Physician-Directed Weight Loss
What Medical Weight Loss Is
Medical weight loss is a physician-directed program in which a licensed provider evaluates your health, orders labs, and prescribes a GLP-1 medication such as semaglutide or tirzepatide when clinically appropriate for adults with a BMI of 30 or higher, or 27 or higher with a weight-related condition, producing mean losses of up to 14.9 to 20.9 percent in clinical trials. Because rapid weight loss can hollow the face and loosen skin at the abdomen, arms, and thighs, the program builds protein targets and resistance training into the plan from the first visit and coordinates with dermal fillers, PRF EZ Gel, or body contouring once weight is stable.
Medical weight loss is a physician-directed program in which a licensed provider evaluates your health, orders labs, prescribes a GLP-1 receptor agonist medication such as semaglutide or tirzepatide when it is clinically appropriate, coaches nutrition and habits, and monitors you every 4 weeks while the dose is escalated and regularly after that. At Functional Wellness at Howarth Plastic Surgery, the Scottsdale practice of board-certified plastic surgeon Ashley Howarth, MD, FACS, the program is for adults with a body mass index of 30 or higher, or 27 or higher with a weight-related condition such as high blood pressure, prediabetes, or sleep apnea, who want supervised, evidence-based weight loss rather than a prescription mailed to the door. The evidence is specific. In the STEP 1 trial of 1,961 adults, once-weekly semaglutide 2.4 mg produced a mean weight loss of 14.9 percent at 68 weeks against 2.4 percent with placebo. In SURMOUNT-1, 2,539 adults on tirzepatide lost a mean of 15.0, 19.5, and 20.9 percent at the 5, 10, and 15 mg doses at 72 weeks against 3.1 percent with placebo. Both were published in the New England Journal of Medicine, and both drugs are FDA-approved for chronic weight management.
What makes the program different is where it lives. Weight loss of 15 to 20 percent changes the face and the body, and a plastic surgery practice is built to see that coming. Rapid loss deflates the fat pads of the cheeks and temples, and the resulting hollowing and loose skin of the face is treated here with dermal fillers or PRF EZ Gel once weight is stable. Loss of 50 pounds or more leaves skin laxity at the abdomen, arms, and thighs that no medication reverses, and body contouring surgery is evaluated by the same surgeon who directs the program. A portion of every pound lost on a GLP-1 medication is lean mass, so protein targets and resistance training are written into the plan from the first visit. Patients whose weight problem is partly hormonal are evaluated alongside bioidentical hormone replacement, and the wellness guide explains how the two services coordinate.
Why Patients Ask for Medical Weight Loss
What Patients Who Choose Medical Weight Loss Notice
Most people who ask Howarth Plastic Surgery about medical weight loss have already tried the rest. They have lost and regained the same 20 pounds, been told by their primary care physician that their A1c or blood pressure is drifting, or been quoted a surgery date that depends on a lower body mass index. Many have a friend on a GLP-1 medication and a specific worry about their face. These are the findings the team hears most.
- Weight that comes back within a year of every diet
- A hemoglobin A1c, blood pressure, or cholesterol number that keeps rising
- A tummy tuck, breast lift, or facelift plan that is waiting on weight loss
- A friend on a GLP-1 medication whose face looks older than it did
- A weight loss prescription from an online clinic with no follow-up
- Weight gained after pregnancy or menopause that exercise alone has not moved
GLP-1 medications solve the appetite and regain problem for most patients who can take them, and a monitored program solves the side-effect and follow-up problem. What the medication cannot do is choose where the weight comes from or what the skin does afterward, which is why the plan is written by a plastic surgeon from the first visit.
