But we wanted to know – are they requesting the compounded versions because their provider won’t write a prescription for the name brand, ie you should try diet and exercise first! Or will they write a prescription but insurance won’t cover the medication and patients don’t want to pay over a $1000 per month for name brand (compounded versions are typically in the $400 – $600 range). Or will insurance cover it but traditional pharmacies are backordered and can’t get the medication for patients. Or is it another reason entirely.

We surveyed our patients currently being treated in our office with the compounded versions of these weight loss medications and the graph below tells the story!

Do these statements reflect your sentiment as well? Tell us in the comments or click here to complete our expedited consultation paperwork and get access to these amazing weight loss medications within the week, shipped to your door!

The post Why patients are getting compounded weight loss medications through their provider first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Whether you’re just starting or taking the maximum dose or anything in between, this video will guide you through the proper way to inject semaglutide (the active ingredient in Ozempic and Wegovy) on a weekly basis.

The post Tirzepatide injection training [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Our one year data is in! The bottom line? Our patients are losing weight on both semaglutide and tirzerpatide! These are amazing medications that allow patients to get to their goal weight and maintain that weight with one of our less expensive maintenance subscriptions that include fewer injections per month.

While both medications are very effective weight loss options, it does appear that with time, patients on tirzepatide are losing more weight than semaglutide. In the early months, tirzepatide patients lose an average of 1-3 pounds more per month than patients on semaglutide. But after month 5, the tirzepatide patients begin to pull away from the semaglutide patients.

And for patients experiencing side effects on semaglutide, they may experience significantly fewer side effects on tirzepatide. See results below and schedule a consultation here if you’re ready to get started.

Weight loss after switching from semaglutide to tirzepatide

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Weight loss with semaglutide over last 12 months

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Weight loss with tirzepatide over last 7 months

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Semaglutide average weight loss (%) by month

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Semaglutide average weight loss (lbs) by month

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Tirzepatide average weight loss (%) by month

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Tirzepatide average weight loss (lbs) by month

The post Our weight management program: 12 months of semaglutide, 7 months of tirzepatide first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Whether you’re just starting or taking the maximum dose or anything in between, this video will guide you through the proper way to inject semaglutide (the active ingredient in Ozempic and Wegovy) on a weekly basis.

The post Semaglutide injection training [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

We now offer maintenance packages to help. Normally we wouldn’t recommend taking medication for the rest of your life but you’ll have to do something for the rest of your life to keep the weight off. Either diet & exercise or medication. The good news is these medications, semaglutide, the active ingredient in Ozempic and Wegovy, or tirzepatide, the active ingredient in Mounjaro, are part of a class of medications, GLP-1 receptor agonists, that have been around for over 20 years – so we know the side effects, mostly gastrointestinal in nature (nausea, vomiting, constipation and diarrhea). And these side effects, if they occur, are tolerable and dissipate completely in most patients.

As we’ve seen in our own program over the last year, the benefits of these medications far outweigh the risks which is why we understand and support patients who feel like they don’t want to quit the medications ‘cold turkey.’ Keep in mind that the FDA has approved the medications for indefinite use.

Maintenance semaglutide and tirzepatide

We’ve developed three options for patients that want to keep taking these medications to maintain their weight.

1. Weekly dosing – patients can continue taking these injections once per week but at a lower dose.
2. Less frequent dosing – the normal dosing regimen is once per week but patients who feel the appetite suppression effects of the medication last for 10 days or even 2 weeks can take the same amount less frequently. We have subscription packages for 3 doses, instead of 4, per month.
3. Oral semaglutide – while not a pill, this is semaglutide in the form of a daily lozenge that dissolves in the mouth

If you’re currently in our weight management program, ask us about one of the options above if you’re nearing your goal weight. You can email us at baelounge@ph-ps.com or call/text 415-923-3005

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GLP-1s weight loss medications

We’re talking about the glucagon like peptide-1 receptor agonists or GLP-1s for short. While this class of medications has been around for over 20 years, you’re just hearing about Ozempic (semaglutide) FDA-approved for type 2 diabetes in 2017, Wegovy (semaglutide) FDA-approved for weight loss in 2021 and Mounjaro (tirzepatide) FDA-approved for type 2 diabetes and for obesity by the end of 2023. The reason you’re just hearing about these medications even though other name brands within this class also contributed to weight loss over the last 20 years, is because these newer medications are weekly rather than daily injections.

