Skin Tightening and Surgery After GLP-1 Weight Loss w/ Dr. Maryam Zamani

What really happens to your skin after major weight loss on GLP-1 medications, and when does surgery make sense? In this episode, Ana talks with Dr. Maryam Zamani, a double board-certified plastic surgeon, about why loose skin happens, how GLP-1-related skin changes may differ from traditional weight loss, and what people can do before jumping into surgery. They also cover the real role of protein and muscle mass, the limits of non-surgical treatments, and the most common surgical options for the face, breasts, arms, abdomen, thighs, and back after significant weight loss.

About Dr. Maryam Zamani:
Dr. Maryam Zamani is a dual board-certified plastic surgeon specializing in refined, natural-looking facial, breast, and body procedures, with particular expertise in helping patients navigate the physical changes that follow significant weight loss, including GLP-1 use. Certified in both the U.S. and Canada, fellowship-trained in aesthetic surgery, and an editorial board member for The Aesthetic Surgery Journal, she combines advanced surgical and non-surgical treatments to address loose skin, facial volume loss, breast changes, and body contouring with an elegant, highly individualized approach.

Guest Links:

• Plastic Surgery In Beverly Hills | Cosmetic Surgery In Los Angeles
• www.instagram.com/dr.maryamzamani

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Transcript

SPEAKER_01 0:00

We actually see in surgery, this has actually has come out of anecdotal experience that surgeons have had performing things like face of surgery. Being like the skin in patients who have had GLP1s, it feels different. It's a little stretchy. It doesn't have the same tone that non-GLP1 weight loss patients do.

SPEAKER_00 0:18

Welcome to the GLP1Hub Podcast. I'm Anna Reisdorf, registered dietitian and GLP1 user. Today I'm joined by Dr. Miriam Zamani, a double board certified plastic surgeon, to talk about what really happens to your skin after GLP1 weight loss and what you can actually do about it. On this episode, we get into whether Ozempic face is real, how GLP1 related skin changes may be different from other kinds of weight loss, and the real surgical and non-surgical options for tightening and skin removal. If this episode helps you, please leave a quick review on Apple Podcasts or Spotify. And if you're watching over on YouTube, make sure you share your thoughts in the comments. Now let's get on to the episode. Welcome to the GLP One Hub Podcast. I want to welcome Dr. Miriam Zimani today. She's going to talk to us about skin tightening, skin removal surgery after GLP1 weight loss. This is such an interesting topic. Thank you so much, Dr. Zamani, for being here. Can you introduce me?

SPEAKER_01 1:21

I'm so excited to be here and to be talking to members of the community and to be helping to share education and letting people know that there are options out there.

SPEAKER_00 1:30

So tell us a little bit about your professional background and like why you know anything about skin tightening surgeries.