Where to Start
Who Medical Weight Loss Is For, and What Happens First
Medical weight loss at Howarth Plastic Surgery is for adults with a body mass index of 30 or higher, or 27 or higher with a weight-related condition, who are not pregnant or planning pregnancy, have no personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, and are willing to attend monthly visits and follow a nutrition and strength plan. The first visit is a medical evaluation, not a prescription. A licensed provider under Dr. Howarth’s direction takes a full history including prior weight loss attempts, thyroid and pancreatic history, gallbladder disease, gastrointestinal conditions, diabetic eye disease, depression, and every current medication; measures weight, waist, and blood pressure; and orders baseline labs, typically a comprehensive metabolic panel, lipids, hemoglobin A1c, and thyroid-stimulating hormone. If the labs point to a thyroid or hormonal cause, the plan turns toward a workup and, where appropriate, bioidentical hormone replacement before or alongside medication. If the history includes medullary thyroid carcinoma or a MEN2 diagnosis in the family, GLP-1 medications are not prescribed and the conversation moves to the alternatives. The provider also photographs the face and asks about the body areas that concern you, because the plan for skin laxity and facial volume starts now, not after the weight is gone.
Dr. Ashley Howarth, MD, FACS is a board-certified plastic surgeon and an instructor in plastic surgery at Mayo Clinic. Howarth Plastic Surgery, including its Functional Wellness and Aesthetica by Ashley Howarth MD services, is at 7373 N. Scottsdale Road, Suite C150, Scottsdale, Arizona 85253.
Medication, Coaching, Monitoring, and the Aesthetic Plan
How Medical Weight Loss Is Done at Howarth Plastic Surgery
GLP-1 Medications: Semaglutide and Tirzepatide
Semaglutide and tirzepatide are once-weekly injections that curb appetite and are escalated gradually to a maintenance dose, with the provider choosing between them based on your history, tolerance, and goal.
Both medications are once-weekly injections that mimic the gut hormone GLP-1, slowing stomach emptying and acting on appetite centers in the brain so that a smaller meal satisfies; tirzepatide also activates the GIP receptor. Semaglutide is escalated over 16 weeks from 0.25 mg to a maintenance dose of 2.4 mg, and in STEP 1 produced a mean 14.9 percent weight loss at 68 weeks. Tirzepatide is escalated from 2.5 mg in 2.5 mg steps every 4 weeks to a maintenance dose of 5, 10, or 15 mg, and in SURMOUNT-1 produced 15.0 to 20.9 percent at 72 weeks. The provider chooses between them on your history, your tolerance, and your goal, and prescribes only after the evaluation and labs. Nausea, diarrhea, constipation, and vomiting are the common side effects, mostly during escalation, and the dose is held or slowed rather than pushed through them.
Nutrition, Protein, and Muscle Preservation
Because a meaningful portion of weight lost on GLP-1 medications is lean mass, coaching centers on daily protein targets, fiber and fluid, and resistance training two to three times a week.
A GLP-1 medication reduces how much you eat; it does not decide what. Because a meaningful portion of weight lost on these drugs is lean mass, the coaching at Howarth Plastic Surgery centers on protein, roughly 1.2 to 1.6 grams per kilogram of body weight each day spread across smaller meals, fiber and fluid to blunt constipation, and resistance training 2 to 3 times a week. Habit coaching covers eating slowly, stopping early, alcohol, and the hydration that Arizona heat demands. The goal is fat loss that the body can maintain and the face and skin can carry, which is a different target from the lowest number on the scale.
Monitoring: Monthly Visits, Labs, and Dose Decisions
Patients are checked every 4 weeks during dose escalation and every 4 to 8 weeks after, with labs repeated at about 3 and 6 months and a supervised maintenance dose or taper once the goal weight is reached.
Every escalation step is a visit or a check-in: weight, blood pressure, side effects, and a dose decision, every 4 weeks until the maintenance dose is reached and at least every 4 to 8 weeks after that. Labs are repeated at about 3 and 6 months. Persistent vomiting, severe abdominal pain, gallbladder symptoms, a change in vision in a diabetic patient, or a mood change is a call to the office, not a wait for the next appointment. When the goal is reached, the program does not stop abruptly; trial data show weight returns when the medication is withdrawn without a plan, so the provider builds a maintenance dose or a supervised taper with the nutrition and strength plan carrying the load.
The Plastic Surgery Angle: Face, Skin, and Body
Once weight is stable, facial hollowing from major weight loss is treated with dermal fillers, PRF EZ Gel, or facelift, while loose skin at the abdomen, arms, and thighs is evaluated for body contouring surgery by Dr. Howarth.