The medications enhance secretion of insulin from the pancreas which drives sugar into the cells to be used for energy. This is why these medications were first used to treat type 2 diabetes, the form of diabetes mostly associated with overweight and obesity. During study trials and in the real world, they were also found to be highly effective at appetite suppression and weight loss.

Despite the amazing weight loss and relatively good safety profile compared to weight loss meds that came before it, the media is always looking for a chink in the armor. Success apparently doesn’t generate as many clicks as scandal. And that’s why the media often highlights side effects associated with Ozempic even though these are side effects we’ve known about for over 20 years.

Success apparently doesn’t generate as many clicks as scandal.

And they often attach a clever name to the side effect to capture more eyes. Below we’ll review the main “complications” of these medications even though they’re really known side effects that, in some cases, are features of the medication, not a bug.

Stomach paralysis

This is just a scarier term for delayed gastric emptying. One way these medications help you lose weight is through delayed gastric emptying, meaning food moves more slowly from the stomach to the intestine. This results in a feeling of fullness so the patient eats less and loses weight.

Ileus

This is similar to delayed gastric emptying. These medications affect and slow motility or movement throughout the entire gastrointestinal track. This could lead to ileus, a slowing of the intestines so food stops moving forward and in the worse of circumstances leads to a bowel blockage. But that’s not common. What’s more common are the other GI side effects like nausea, vomiting, diarrhea or constipation. All treatable ailments if they occur and one option is to switch to tirzepatide which has fewer side effects compared to semaglutide as seen in independent studies below.

Pancreatitis

Also a known rare side effect. These medications, even when approved for type 2 diabetes work to stimulate or enhance insulin secretion from a “burned out” pancreas in a type 2 diabetic state. They work for weight loss by stimulating the pancreas to release insulin which contributes to a feeling of satiety (less hungry, eat less). Out of 2,116 patients studied in the Wegovy trial that was ultimately submitted to the FDA for approval, 4 patients taking the active ingredient semaglutide and 1 patient taking the placebo or inactive ingredient for comparison had pancreatitis. So the risk isn’t high in developing pancreatitis in general, but can still occur, even in a patient not taking the medication (placebo)!

Medullary thyroid cancer

When these medications were first being studied on lab rats in the lab, some rats contracted a rare form of thyroid cancer, medullary thyroid cancer. But even some of the rats taking the placebo, the nonactive medication, developed medullary thyroid cancer. So it’s not clear what that association is and the FDA even states they’re not sure of the significance in humans. Even though the incidence of medullary thyroid cancer in humans has been rare and unchanged for the last 30+ years despite these medications being available on the market for human use since 2005, we still recommend our patients examine the middle of their neck to ensure there are no lumps and bumps around the neck that weren’t there the month before.

Suicidal ideations

There is a risk of suicide with all weight loss medications. This isn’t specific to Ozempic, Wegovy or Mounjaro. It’s not clear yet what the association is, possibly pre-existing depression, but patients on weight loss medications are known to consider suicide. There’s no evidence this is specific to or worse for patients on Ozempic or Wegovy. But the drug manufacturer isn’t attempting to hide this. It was in the FDA application for approval.

This won’t be all. The media will look at other side effects and act like they’re new or riskier than they are. For the next trending risk, my money is on alopecia. 3% of patients taking the medication had some alopecia but the placebo group still had 1% incidence of alopecia. This isn’t specific to the medication. Any stressor, like weight loss, can lead to hair loss. It’s called telogen effluvium.

Nothing new here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyHealth.

The post Ozempic is safe. How fake news wants you to believe otherwise. first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

We’re very excited to release our October weight loss data from our weight management program that includes semaglutide (the active ingredient found in Ozempic and Wegovy) and tirzepatide (the active ingredient in Mounjaro). The medications we offer come from a compounding pharmacy which by law, must be a duplicate of these name brand active ingredients while Ozempic, Wegovy and Mounjaro are on the FDA shortage list.