SPEAKER_01 1:36

Absolutely. Thank you for that. So I am a double board certified plastic surgeon. I have my board certification both in Canada and the US. And I have subspecialization in aesthetic surgeries. And my interest has always been with aesthetic surgery and helping people feel comfortable in their own skin. No matter what the procedure is, that's the ethos of my practice, is to help people feel that there's great harmony between how they feel on their inner in their inner self and how they're able to present that to the outside world. Because I think when there is that cohesion, people are just glowing in their bodies, they're glowing. You can see the confidence just radiating from them. And it manifests in so many different aspects of their lives, whether it's personal, whether it's professional, and whether it's just how they feel about themselves in their day-to-day. You really see these transformations change people's perspectives. So it's been an absolute pleasure of mine to be able to tailor my practice to help different patients, women and men, realize their full potential through that. So, you know, I my practice is located in Beverly Hills, and I have the pleasure of seeing a lot of patients for a variety of reasons. I treat the face, the breasts, the body. And one of the things that I specialize in is integrating different surgical and non-surgical solutions to provide a more comprehensive approach to patients. And I really do value a more bespoke, tailored approach to each individual treatment, meaning that sometimes what works for one patient in terms of, let's say, skin tightening may not work for someone else, depending on their anatomy, their body, and even their goals and downtime. Sometimes I have patients that present with the exact same, you know, concerns about loose skin. They're pretty similar in their body, but one person is willing to have a bit more of a downtime, is okay with scars as long as they're strategically placed. And I have another patient who doesn't want that. And I can offer different procedures to different patients to help them along with that. In addition to my clinical practice, I'm actually also I sit on the editorial board of the Aesthetic Surgery Journal, and it's this publication of aesthetic surgery journal open forum. And that really helps me stay at the forefront of the research that's coming out. And you and I were talking before starting our recording about how because the changes that we're seeing on this grand scheme with a lot of people being on GLP1 medications and losing their weight, it is relatively recent. So there's a lot of research that's coming down the pipeline to not just study its overall effects on you know the body and how it heals, but also within this aesthetic sphere of how is it impacting the skin? What are the different things that we can integrate? Because skin loxity from different reasons, whether it's you know, traditional weight loss, post-pregnancy, or the GLP ones, can be quite different. And we need to understand that so that we can customize those solutions and really care for our patients properly.

SPEAKER_00 4:40

Sure. So with the GLP ones specifically, there's a lot of concern. I think early on, the New York Times or something coined this osempic face. Yes. I'm gonna get Ozempic face from this. So what happens? Maybe we don't need to focus on the face necessarily, but what happens to your skin as you lose weight? Is it the weight loss or is it the medication that's doing something to your skin?

SPEAKER_01 5:03

So actually it's it's both. And that's the part that we need to understand because, like I was kind of alluding to at first, is you know, there are certainly changes that are consistent when someone has a very dramatic weight loss, say 50 pounds or more, whether that's through surgery, bariatric surgery, or whether it's through medications or driving exercise, there's sometimes we see very similar changes across the scope. And the reason that we see those changes, the reason people develop loose skin is sometimes the rate at which you're losing weight outpaces the rate at which your skin can naturally contract. So sometimes it's just simply a