This is the card no weight loss clinic can write. Loss of 15 to 20 percent of body weight deflates the cheeks, temples, and under-eye area and loosens the jawline, and once weight is stable those changes are treated with dermal fillers, PRF EZ Gel, or, when the descent is real, facelift and neck lift. Loss of 50 pounds or more leaves an abdominal apron, loose arms and thighs, and deflated breasts that no cream, laser, or medication tightens; those are evaluated for body contouring surgery by Dr. Howarth once weight has been stable for about 6 months. Mild skin laxity in between is where SkinTyte, SkinPen, and Ellacor have a role, and the honest line between those and surgery is drawn by a surgeon.
At a Glance
The Program at a Glance
The stages of medical weight loss at Howarth Plastic Surgery, what happens at each, typical timing, and who is involved; individual plans are set at the medical evaluation.
| Stage | What happens | Timing | Who is involved |
|---|---|---|---|
| Medical evaluation | Full history, screening for medullary thyroid carcinoma, MEN2, pancreatitis, and pregnancy, weight, waist, blood pressure, baseline facial photographs | Visit 1, about 45 to 60 minutes | Licensed provider under Dr. Howarth's direction |
| Baseline labs | Metabolic panel, lipids, hemoglobin A1c, thyroid-stimulating hormone; hormone labs when history suggests it | Drawn at or just after visit 1; reviewed before any prescription | Licensed provider; Dr. Howarth reviews abnormal results |
| Prescription and teaching | Semaglutide or tirzepatide chosen and prescribed, injection taught, written escalation schedule, protein and strength plan | Once labs are reviewed, usually within 1 to 2 weeks of visit 1 | Licensed provider |
| Escalation | Dose stepped up every 4 weeks as tolerated; side effects managed; weight and blood pressure recorded | 16 weeks for semaglutide; 12 to 20 weeks for tirzepatide | Licensed provider at monthly visits |
| Maintenance and monitoring | Maintenance dose, visits every 4 to 8 weeks, labs at about 3 and 6 months, facial volume and skin tracked | Months 5 to 12 and beyond | Licensed provider; Dr. Howarth reviews the aesthetic plan |
| Goal and aesthetic planning | Maintenance dose or supervised taper; fillers or PRF for facial volume, devices for mild laxity, surgical consultation after major loss | At goal, with weight stable about 6 months before surgery | Dr. Howarth with the licensed provider |
Two Medications
Semaglutide vs Tirzepatide
How the two GLP-1 receptor agonist medications prescribed at Howarth Plastic Surgery compare, using their pivotal New England Journal of Medicine trials and FDA labeling; the provider chooses between them at the medical evaluation.
| Semaglutide | Tirzepatide | |
|---|---|---|
| Mechanism | GLP-1 receptor agonist: slows gastric emptying and reduces appetite through GLP-1 pathways | Dual GIP and GLP-1 receptor agonist: the same GLP-1 actions plus GIP receptor activity |
| Trial result | STEP 1, 1,961 adults: mean weight change minus 14.9 percent at 68 weeks vs minus 2.4 percent with placebo | SURMOUNT-1, 2,539 adults: mean weight change minus 15.0, minus 19.5, and minus 20.9 percent at 5, 10, and 15 mg at 72 weeks vs minus 3.1 percent with placebo |
| Dosing cadence | Once weekly; 0.25 mg for 4 weeks, then 0.5, 1.0, 1.7, and 2.4 mg at 4-week steps; maintenance 2.4 mg | Once weekly; 2.5 mg for 4 weeks, then increases of 2.5 mg every 4 weeks; maintenance 5, 10, or 15 mg |
| Common side effects | Nausea, diarrhea, vomiting, constipation, mostly mild to moderate during escalation | Nausea, diarrhea, constipation, vomiting, mostly mild to moderate during escalation; dose-dependent |
| Who it suits | Adults meeting the body mass index criteria who prefer a single-agonist medication with the longer track record, including cardiovascular outcome data | Adults meeting the criteria who need the larger expected loss, or who did not tolerate or plateaued on semaglutide |
| What to know | Boxed warning for thyroid C-cell tumors; not for personal or family history of medullary thyroid carcinoma or MEN2; not in pregnancy; weight returns when stopped without a plan | The same boxed warning and contraindications; not compared head to head with semaglutide in the pivotal trials; the practice prescribes the FDA-approved medication only |
A Program Built Around Your Labs
What to Expect at a Medical Weight Loss Visit at Howarth Plastic Surgery
A medical weight loss program at Howarth Plastic Surgery has three parts: a medical evaluation with labs that decides whether a GLP-1 medication is appropriate and which one, a prescription with a written escalation schedule and injection teaching, and a monitoring calendar with nutrition coaching and an aesthetic plan. The first visit takes about 45 to 60 minutes; follow-ups about 15 to 20.