Weight loss on semaglutide after 8 months

This first graph shows the effects of semaglutie on our patients over the last 8 months. As you can see, the average weight loss is 7.59 pounds in the first month, 12.86 pounds over the first two months, 18.23 pounds over the first three months, 23.49 pounds over the first four months, 27.27 pounds over the first five months, 32.83 pounds over the first six months, 38.49 pounds over the first seven months and then 40.92 pounds over the first eight months. At eight months, that weight loss equates to 27% of the patient’s body weight! According to the FDA submission for Wegovy approval (the weight loss medication produced by NovoNordisk that contains the active ingredient semaglutide), the average weight loss over 1 year and 4 months was 15.1%! We’re not saying our semaglutide is better than their semaglutide, we’re just saying that our compounded version of semaglutide is the real deal!

When semaglutide patients switch to tirzepatide

In the graph below, you can see that patients who switched from semaglutide to tirzepatide, either because of greater side effects on semaglutide or because they felt they hit a plateau on semaglutide, they continued to lose weight on tirzepatide. Not necessarily at a faster rate but the graph shows that weight loss of both medications follows the same downward trend that we want to see when it comes to weight loss.

Weight loss on tirzepatide after 4 months

So is tirzepatide better than semaglutide when it comes to weight loss? As described above, with semaglutide, the average weight loss is 7.59 pounds in the first month, 12.86 pounds over the first two months, 18.23 pounds over the first three months, 23.49 pounds over the first four months.

For tirzepatide, the average weight loss is 8.31 pounds in the first month, (not even a pound greater than semaglutide), 15.73 pounds over the first two months (almost three pounds more than semaglutide), 19.34 pounds over the first three months (a pound greater than semaglutide) and 26.40 pounds over the first four months (three pounds more than semaglutide).

Semaglutide is $500 per month in our practice and tirzepatide is $600 per month. You may not think that difference in weight loss is enough to spend $100 more on tirzepatide. But as the graphs below show, the side effects occur less often in patients who’ve switched from semaglutide to tirzepatide. Which will you choose?!

The post Weight loss results after 8 months on semaglutide, 4 months on tirzepatide first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

While some rules regarding telemedicine were relaxed during the pandemic, those waivers have expired. Now, providers offering services in other states via telemedicine are required to have a license in the state they’re practicing, even if that practice of medicine is virtual through FaceTime, ZOOM, etc.

So if you’re considering the latest weight loss medications Ozempic, Wegovy or Moujaro, we offer the active ingredients from a compounding pharmacy found in these meds. Specifically, we have semaglutide, the active ingredient in Ozempic/Wegovy or tirzepatide, the active ingredient in Mounjaro. The first step is to schedule a consultation to find which medication may be appropriate for you. After getting baseline labs, you’ll sign up for one these once-per-week injections online, similar to a Netflix subscription. Every 28 days you’ll be charged for the medication of choice and we’ll ship them to your doorstep.

While these medications are paid out of pocket and not covered by insurance when getting them through our office, you’re benefiting from the convenience of getting these meds delivered to you rather than having to deal with the hassle of finding a pharmacy that 1) has the name brand drug and 2) has the dosage you need. Not to mention the hassle of trying to get insurance to cover these medications, which statistically will not happen.

So if you’re in California, Arizona, Hawaii or Florida, start by scheduling a consultation here.

The post Weight management now available for patients in California, Arizona, Hawaii and Florida first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

That’s right. Behind smoking and excessive exposure to ultraviolet light from the sun or tanning beds, obesity is the third most common risk factor for thirteen different types of preventable cancer, including endometrial (uterine) cancer, breast cancer in postmenopausal women, and colorectal cancer. Considering that 42% of US adults have obesity, this is a major emotional and financial cost to the health of society and the economy.

Based on evidence from the Cleveland Clinic, weight loss by any means, not necessarily from weight loss surgery, led to a reduction in cancer incidence. And with greater weight loss, there was an even greater reduction in the risk of cancer.