balance of that. When we undergo rapid weight loss, the skin simply can't keep up with it. So having a more measure-tailored approach to weight loss sometimes can definitely assist that. The next part is also about how much weight are we losing, right? If you think about it, the skin is, you know, sometimes I like to think of it like a, you know, our cylinder, or like think of it as a fondant over a kick, right? There's there's a certain amount that we stretch out, there's a certain amount of skin that we have. And that relative amount is important to like what was our starting point, what's our end point? And if it's really critically different, it doesn't matter if you really do even do gradual weight loss, at some point there's going to be some laxity that's left over. So some of it is that relative difference. And unfortunately, our age also matters, right? When patients that are much younger, and we're seeing this because we have younger and younger patients that are on GLP once, they undergo tremendous weight loss, their skin just has better elasticity, better collagen. So it just tends to, you know, um recoil better. So some of it is, you know, the way we can help it is doing more measured gradual loss. The other thing is to think about it is the skin needs to have to overlay, right? The fauna needs to sit on something on top of the cake. We don't want that to be fat, but muscle certainly can help expand the volume underneath, right? And muscular bodies will still help that our skin drape over properly so it doesn't look so saggy and and crepey, but you still retain a much more athletic tone shape than if you've lost the weight and then you've also lost muscle tone. And we do know this about the GLP ones, right? Is that unfortunately a lot of times, sometimes using the medication itself, sometimes just because of the dietary changes, when patients aren't having enough protein intake, they're not making sure to integrate exercise and weightlifting into their lifestyle to maintain muscle mass. Unfortunately, in addition to losing fat, they're also losing muscle mass, that means muscle mass, which we want to keep. So another strategy to really help keep things optimized is to make sure that you are making sure to have a lot of protein intake through your diet and or supplements if needed. And you are also integrating good, healthy lifestyle and physical activity to help promote gaining muscle mass. So those are some of the things. Now, the other part of your question was whether the medications themselves do have some effects. And some of the research that we're seeing is actually yes. You know, we know this certain medications have effects on skin. For example, we know if patients have been on steroids for a long time, it tends to thin their skin, it inhibits the body's potential to renew and build and create more skin, let's say, for simpler terms. And sometimes taking things like vitamin A can help that because it's helping some of the receptors that are being inhibited by steroids. We actually see in surgery, this has actually has come out of anecdotal experience that patients have had. Surgeons have had performing things like phase of surgery, being like the skin in patients who have had GLP1s, it feels different. It's a little stretchy. It doesn't have the same tone that non-GLP1 weight loss patients do. And so that's promoted a lot of surgeon investigators to look into this, and they are finding that, you know, there are specific skin changes that are happening, that the top layer of the skin, the epidermis, is getting thinner. The keratinocytes, which help build the skin, are actually kind of downregulated. So there is chemically something that's going on. And so the next exciting phase that we're coming into is specifically looking at, okay, well, we know these changes are happening. What are the ways that we can help counter that, help renew the skin, not just by you know creating more collagen or removing the excess skin, but how do we restore its potential to have healthier tissues to regain that thickness that we want back? So there's a lot of exciting things coming down the pipeline that I think is gonna really help our patients.