History, measurements, baseline labs, and a candidacy decision
The licensed provider takes a full medical and weight history, screens for medullary thyroid carcinoma, MEN2, pancreatitis, gallbladder disease, and pregnancy, measures weight, waist, and blood pressure, photographs the face, and orders a metabolic panel, lipids, hemoglobin A1c, and thyroid-stimulating hormone. Labs are reviewed before any prescription is written.
The medication chosen, the schedule written, the first injection taught
If you are a candidate, semaglutide or tirzepatide is prescribed with a written escalation schedule, and the provider teaches the once-weekly injection on a training pad and then with you. You leave with the side-effect plan, the protein target, a resistance training plan, and the date of the 4-week check-in.
Monthly dose decisions, repeat labs, and planning for face and skin
Every 4 weeks during escalation the dose is held, slowed, or advanced based on weight and side effects; labs repeat at about 3 and 6 months. At each visit the provider notes facial volume and skin changes, and at 10 to 15 percent loss Dr. Howarth reviews whether fillers, PRF, or a surgical consultation belongs on the calendar.
Clear Information. Informed Choices.
Safety and Limitations of Medical Weight Loss
GLP-1 receptor agonists are safe for most adults who qualify when they are prescribed after a medical evaluation and escalated slowly under monitoring. The common side effects are gastrointestinal, nausea, diarrhea, vomiting, and constipation, affecting a substantial share of patients in both pivotal trials, mostly mild to moderate and concentrated in the escalation weeks. The serious risks are less common and are the reason the evaluation exists: pancreatitis, gallbladder disease including gallstones that form during rapid loss, dehydration and kidney injury from persistent vomiting in the Arizona heat, low blood sugar when combined with insulin or sulfonylureas, worsening of diabetic retinopathy, and, rarely, bowel obstruction. Both medications carry a boxed warning for thyroid C-cell tumors seen in rodents, and neither is prescribed to anyone with a personal or family history of medullary thyroid carcinoma or MEN2. Neither is used in pregnancy, and semaglutide is stopped at least two months before a planned pregnancy. Weight returns when the medication stops without a maintenance plan. And no medication chooses where the weight leaves; the face and skin changes are real, and the practice plans for them rather than pretending they do not happen.
Possible Side Effects Include
- Nausea, diarrhea, vomiting, or constipation, mostly during dose escalation
- Fatigue, headache, dizziness, or reflux
- Gallstones or gallbladder inflammation with rapid loss
- Rarely, pancreatitis, kidney injury from dehydration, or bowel obstruction
- Facial volume loss and skin laxity as weight comes off
What Treatment Cannot Guarantee
- Weight loss that stays off after stopping without a maintenance plan
- Fat loss without any loss of muscle
- A face or body that looks as it did before the weight was gained
- Skin that tightens on its own after 50 or more pounds lost
- A prescription without an evaluation, labs, and follow-up
What Happens on the Program
The Medical Weight Loss Timeline
Medical weight loss is a timeline rather than a recovery, and it runs in months. The escalation phase is 16 to 20 weeks, most weight comes off between months 2 and 12, and the maintenance decision arrives at about a year. Appetite changes within the first two weeks; body composition and energy change over 6 to 8 weeks; the face changes by about 10 percent loss; and skin laxity declares itself after 30 to 50 pounds. Every stage below includes the aesthetic plan, because at Howarth Plastic Surgery the surgeon who reads the labs is the surgeon who will be asked about the skin.