Despite the benefits of cancer reduction and avoiding other obesity-related diseases, consumers who fit the Body Mass Index (BMI) parameters are hesitant to start these medications. They may be falling prey to erroneously emphasized risks and other misconceptions surrounding GLP-1 receptor agonists.

GLP-1 Receptor Agonists

Ozempic and Wegovy, the popular weight management drugs making the rounds on social media are part of a class of medications called incretin mimetics. They mimic the effects of the naturally occurring glucagon like peptide (GLP-1) gastrointestinal hormone that increases after eating, leading to a release of insulin from the pancreas to drive sugars from the blood into tissues for use as energy. That release of insulin also creates a feeling of satiety or fullness.

Ozempic, approved for use in type 2 diabetes in 2017, was found to also lead to weight loss in patients taking the medication. And since 86% of patients with type 2 diabetes are also obese, this suggests that treating obesity will also treat other obesity-related diseases such as high blood pressure, diabetes, sleep apnea and non-hereditary high cholesterol.

NovoNordisk, the makers of Ozempic recognized this pattern of weight loss in their FDA approval studies for Ozempic. So they gained FDA approval specifically for obesity under the brand name Wegovy in 2021. The active ingredient in both Ozempic and Wegovy is semaglutide. The only difference in the two drugs is that Wegovy is approved for a higher 2.4 mg once-per-week injection versus Ozempic’s maximum 2 mg weekly injection.

Safety Profile of Ozempic and Wegovy

One reason these medications have received so much fanfare, aside from the average 15.1% weight loss (~35 pounds) after 68 weeks of treatment, is the relative safety of the medications compared to previous weight loss medication. For example, in the 1990’s the weight loss combination of phentermine and fenfluramine (Phen-Fen) were found to cause heart valve dysfunction. As the offending agent in that treatment, fenfluramine was taken off the market, leaving phentermine still available but limited to 90 days of on-label use per the FDA.

Ozempic and Wegovy can be used indefinitely but there are side effects, mostly associated with how the medication works. They produce weight loss through delayed gastric emptying and stimulation of insulin release from the pancreas. The delayed gastric emptying, slowing the movement of food from the stomach to the intestine, results in a feeling of fullness, less eating and therefore loss of weight. But that fullness can also lead to reflux (5%), abdominal pain (20%), nausea (44%) and vomiting (24%). The overall affects on gastrointestinal motility lead to other common side effects such as constipation and diarrhea.

The stimulation of insulin from the pancreas can also cause inflammation of the pancreas, aka pancreatitis (0.18%). Other known side effects include dehydration which can lead to kidney dysfunction (0.3%) but this is mostly seen in patients with pre-existing kidney disease.

Risk of thyroid cancer

The most attention grabbing, but least common risk of these medications is the occurrence of medullary thyroid cancer, an extremely rare form of thyroid cancer. During the approval studies for these medications, rats receiving doses of GLP-1 receptor agonists had a higher risk of developing medullary thyroid cancer. But medullary thyroid cancer also occurred in rats receiving the placebo (inactive compound) as part of the control group in the study.

How does this risk convert to humans? Two facts suggest the risk to humans is very low. First, the cell biology characteristics of a rat thyroid that makes it susceptible to medullary thyroid cancer are absent in a healthy human thyroid. Secondly, while Ozempic and Wegovy have only been on the market since 2017 and 2021 respectively, this class of medications first came on the market in 2005 in the form of Byetta. Of course, years of studies and testing were required well before its approval in 2005.

Therefore, humans have been using these medications for over 20 years. And even though the more common form of thyroid cancer, follicular, which is not related to GLP-1 receptor agonist use, has increased in incidence, medullary thyroid cancer “has remained relatively stable over the past 30 years” according to Filetti et al in the Annals of Oncology.

Stopping the medication

Once the 68-week trial studies for Wegovy concluded, a subset of those patients continued in a new study to evaluate weight rebound once test subjects stopped the medication as well as lifestyle changes such as diet and exercise. The study found that after stopping all forms of intervention, patients regained two-thirds of their weight within a year.