SPEAKER_00 9:39

That's so fascinating. I would have thought before you came here that it was protein and you know, age, rapid weight loss, must, you know, muscle, like those lifestyle things that you said. And I mean, age, you can't control your age, it is what it is, but genetics, right? Yeah, absolutely. So you're the theory up and coming of your colleagues is maybe that they're that they're seeing actual differences that would not that were maybe not present in those who maybe had a gastric bypass or lost weight on their own.

SPEAKER_01 10:09

Absolutely. We are seeing some of that changes. And so that's an area that's being really, you know, there's a lot of interest in it because there's a lot of demand for this. So we are looking into it. But also exciting to know is that, you know, we are there's a lot of interest in this field. So there's a lot of interest in how can we reverse it or how can we prevent it. So there's a lot of things that we can do both surgically and non-surgically to help patients restore. And it's like the speed at which a lot of these technologies and techniques are emerging is kind of astronomical. It's fantastic. I absolutely love it.

SPEAKER_00 10:42

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SPEAKER_01 12:28

Sure. So I think in addition to some of the things that we talked about, whether it's, you know, making sure you have enough protein intake, increasing the muscle. Obviously, in your face, you're not going to be increasing your muscle mass. Like, I mean, unless you want the ambassadors to get big, but no one likes that either. But in the rest of your body, increasing muscle mass that can be absolutely helpful. You know, there are things out there that can even help you increase muscle mass. In addition to, you know, you going to the gym, having adequate protein intake. We do have things like that engage electromagnetic simulation to help your muscles even accelerate how much it's gaining. We have, we're going to try not to say too many brand names, but we have machines that, you know, their paddles you put on, and we put on a patient's stomach, they're there for 45 minutes. Four sessions of that, six months down the line, is supposed to grow your muscle to the amount of if you were doing, you know, 10,000 sit-ups. That is significant. That is a lot of growth. Um that's gonna help you. So there are little things that, you know, depending on the patient, we can definitely institute. In terms of just overall skin elasticity, collagen, basics are basics. Having a really great skincare system in place, a regimen that's tailored to you is important. You know, having, you know, the retinals and things in place that are gonna help with your skin turnover, making sure you have a really good sunscreen program in place because believe it or not, that thinning of the skin that happens actually does make you more prone to sun damage. And sun damage is gonna make your skin even more thin. It's gonna create more wrinkles, more changes that you're gonna, that's gonna make you feel really tired and just, you know, not at your full potential. You are unfortunately, and to different degrees, going to lose volume in certain parts of your face. And each person, depending on their bone structure, may present differently. And that's where other things can come into place. If you're not ready for a face of surgery, there are ways of restoring volume. Now we have the option. You know, before we used to be limited about if you don't have, you know, our the best way to restore volume is what? Use your own fat, right? But one of the challenges in GLP1 patients is we're trying to reduce all the fat. What's the point of that? I sometimes like, I know you want a fat transfer, but where am I gonna take it from? You have nothing. This is all skin. Um, whatever you have, I want to keep for you. So now we have options that allow us to like off-the-shelf options of syringes that have processed sterile fat in them that have incredible take-in patients and are really great for restoring that rejuvenation. We know fat cells have kind of like stem cell rejuvenating properties in them. So they will also help renew your skin. There's easy biostimulators, you know. We hear about them more and more nowadays, like the sculptures or the radius that, if used judiciously, can help increase the collagen and the thickness of your skin. That's gonna be really great. We also have, you know, devices that use energy to different degrees, whether it's radio frequency or ultrasound, these can help tighten the skin by creating more collagen. The important difference, and then of course we have both oxymillas, which are fantastic. They're baselines. Those that everyone needs. I'm I'm a fan of those anyways. Yes. The important thing is to the best advice I could give someone is to go to a practitioner who is able to offer you the full spectrum, whether it's non-surgical, whether it's surgical, because the pitfall people fall into is when you're going to someone who only does one thing, right? They only have one tool in their toolbox. So if they only have a hammer, they're just using that hammer on everything. And that's where people get into trouble with looking overfilled, badly placed fillers, or even surgery, you know, just getting stuff cut out when other portions aren't there to make it look harmonious and good. When you go to someone who has the full complement at their disposal, right, then they can choose the right tool for the problem at hand and or use different things together so that you have that best outcome. So that's the thing is sometimes we can get away with non-surgicals, but sometimes surgery is ultimately the answer. And more often than not, combining the two is going to give you the best results.

SPEAKER_00 16:32

Right. That totally makes sense. Like the surgery can do 70% of the work, 80% of the work, but then there's still some fine-tuning or maintenance or things.

SPEAKER_01 16:41

Absolutely. And I hate to compare surgery to, you know, being a seamstress, but sometimes it's an easy, you know, easy way to speak about it is if I have a fabric, right? If I have extra fabric, I can remove the extra fabric. But with surgery, I can't really change the quality of the fabric. That's where the non-surgicals can help me improve the quality of the fabric. And that's where I would say is the key in knowing that there's a lot of things we can do. So, for example, when I'm talking about that, when we're doing, you know, when I'm planning for say evasive surgery, right? The non-surgicals that are gonna come in is like a full pre-operative and a post-operative recovery program that's going to optimize your nutritional status, right? That's gonna prep your skin for healing. It's going to improve blood supply to the skin. We know bringing more blood helps the skin renewal, helps the skin thickening, all of that, right? And then being on a good regimen afterwards to help support and protect that investment. So you're healing faster and your results are lasting faster. And that means that, you know, we're also going to integrate some maintenance therapies throughout the way so that yes, you know, your skin looks fantastic. Let's keep it that way. How do we do a little bit every now and then so that we're stimulating more collagen growth? We're, you know, making sure the volume is staying restored where it ought to be. Because one of the other things with surgery is the second I put my scalpel down, right? The clock keeps ticking. I can only set the clock hands back. I can't prevent time from going forward. So that's another really important thing.

SPEAKER_00 18:17

Yeah, definitely. Okay, so let's talk a little bit about the surgery. I would assume that most people, probably not all, want abdominal surgery. Like that's where the loose skin is primarily. What other areas are people looking for uh skin, or can you fix loose skin? You know, if you have the loose skin, we can almost fix it anywhere and everywhere.