The first injection is given in the office. Within days meals feel smaller and food noise drops; mild nausea, fullness, or constipation is common and is managed with smaller meals, fluids, and fiber. Weight loss in the first month is modest, usually 2 to 4 percent, and the point of the low starting dose is tolerance, not speed. Protein and resistance training begin now so that what is lost is mostly fat.
The dose steps up at each monthly visit if side effects allow, over 16 weeks for semaglutide and 12 to 20 weeks for tirzepatide depending on the target dose. This is when most gastrointestinal side effects occur and when a step is held or slowed. By the end of escalation most patients have lost 8 to 12 percent, energy has improved, and the provider has begun tracking facial volume in the chart. Labs repeat at about 3 months.
On the maintenance dose weight continues down toward the 15 to 20 percent seen in the trials by month 12 to 17. This is when cheeks and temples hollow and when abdominal, arm, and thigh skin loosens after major loss. Dr. Howarth reviews the photographs and the plan: fillers or PRF EZ Gel for facial volume once weight is stable, SkinPen or SkinTyte for mild laxity, and a surgical consultation when the skin will not recover on its own.
At goal, the provider and Dr. Howarth decide between a long-term maintenance dose and a supervised taper, with the nutrition and strength plan carrying the result; trial data show most weight returns within a year of stopping without one. For loss of 50 pounds or more, body contouring surgery is evaluated once weight has been stable for about 6 months. Hormonal contributors are reassessed alongside bioidentical hormone replacement where relevant.
Surgeon-Directed Care
More Tools in the Toolbox: Why a Plastic Surgeon Directs Medical Weight Loss
Functional Wellness at Howarth Plastic Surgery is directed by Ashley Howarth, MD, FACS, a board-certified plastic surgeon and instructor in plastic surgery at Mayo Clinic. A weight loss clinic measures success on a scale. A plastic surgeon measures it on the whole patient, because she is the physician who will be asked, twelve months from now, why the face looks tired and whether the abdominal skin will recover. Her direction shapes the program in three ways. First, candidacy is a medical decision, and the evaluation screens for the conditions that make GLP-1 medications unsafe, medullary thyroid carcinoma and MEN2 in the family, pancreatitis, pregnancy, before any prescription is written; a patient who is not a candidate is told so and given the alternatives. Second, the plan protects muscle and skin quality from the first visit, with protein targets and resistance training written into the coaching, because a surgeon knows that skin retracts better over preserved muscle and that a deflated face ages a patient faster than the weight did. Third, the aesthetic consequences are planned rather than discovered: facial volume is photographed at baseline and tracked, and the conversation about fillers, PRF, or surgery happens on schedule.
The program is provided by a licensed provider under her direction; the medical evaluation, the candidacy exceptions, and the escalation to surgery are hers. When the honest answer after 60 pounds lost is that the abdominal apron will not tighten with any device, the same surgeon explains body contouring after weight loss, and when the honest answer to a patient’s request for a quick prescription is that her labs point to a thyroid or hormonal problem instead, that conversation and the hormone workup happen in the same building. A recent analysis in Plastic and Reconstructive Surgery found GLP-1 therapy associated with a higher rate of facial and eyelid procedures afterward; a program run inside a plastic surgery practice sees that pattern early and plans for it. More tools in the toolbox, and an honest answer about which one you need.
SCOTTSDALE · MODERN OFFICE SETTING
Before & After
Medical Weight Loss, Before and After
Weight loss results are best judged by the whole picture: the change on the scale and in the labs, and what the face and skin look like once weight is stable. Howarth Plastic Surgery does not publish weight loss photographs of program patients, but its surgical galleries show body contouring after major weight loss and facial rejuvenation, and the injectable galleries show volume restoration in patients whose faces had deflated. During your consultation the team can show you cases that match your starting point and your goal.
Patient Case Summaries
Selected Medical Weight Loss Case Summaries
These deidentified case summaries illustrate how the physician-led team at Howarth Plastic Surgery plans medical weight loss in Scottsdale. They include a patient with a family history of medullary thyroid carcinoma who was not prescribed a GLP-1 medication, a patient referred for body contouring after 60 pounds lost, a patient whose facial volume loss was treated with filler, a patient preparing for surgery, a patient who arrived with a prescription from an online clinic and no follow-up, and a man with prediabetes whose plan centered on muscle preservation. Each summary connects the patient’s history and assessment with the treatment performed or the recommendation made.
