer to give them back some of that volume and youthfulness that can go with losing fat. So definitely facial procedures. And then even sometimes patients will want to do some body work where you might have a skin tummy tuck or arm lift or something to deal with that. But really, if it's not an extreme weight loss, your body usually can be pretty resilient and there might just be some fine tuning. Even there's always some stubborn areas like our love handles that sometimes are resistant to diet and exercise. And so lipo can kind of give you that finishing touch to all the hard work that you've done to get some of those stubborn areas and sculpt, because sometimes weight loss won't necessarily sculpt you and give you that hourglass figure that we all kind of would love to have.

(24:46):
And then of course, breast lift, sometimes people lose weight in their breasts and they may need to have a lift then if they got kind of lax after losing that. So lots of things.

Monique Ramsey (25:00):
And lots of things. And what do you think maybe are the biggest misconceptions that people have about GLP-1s?

Janelle (25:08):
I think a lot of people think you lose your muscle and you can if you don't do it right. If you're not feeding your body and not eating the right things like protein, that can come with any weight loss. It's not necessarily the GLP, the medication itself, it's weight loss. That is what's doing that to your body if you're not feeding it appropriately. So same thing with hair loss. Hair loss is something that can happen with any weight loss, not necessarily correlated to the medication. And I think too, the faster that you lose weight, the more some of those things can happen. So doing it more slowly and steady and safely, you're not going to have some of those.

Monique Ramsey (25:54):
And thinking about hair loss, I think that's something that good that you brought up because yeah, that can happen with any weight loss. And if you're not taking all your vitamins and you're not eating the protein, but also as you get older, your hair starts falling out. I'm the first one to attest. So it's almost like a double whammy. If you happen to be in an age where your body's changing and hormones are fluctuating, it's just like when you're pregnant, all of a sudden you have this amazing lush mane of hair and then you have the baby and you're like, "Where do my hair go? " And people lose a ton. Well, it's all these hormonal shifts.

Janelle (26:30):
It's only a certain percentage of people that might have that struggle, but like you said, there's so many things that can contribute to it. And again, people just sort of glom on and hold onto the negatives and the small percent, and that doesn't really represent the majority.

Monique Ramsey (26:47):
What I've noticed about this Skinny Shot program, when we started offering it, I was super excited about it, I still am super excited about it because it does fill that gap for patients. But what's so interesting is that people have chosen us to come to. It's like there's a bazillion other places out there that offer some version of a skinny shot, but I think the trusted part of the practice. And tell me a little bit about how you see that manifest.

Janelle (27:17):
It's true because there's just so many people popping up and offering this and this is a medication. You don't want to just be taking it with somebody that you don't know how they're going to be managing it or what the ... I mean, we do lab work and everything to make sure you are safe to have this medication. And so it's really, I think, just like even with our med spa, I think a lot of our surgery patients felt comfortable going and exploring other procedures because they trusted the care that we provided through their surgical procedure. And so same thing. I think we have such a strong reputation of trust with our patients, but also in the community. And so if you're going to embark on a new thing like this, you want to make sure it's being managed by someone you can trust.

Monique Ramsey (28:11):
That's true. That's true. And I think having that kind of trusted team between Dr. Haas and Lauren, you've got somebody that's never more than a text message away to help you navigate something. Or if you're really having some side effects that are not good, let's fix it. Let's figure, let's problem solve and them helping you through any hiccups you have. And they're part of your team. And I'll put a link in the show notes too, because we've been surveying our Skinny Shot patients. And so the reviews are just wonderful.

Janelle (28:49):
So good.

Monique Ramsey (28:49):
It's so heartwarming, So heartwarming. When I see one of those reviews come through of how it helped change their life and how the team at La Jolla Cosmetic Surgery Center has helped them through this skinny shot navigation. It's not some drug company shipping you something in the mail and you're like, "Okay, here we go. " And you don't know who to ask for help if you need it.

Janelle (29:14):
Well, and we make that part of it individual too, because we've had, in the very, very beginning, we were so high touch and wanting to talk to them all the time, see how they were doing before we gave them their next round of medications. And there were several people that were like, "I don't want to have a phone conversation or a consult. I just want my medications and leave me alone." And so we developed an online evaluation that you can take every month to track your progress where you can do it at your own time and make the follow-up and make the experience however you want it. And of course, you can request a call and all of those things. And there is a point where we still have to connect with you over the phone or in person, but you can make that whatever you want too, because there are some people who are like, "I just want to pick up my medications. I'm fine. I'm happy. Let me go. "

Monique Ramsey (30:13):
You don't have to hold my hand through, but for the people who do need that-

Janelle (30:17):
Then we're here.

Monique Ramsey (30:19):
I like that. I like that because it's sort of like the old days of Jenny Craig and you had to go to the meeting if you wanted to pick up your special food. Yes. It's like, "I don't want to go to the meeting." So I like that, that kind of the administrative side of it is sort of customized as well.That's really good.

(30:39):
This was so good. Janelle, thanks for being so open and transparent and sharing the reasons why you started the Skinny Shot and how you're using it today. And for everybody listening, I have a lot of things that I said I'll put in the show notes and I promise you I won't, but Hannah will. And we'll have that there for you, all these different resources. So thanks everybody today. And if you're thinking about the Skinny Shot, all you have to do is just send us a text message or give us a call and Lauren can tell you about pricing, about how the Skinny Shot program works, how to get started. It's not hard to get started at all. So thanks again, Janelle.

Janelle (31:19):
Of course. Thank you.

Monique Ramsey (31:20):
And we will see you on the next one. Bye.

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