SPEAKER_01 18:36

So let's go simple. I like to kind of do like a head-to-toe approach because that's gonna keep it simple. Keep it simple and organized. I like it that way. So, you know, in the face and that, very simple to understand. You're gonna get some, unfortunately, there will be some sagging. There's gonna be a little bit of loosen of skin. If it's mild, we can do milder treatments. But if it's substantial, then you're really gonna get the best result that you're gonna get with a facelift and necklift. And it sounds scary, it really isn't. We've, you know, the techniques have evolved so much that downtime is really minimized nowadays. Patients love it. So that's kind of your number one surgery. Then when we're going down, unfortunately for our female patients, we wish the breasts would not be affected by the GLP ones, but a lot of times they do get deflated, right? And when they get deflated, they get droopy, and you just kind of on almost sometimes lose that femininity that you love and are working so much towards, right? So that's another great area where we have options available. Mostly it comes down to doing a nice lift, right? Restoring everything back where we wanted, but also because we want to bring some fullness back. Usually we're looking at sometimes we can do a little bit of fat transfer, but usually to restore the amount that people want. Implants, breast augmentation is really a great option. And nowadays we have newer types of implants, the latest generation implants have really good one breast feel. And we have other things like an internal bra to help your skin hold it up. Because we've kind of talked about how the skin itself is compromised a little bit, so it just isn't holding up as well. So that would be one. In the arms, unfortunately, laxity in the arms is a problem, right? We get what people call like bat wings. Hate that word, but it's the thing. And that's where it really for me, the arms are a really big area because a lot of places, you know, if you the abdomen is certainly a problem area for a lot of patients, but a great pair of, you know, spanks or skims, tucks right that back in, but the arms are hard to deal with, right? Unless you're wearing long sleeves all the time, and that's pretty inhibiting. So this is where I really like to try and minimize scars as much as I can. Because, you know, in my perspective, you know, I've I've yo-yo dieted, I've I've kind of gone up and down in weight. So I'm kind of familiar with the challenges of weight loss as well. And I always try and put myself in my patient's trees, and I'm like, would I want to trade floppy arm skin for a really long scar running down the inside of my arm? That's a difficult decision. For some people, it's clear cut, they want the snatched arm and they're like, do it. I don't mind my skin heals well, my scars heal well. And of course, we provide a lot of little things that we have a lot of tips and tricks up our sleeves that help you have better outcome, but that's an idea. But sometimes if you don't have a very severe amount of skin laxity and are willing to have more tone and more tightness, but just maybe not as, you know, super snatch as with an arm lift. I have a lot of skin tightening uh devices at my disposal that can heat the skin from the inside, whether it's using radio frequency alone or helium plasma radio frequency, these are my favorite devices. They really have kind of a shrink wrapping effect. Um, and my patients love it because it's this tiny scar hidden in the, you know, in your axilla, hidden in the elbow, and that's it. That's the only giveaway. So it's great. It's and it all really comes down to the trade offs.

SPEAKER_00 21:54

Sure.