Case 01
Not a candidate
A family history of medullary thyroid carcinoma, and a GLP-1 medication that was not prescribed
Patient presentation
A woman in her fifties, a long-term Scottsdale resident, asked for semaglutide after two friends had lost weight on it; her body mass index was 33 and she had well-controlled hypertension.
Skin assessment
The history revealed that her father had been treated for medullary thyroid carcinoma. Labs were unremarkable apart from a mildly elevated hemoglobin A1c in the prediabetic range. A family history of medullary thyroid carcinoma is a contraindication in the FDA labeling of both semaglutide and tirzepatide because of the thyroid C-cell tumors seen in rodent studies.
Recommendation
No GLP-1 medication. The provider explained the contraindication and the reason, referred her to her primary care physician and an endocrinologist for her own thyroid evaluation and calcitonin testing given the family history, and enrolled her in the nutrition and resistance training program with monthly visits and a discussion of other medication classes with her physician.
Clinical rationale
The boxed warning exists precisely for this history, and a program directed by a physician declines the prescription rather than finding a way around it; the family history also warranted a workup she had never had.
Follow-up
Over eight months of coaching she lost 9 percent of her body weight, her A1c returned to the normal range, and her thyroid evaluation was negative; she continues monthly visits.
Case 02
Body contouring referral
Sixty pounds lost on tirzepatide, and an abdominal apron that needed surgery, not a device
Patient presentation
A woman in her forties with a starting body mass index of 38 asked at her twelve-month visit whether a skin tightening treatment would fix the loose skin across her lower abdomen and inner thighs.
Skin assessment
She had lost 60 pounds over eleven months on tirzepatide escalated to 12.5 mg, with normal labs, preserved strength from twice-weekly resistance training, and a weight that had been stable for two months. The assessment showed a redundant abdominal apron with a fold below the navel, striae, and loose inner thigh skin, changes far beyond what any energy device tightens.
Recommendation
A surgical consultation with Dr. Howarth for abdominoplasty, with thigh lift discussed as a second stage, scheduled once weight had been stable for six months; the maintenance dose was continued and the protein target raised in preparation for surgery.
Clinical rationale
Skin that has been stretched by 60 pounds does not retract, and offering a device would spend money and months on the wrong problem; a plastic surgeon directing the program can say so and plan the operation at the right point in the weight curve.
Follow-up
She underwent abdominoplasty at month eighteen with weight stable, and remains on a maintenance dose with quarterly visits; the thigh lift is planned for the following year.
Case 03
Facial volume loss
Hollow cheeks after 35 pounds lost, treated with filler once weight was stable
Patient presentation
A woman in her sixties who had moved to Scottsdale from the Northwest told her provider at month nine that she looked ten years older than when she started semaglutide, and asked whether she should stop.
Skin assessment
She had lost 35 pounds, about 17 percent of her starting weight, with labs improved and blood pressure medication reduced. Comparison with her baseline photographs showed deflation of the midface and temples, deeper nasolabial folds, and early jowling, with skin of good quality and no significant descent; Fitzpatrick II skin.
Procedure performed
The medication was continued at the maintenance dose, and once her weight had been stable for eight weeks Dr. Howarth restored volume to the midface and temples with hyaluronic acid dermal filler over two sessions, with a plan for PRF EZ Gel under the eyes at a later visit.
Clinical rationale
Stopping the medication would have returned the weight, not the face; facial fat lost with rapid weight loss is replaced with filler or PRF once the weight is stable so the result is not chased downhill, and the baseline photographs taken at enrollment made the change measurable.
Follow-up
She kept her weight loss and her blood pressure result, described the filler as giving her face back, and returns twice a year; a facelift was discussed as a future option if descent progresses.
Case 04
Preparing for surgery
A tummy tuck that waited for a body mass index under 32, reached on semaglutide
Patient presentation
A woman in her thirties, two years after her second pregnancy, consulted Dr. Howarth for abdominoplasty and was told her body mass index of 36 raised her surgical risk and would compromise the result.