Would patients gain less weight or maintain their lowest weight prior to stopping the medication if they continued with diet and exercise? Future studies will address this question but there’s reason for optimism. While patients regained two-thirds of their weight, they didn’t regain all of it. Additionally, are we really surprised weight loss results on the medication aren’t permanent?

Aside from chemotherapy that we hope will cure cancer or antibiotics that we hope will cure an infection, chronic diseases such as high blood pressure, depression or obesity are different. No one would think that taking high blood pressure medication cures the underlying high blood pressure. It treats the elevated pressure but doesn’t cure it. In the circumstance of a patient stopping their medication for blood pressure or depression, a physician would deem the patient noncompliant. So why consider obesity medication a failure because the weight returns after stopping the medication? There is no guarantee that these medications will reset your body set weight, similar to a thermostat to regulate the heat in your house.

So stop focusing on unrealized shortcomings or holding these medications to a double standard. They’re leading to amazing weight loss results under relatively safe circumstances. Let’s embrace success and the inevitable pharmaceutical improvements to come.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyHealth.

The post Consumers’ misguided focus on the risks surrounding Ozempic and Wegovy first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Benefits of coaching

In studies, patients who stopped medication, stopped exercise and stopped dieting, regained 2/3 of their weight over the course of a year. That’s not terrible news. They didn’t regain all of their weight during that year. It actually took 5 years to regain it all! For that reason, reports of regaining double are overblown.

The point is, coaching will increase the chances you maintain your goal weight after stopping the medication. But if you don’t want the coaching program, we do offer a non-coaching program that still includes a bluetooth-enabled scale, a journal and baseline labs.

How to get started

After scheduling a consultation by purchasing online here, we’ll schedule your lab work through LabCorp (or you can send us recent labs that include a CBC, CMP, HbA1c and TSH) to frontdesk@ph-ps.com. After reviewing your labs, you can purchase your medication subscription of semaglutide (active ingredient in Ozempic/Wegovy) or tirzepatide (active ingredient in Mounjaro) online and we’ll send the medication to you on ice every 28 days.

Once you receive your medication, contact us for an injection training via FaceTime or ZOOM. At the time of your injection training, we’ll schedule you for your first coaching call the following week. You’ll inject yourself in the abdomen or thigh once per week. Your card on file will automatically be charged every 28 days and we’ll send out four pre-filled syringes with the correct dose every 28 days. When you reach your goal weight, in 3 months or 12 months or whenever, you have the ability to turn off your subscription through the Patient Portal here. You’re not locked into the medication subscription for any predetermined period of time. Your destiny is in your hands!

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Results of weight loss program

The data is in! After 4-5 months of our patients on semaglutide in our weight management program, we’re still seeing amazing results. You can see average weight loss each month in the graph above.

Each month, patients increase their dosage with each injection, starting at 0.25mg then up to 0.5mg, 1mg, 1.7mg and finally maxing out at 2.4mg. We’ve had some patients that didn’t lose as much as they hoped on semaglutide that are switching to the new option we now have available – tirzepatide, the active ingredient in Mounjaro.  So we’ll present their weight loss results in the coming months.

Extreme weight loss

Remember that this is the average weight loss. We did have patients who lost a moderate amount but we also had patients losing over 15 pounds and even over 20 pounds so far! Pretty amazing and we wish everyone could see those same results.

It’s impossible to know for sure what makes one patient lose more than another but certainly diet, exercise and avoiding high carb and highly refined sugars helps. We’ll continue to track this data and publish it every month.

Where we get our semaglutide

We are getting semaglutide, the active ingredient in Ozempic and Wegovy, from a compounding pharmacy that is FDA-approved, and sources the semaglutide base (not the salt) from an FDA approved manufacturer that follows current Good Manufacturing Practices (cGMP). These results would not be possible if the semaglutide we’re sourcing wasn’t a duplicate of the active ingredient found in the name brand drugs. And I don’t believe this large number of patients in our program would lose that much weight with diet and exercise alone in such a short period of time. So in other words, any doubts people may have about semaglutide from a compounding pharmacy should be put to rest.

Mounjaro (tirzepatide) on tap?