SPEAKER_01 21:54

Moving down to the tummy, of course, that's a really big problem area. Tummy tuck typically tends to be the best. Answer there. And a lot of times, you know, especially if my patients are coming to me and they've had children, they've had pregnancies, children, it's a great thing. You know, we're taking away the extra skin and we're tightening up your muscles, right? It will really help cinch in that waist. And sometimes, depending on that, it could be different degrees of tummy tuck. Sometimes it's just the front, and sometimes we circle all around you to help even pull up the tissues from the back. That's like a 360 tummy tuck or a body length. The thighs, the inner thighs tend to be a bit of a problem because, much like the inner arm skin, that's thin skin, it stretches out just it's just gnarly. And again, that area tends to respond usually best to a thigh lift. Now we have different patterns, different ways of hiding incisions, all of that. And that can really help you. And then the other part that patients don't know is the back usually is a giveaway. A lot of times we have big folds along the back. We can get really creative with how do we do a back lift so that you know you're able to wear the clothes that you want without having a bunching of skin above the bra. That's a huge problem for a lot of patients, where it's just that loose upper back skin just doesn't want to behave. And so we can tighten it up to the sides like a lateral chest lift, or sometimes we just put a little line right along where your bra sits, anyways, and that's called a bra lift. So that's an option. And then, you know, we've talked about the areas where we need to have a little bit more fluff put back in so that that feminine shape comes back in, and the buttock is one of them, right? So a lot of times, unfortunately, patients lose volume in their bumps and it kind of the skin gets a little bit saggy, wrinkly there, and that's a look that they don't want. You know, they've been trying to get into their swimsuits this whole time. Now it's like a well wrinkly bottom. Is that what I want to show off? Number one advice is do your squats, ladies. Build that muscle because glute, the glutiest muscles have such an immense potential to grow. They really can create a great foundation, if not on their own, to allow us to redrape the skin on top and put fat on top of it if needed to help create that contour again. So, you know, I've run through a lot of surgeries here. There's, and that's what I mean when I say if you have loose skin, we have options, whether it's by cutting the skin out, right? And the important thing about plastic surgery, what I love about aesthetic class surgery is we really do care about hiding scars in areas where your body naturally has curves, lines, shadows, so that it's less perceptible and being very diligent with how clothing is usually worn. So these are things that, you know, I personally think is really important and I take into account in my consultations. And we have lots of things that now help you recover from your surgery so much better afterwards, whether it's hyperbaric oxygen therapy, so you're getting that blood flow back faster, lymphatic massages to make sure that, you know, inflammation's coming down really well. Having little things, little dressings now that take tension off the scars. That's been really imperative in our change. That before, one of the worst things that would happen after big weight loss skin excision surgeries is the scars would spread. But now we have devices that actually take the tension onto themselves and take it away from the skin. So now we're getting able to deliver really fine scars that over time can almost be imperceptible.

SPEAKER_00 25:15

Wow. So much happening here. So so much. So if someone is interested in these types of surgeries or procedures and can't unfortunately travel to your lovely clinic in Beverly Hills, what type of um things should they look for in where they wherever they live to know that the person who they're going to is uh quality?

SPEAKER_01 25:37

Absolutely. Well, I'm gonna say we do offer a virtual consultation so you can always have your I'm happy to discuss and always give education to patients. That's always really paramount to me. But what I would always advise is make sure that you're seeing a board-certified plastic surgeon. And that in itself is really important because it means that they've gone through the rigors of the training and are basically have that mark of approval by their peers. So you know you're in good hands, good safe hands. The other thing I would look at is looking at their body of work and really making sure that when you're meeting with them, they're able to speak to the whole catalog of surgeries and treatments that are available and can tell you about both the pretreatments and the post-treatments that are gonna give you ideal results. So don't be shy about asking questions. Make sure you're meeting the surgeon themselves. Make sure that you feel comfortable with the recovery process and that you're gonna be supported throughout. And inquire about, well, what are the what what do you offer to help optimize my journey through this process, right? And if there's someone who is well versed in different types of technologies, right, and stays at the forefront of what's, you know, what's available to us in the aesthetic sphere, right? Whether it's having different energy devices that are gonna help supplement your skin tightening journey, or it's having like the off-the-shelf options of bringing volume, bringing fat, bringing extra cellular matrix to the area. You want to make sure someone is able to deliver on all those fronts because again, it means that their toolbox is stacked. They can really create a tailor treatment for you.

SPEAKER_00 27:15

Right. And so you want to have somebody who's like keeping up with the new things, not just cutting and seeing you later. Exactly. That's great. That's great. So, what are some of, besides appearance, are there any medical reasons why someone would choose to have skin removal surgery?