Skin assessment
The medical evaluation found no contraindications, labs within normal limits, and a history of regaining weight after every diet since her first pregnancy. She was not planning further pregnancy and had reliable contraception.
Procedure performed
Semaglutide escalated over 16 weeks to 2.4 mg with monthly visits, a protein target, and a resistance training plan aimed at a body mass index under 32 and six months of stability before surgery.
Clinical rationale
Wound complications and the quality of an abdominoplasty result both track with body mass index, so the same surgeon who will operate directed the weight loss that made the operation safer; the requirement for weight stability before surgery is what separates a good result from a revision.
Follow-up
She reached a body mass index of 30 at month ten, held it for six months, and underwent abdominoplasty at month sixteen; she continues a maintenance dose under monitoring.
Case 05
No follow-up elsewhere
A prescription from an online clinic, persistent vomiting, and a program that started over
Patient presentation
A man in his forties came in on a semaglutide dose he had escalated on his own from an online prescription, with daily nausea, vomiting twice a week, and a 20-pound loss in ten weeks that he was pleased with.
Skin assessment
He had never had labs or a visit. Blood pressure was low-normal and he was mildly dehydrated after a summer of outdoor work in Arizona heat; the metabolic panel showed a raised creatinine consistent with dehydration, and he had been escalating doses faster than the labeled schedule.
Recommendation
The dose was stepped back down and held, with fluids, smaller meals, and a two-week recheck of kidney function; once symptoms and labs settled, the medication was re-escalated on the standard 4-week schedule under monthly monitoring with the nutrition and strength plan added.
Clinical rationale
Rapid escalation without monitoring produced the vomiting, and vomiting in a Scottsdale summer produced the dehydration and kidney strain; a program that watches labs and side effects reaches the same weight loss more slowly and more safely.
Follow-up
His creatinine normalized at two weeks, he reached the maintenance dose without vomiting, and he lost a further 12 percent over the following year with strength preserved.
Case 06
Muscle preservation
Prediabetes in a new arrival, and a plan built around protein and strength
Patient presentation
A man in his fifties who had recently retired to Scottsdale wanted to lose 40 pounds after his primary care physician flagged a hemoglobin A1c in the prediabetic range, and worried about becoming frail because his father had.
Skin assessment
Body mass index 34, A1c 6.2 percent, normal thyroid function, no contraindications, low baseline muscle strength on grip testing, and no resistance training history.
Procedure performed
Tirzepatide escalated to a 10 mg maintenance dose over 16 weeks, a protein target of about 1.5 grams per kilogram spread across three meals, a supervised resistance training program three times a week, and hydration guidance for the desert; labs repeated at 3 and 6 months.
Clinical rationale
A portion of weight lost on any GLP-1 medication is lean mass, and in a man in his fifties that loss is the frailty he feared; protein and progressive resistance training are the interventions that shift the loss toward fat, and the program measured strength as well as weight.
Follow-up
He lost 18 percent of his starting weight over fourteen months with his grip strength improved from baseline and his A1c at 5.6 percent; he is on a maintenance dose with visits every two months.
From First Visit to a Plan You Can Keep
Booking, Planning, and Follow-Up at Howarth Plastic Surgery
Howarth Plastic Surgery is a medical practice with a spa’s convenience. Established patients book online. New patients can book online or request a consultation, and the team responds usually the same day.
Online booking or a consultation request
Book a medical weight loss evaluation directly online, or request a consultation and describe your goal, prior weight loss attempts, and any medications you take. Bring recent labs if you have them; the evaluation orders what is missing.
A written program, not a prescription alone
You leave your first visit with a written plan: whether a GLP-1 medication is appropriate and which one; the escalation schedule; the protein and strength targets; the monitoring calendar; and the aesthetic plan for facial volume, skin, and body contour as weight comes off.
Monthly visits, labs at 3 and 6 months, and a maintenance decision
Visits every 4 weeks through escalation and at least every 4 to 8 weeks after, labs at about 3 and 6 months, and a maintenance or taper decision at goal. Injectable and surgical planning is paired with the same visits. A-List members have the next visit scheduled before they leave the last one.
