Abdominal Body Contouring After Bariatric, Pharmacological, and Combined Weight Loss: A Narrative Review and Clinical Decision Framework

Abdominal body contouring after substantial weight loss increasingly involves patients treated by bariatric surgery, incretin-based pharmacotherapy, or both. This focused narrative review updates surgical planning across these trajectories, with emphasis on timing, nutritional and hematological preparation, procedure selection, perioperative incretin management, complications, and patient-reported outcomes. The original structured PubMed searches were supplemented during revision by a focused screen of comparative incretin/body-contouring studies and primary perioperative aspiration studies through 24 October 2026. Comparative body-contouring evidence remains observational and heterogeneous: some cohorts report no independent modality effect, whereas others associate GLP-1 receptor agonist exposure, rapid weight loss, or combined treatment with selected wound complications. Two recent meta-analyses similarly identify limited and inconsistent signals rather than a uniform risk pattern. Gastric-ultrasound studies demonstrate more residual gastric content in semaglutide users, but clinical aspiration data are conflicting, supporting individualized anesthetic assessment rather than a universal interruption interval. Practical assessment should integrate weight trajectory, achieved intake, anemia and micronutrient risk, anatomical deformity, psychological readiness, venous-thromboembolism risk, abdominal-wall pathology, and the cumulative recovery burden of combined procedures. Comparative evidence supports dead-space reduction and consideration of Scarpa fascia preservation for seroma prevention. A proposed decision framework distinguishes evidence from professional guidance and review-derived clinical judgment. The framework is not a validated prediction instrument and requires prospective evaluation.