Yes, we now have tirzepatide, the active ingredient found in Mounjaro! While one study suggests Mounjaro leads to better weight loss than semalglutide (Ozempic, Wegovy), that one study was financially supported by Eli Lilly, the maker of Mounjaro. That study also suggests the risk of nausea is less with tirzepatide than semaglutide. We’ll continue to track this in our practice and let you know what we find now that we can compare them head to head.

Pricing

For pricing on our weight management coaching program, click here (non-coaching, click here). For pricing on the medication subscription monthly fee, click here for semaglutide or here for tirzepatide. And if you’d like to schedule a consultation, you can pay for the $100 consultation fee here and it will go towards the cost of the weight management program.

Lastly, if you do lose weight and eventually decide you would like body contouring surgery, the weight management program fee will go towards the cost of surgery. To check pricing on all of our body contouring procedures, click here.

The post Weight Loss Results after 4-5 months on semaglutide first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Incretin Mimetics

All of these medications are part of the class of drugs referred to as incretin mimetics. They mimic naturally occurring gastrointestinal hormones such as glucagon-like peptide (GLP-1) and gastric inhibitory peptide (GIP) that suppress appetite after eating and stimulate the release of insulin from the pancreas. That’s one of the reasons these were originally approved back in 2005 under the name Byetta to treat type 2 diabetes, the form of diabetes most attributed to obesity.

Approval for type 2 diabetes and obesity

In the process of treating type 2 diabetes, the injectable medications were found to also result in weight loss. For example, Ozempic, first approved in 2017 for type 2 diabetes, was so effective at reducing weight that it was approved specifically for obesity under the name Wegovy in 2021. The active ingredient in both of these medications is semaglutide. We source our semaglutide from a compounding pharmacy because they’re 1) more readily available than the name brand drugs that are currently on the FDA shortage list and 2) they’re substantially less expensive than the name brand drugs.

According to the Wegovy website, patients on the medication during the 68 week trial (1 year and 4 months) lost 15.1% of their body weight, the equivalent to approximately 35 pounds. These results were based on adult participants in the study.

Kids and Obesity Drugs

A similar study was undertaken in kids ages 12-17. And the results were similarly stunning. “…adolescents with obesity treated with semaglutide for 68 weeks had a 16.1% reduction in BMI compared with a 0.6% increase in BMI in those receiving placebo. Both groups also received lifestyle intervention. Mean weight loss was 15.3 kg (33.7 lb) among teens on semaglutide, while those on placebo gained 2.4 kg (5.3 lb).” Based on this data, Wegovy is now FDA-approved in kids ages 12-17.

Prior to Wegovy’s approval for childhood obesity, there was another medication available. Saxenda, also an incretin mimetic, was approved for obesity with the active ingredient liraglutide (and previously approved for type 2 diabetes under the name Victoza) as a daily injection. So while there was a medication available previously for obese adolescents, the ability to switch to a weekly injection in the form of Wegovy will be a huge improvement.

Our Program for Kids

Similar to our program for adults, we are now welcoming kids ages 12-17 to apply for our weight management program. While there is a required coaching program during the first 6 months of treatment ($1199), the monthly medication/prescription cost is significantly reduced to $250 every 28 days.

The $250 will go towards the actual medication in the form of semaglutide that we get from an FDA designated “outsourcing facility” that abide by current Good Manufacturing Practices (cGMP) and sources their ingredients from a USP manufacturer approved by the FDA. Or if you can get the medication approved by insurance or Medi-Cal, which is unfortunately unlikely, then we’ll provide you with a prescription each month for the same price.

We are now accepting applicants. Start the process by paying for ($100) and scheduling a consultation (virtual or in-person) here. After the consultation, you can move forward by paying for the balance of the coaching program ($1199 – $100 consultation fee = $1099). At that point, we’ll send you a bluetooth-enabled scale, a journal and order baseline labs which can be drawn in our office or at a LabCorp of your choice.

Once labs are reviewed, the monthly subscription to the medication/prescription can be purchased here at this special link for kids at the reduced rate.

Any questions? Please reach us via email at frontdesk@ph-ps.com or call/text 415-923-3005

The post Kids approved for weight loss drugs! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.