Your Questions, Answered
Medical Weight Loss Frequently Asked Questions
The program at Howarth Plastic Surgery in Scottsdale includes a full medical evaluation with baseline labs, a GLP-1 receptor agonist such as semaglutide or tirzepatide prescribed when clinically appropriate, injection teaching, a written escalation schedule, nutrition and habit coaching with protein and strength targets, monitoring visits every 4 weeks during escalation, repeat labs at about 3 and 6 months, and an aesthetic plan for facial volume and skin as weight comes off.
A licensed provider under the medical direction of board-certified plastic surgeon Ashley Howarth, MD, FACS evaluates you, reviews your labs before prescribing, and sees you every 4 weeks during dose escalation and at least every 4 to 8 weeks on maintenance. Each visit records weight, blood pressure, and side effects and makes a dose decision. Persistent vomiting, severe abdominal pain, or vision changes are a call to the office, not a wait for the next visit.
Howarth Plastic Surgery prescribes GLP-1 receptor agonist medications, semaglutide and tirzepatide, when clinically appropriate after a medical evaluation and labs. Both are once-weekly injections approved by the FDA for chronic weight management in adults with a body mass index of 30 or higher, or 27 or higher with a weight-related condition. The provider chooses between them based on your history, tolerance, and goal, and always pairs the prescription with nutrition, hydration, and strength guidance.
Tirzepatide produced more weight loss in its pivotal trial: a mean of 15.0 to 20.9 percent at 72 weeks in SURMOUNT-1 depending on dose, against 14.9 percent at 68 weeks for semaglutide 2.4 mg in STEP 1. The two were not compared head to head in those trials, both cause similar gastrointestinal side effects, and tolerance, medical history, and availability decide the choice more often than the trial numbers do. The provider explains both at your evaluation.
In the pivotal trials, adults on semaglutide 2.4 mg lost a mean of 14.9 percent of body weight at 68 weeks, and adults on tirzepatide lost 15.0, 19.5, or 20.9 percent at 72 weeks on the 5, 10, and 15 mg doses. Individual results vary widely, roughly a third of trial participants lost more than 20 percent and some lost little, and results depend on tolerance, dose reached, and the nutrition and strength plan alongside the medication.
No. Some patients start medical weight loss because a tummy tuck, breast lift, or facelift plan depends on a lower body mass index, and losing weight first makes the surgery safer and the result better. Many others come for health reasons, post-pregnancy or menopausal weight gain, or a weight loss prescription elsewhere that came with no follow-up. The program is the same; the aesthetic plan is added when it is wanted.
Appetite changes within the first two weeks, and most patients lose 2 to 4 percent of body weight in the first month on the low starting dose. Body composition and energy usually change by 6 to 8 weeks. The steepest loss comes on the maintenance dose between months 5 and 12, and the trial results of 15 to 20 percent were measured at 68 to 72 weeks. Slow, monitored escalation makes the loss tolerable and sustainable.
Yes, and for most patients the plan should assume it. Trial extension data show that most weight returns within a year when a GLP-1 medication is stopped without a maintenance plan. At goal, the provider and Dr. Howarth decide between a long-term maintenance dose, sometimes lower or less frequent, and a supervised taper with the nutrition and strength plan carrying the result. The program does not stop abruptly or send you home alone.
Both are planned for from the first visit. Facial volume loss in the cheeks and temples appears at about 10 percent loss and is treated with dermal fillers or PRF EZ Gel once weight is stable. Mild skin laxity responds to SkinPen, SkinTyte, or Ellacor in the right patient, and skin stretched by 50 pounds or more is evaluated for body contouring surgery by Dr. Howarth once weight has been stable for about 6 months.
Anyone with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, anyone pregnant or planning pregnancy, and anyone who wants a prescription without an evaluation, labs, and monthly follow-up. A history of pancreatitis, gallbladder disease, severe gastrointestinal disease, or diabetic retinopathy calls for caution or specialist input. In Arizona, an outdoor worker who cannot stay hydrated through the escalation weeks is watched especially closely.
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