SPEAKER_01 27:32

Absolutely. Unfortunately, you know, there's there's the physical sides of what can happen. And then there's also the emotional side that we have to take into account. So the physical side, sometimes having a lot of redundant skin, skin on skin, creates an area where moisture gets trapped. Unfortunately, bacteria and fungi can get trapped. And so people unfortunately can suffer from rashes, skin breakdowns, odors, and really have more along like medical problems because of this. We see that really commonly in the abdominal area, groin area, or even the thigh. So those are um common reasons why patients, you know, they may not be um aesthetically um motivated, but it becomes a functional issue for them. And the other version of that, the other side of it, is the um personal, the emotional side, right? And the um social side of it, where having a lot of loose skin can really impact how you're able to interact. And unfortunately, they can have mental health ramifications as well. So those are true reasons where patients do present to us if they're not necessarily they may not be fully aesthetically focused. Usually, I mean, everyone still wants to look great, but their primary driver is perhaps more uh a medical need than otherwise.

SPEAKER_00 28:48

Absolutely. So you mentioned that people can speak with you on a virtual consultation. So where can people find out more about your wonderful practice?

SPEAKER_01 28:55

Oh, thank you so much. So if you visit our website at zamaniplastic surgery.com or follow any of our social media handles on TikTok and Instagram at dr dot Miriam Zimani, you'll be able to book a consultation and we offer HIPAA compliant telehealth consultations for everyone.

SPEAKER_00 29:12

Awesome. That's wonderful. And and that's like they can just come and inquire about all the different options and see if the if it's a good fit for them.

SPEAKER_01 29:19

Absolutely. And I think, you know, I'm always happy to share knowledge and to even give local recommendations if it's something that the patient isn't really able to come out to us. If it's if I'm able to, I'd be more than happy to help assist them so that their recovery journey can be assisted locally so that they don't have to feel like they have to stay in Beverly Hills, although people want to for an indefinite period of time.

SPEAKER_00 29:42

I used to live in LA and I think that there's some like fancy recovery centers there that you can there are many, yes, be waited on hand and foot. So maybe something. Absolutely. When we love to offer that. We like to pay for our patients. Awesome. Well, thank you so much, Dr. Mani, for being here, and I appreciate all your lovely insights. Thank you so much for having me. This has been wonderful, awesome. Thank you so much for listening to this episode of the GLP One Hub Podcast. And now it is time for our question of the week. And this question comes from one of our GLP One Hub members. You can learn more about our membership down in the show notes. Chips start at just$9 a month if you need a little bit of extra support. So this week, Sherry asks, what does maintenance look like for someone who is diabetic, metabolic syndrome, autoimmune disease? After three years of being on a GLP1, have you implemented changes? That's like a big question. Maintenance right now looks like it really needs to be personalized. For most people, this will probably mean staying on the medication to some degree for life. So if you have diabetes, you probably wouldn't stop taking your diabetes medication once you controlled your blood sugar, right? Because what would happen is the diabetes medication, you know, the diabetes would just come back. The blood sugar would go back up once the medication was no longer there. So for most people, this will look like they will need to stay on the medication. And how much and what that looks like is very, very individualized. Some people have to stay on the highest dose, and that is what they have to stay on. Some people are able to spread out their doses every 10 days. Some people are able to lower the dose to the lowest possible dose or even less than that. So it really is going to require you working with your provider to determine what the best plan is for you. Personally, I have been on and off this medication for three years. I have tried to get off the medication twice, and I have gained weight back. And for me, it is simply not worth it to be so stressed out about my weight. If I have a solution that works very effortlessly with my life, allows me to implement the healthy habits that I like to have, eating my protein, my fruits and vegetables, working out at the gym. And it just really relieves a lot of the mental stress that I felt my whole life around my weight. So for me, my personal plan is to remain on the medication. I do occasionally stretch it out to every 10 days or so, but I am not dealing with a variety of medical conditions like diabetes, autoimmune disease, metabolic syndrome, all of that. So it is a little bit different for me in terms of what I can do and the flexibility that I have. My recommendation would be to work with a provider, particularly one who is trained in these types of medications and how to prescribe them and how to titrate them. That person can help create a personalized plan for you. So I hope that helps. And uh be sure if you are loving the podcast, that you leave a review on Apple Podcasts for Spotify. I'll see you in the next episode.