About two years ago, Dr. Paul Jarrod Frank, a cosmetic dermatologist based in New York, began to notice a new trend in his practice. As more Americans turned to weight-loss medications like Ozempic, he observed a significant rise in patients reporting negative side effects.
“Although they felt much better losing weight, in some ways they felt they looked older,” he explained with a voice note. “This was due to the loss of facial volume.”
Frank coined the term “Ozempic face” to describe this phenomenon. It refers to the sagging skin and hollowed appearance that can accompany the use of GLP-1 medications like semaglutide, which is found in drugs like Ozempic and Wegovy.
“Typically, with patients in their mid-40s and older, losing 10 pounds or more can create a deflated look,” noted Frank, who runs the aesthetic healthcare brand PFRANKMD and authored “The Pro-Aging Playbook.” “Certainly, people dropping 20 or 30 pounds are more likely to have this issue.”
Semaglutide works by stimulating insulin production in the pancreas, helping control appetite and promoting feelings of fullness. Originally approved for type 2 diabetes, Ozempic is now frequently prescribed off-label for weight management. In fact, recent data suggests that around 1 in 8 adults in the U.S. have used a GLP-1 drug, with a significant portion doing so primarily for weight loss.
Currently, more than 20% of Frank’s patients are incorporating GLP-1s into what he describes as their “longevity regimen.” After losing weight, they seek treatments like dermal fillers, facelifts, and fat transfers to regain facial volume.
“You can only refill a deflated balloon so much; often, surgical intervention is necessary,” he added. But he mentioned that “just increasing the dosage of their volume replacement is usually enough for many.”
“Someone who may have previously used one syringe of filler is now using two or three,” he noted.
The American Society of Plastic Surgeons recently reported that a significant number of GLP-1 patients were contemplating cosmetic surgery, with many already undergoing procedures.
Kimberly Bongiorno, a government land use administrator from New Jersey, is one such patient seeking cosmetic surgery. After gastric sleeve surgery in 2019, she regained weight during the pandemic and was prescribed Wegovy. Despite considering the drug a game-changer, reducing her weight from 170 to 125 pounds, she was troubled by how it affected her appearance.
“Everything just kind of hung and was very loose,” she recalled during a Zoom call, reflecting on a photo shared by a friend. “I felt I had lost my cheeks and had loose skin under my neck.”
“It looked like I had melted. It was horrifying,” she added. “Seeing how my face had changed was really disheartening, and I felt like I looked older than I actually am.”
After visiting Dr. Anthony Berlet, Bongiorno opted for a deep plane facelift, which lifted her skin and adjusted deeper tissues. She also underwent a neck lift to improve the contours left from her weight loss.
“Before I did this, I probably looked closer to 60, or maybe even older. And now I have people who I’ve recently met think I’m in my 40s,” she shared, appreciating the compliments she receives, saying, “People say I look healthy and happy now, which is nice to hear because I didn’t feel that way for a while.”
The number of facelifts performed in the U.S. has risen by 8% between 2022 and 2023, according to the Society’s data, and the use of hyaluronic acid fillers has doubled in that timeframe. While the society cannot directly link these increases to GLP-1 usage, its former president noted that these medications are influencing aesthetic surgery trends.
“Now we have a brand-new tool that works for many patients,” he remarked, pointing out that GLP-1s come without many of the drawbacks associated with surgeries like gastric bypass.
He emphasized that it’s essential to have open discussions with patients about the reality of using GLP-1s for weight loss and the potential consequences, particularly what it means to appear significantly slimmer.
The term “Ozempic face” may reflect modern culture, but the effects, such as decreased facial subcutaneous fat, are not new. Surgeons have long been treating side effects from weight loss. Interestingly, one popular filler, Sculptra, was initially created in the 1990s for HIV patients.
As adults don’t generate new fat cells, during weight loss, existing fat cells simply decrease in volume, resulting in less facial fullness. Age also plays a role; younger people are typically less affected by aging signs linked to GLP-1 use.
“Those in their 20s and 30s tend to have better skin elasticity, which allows for a better rebound,” Frank mentioned.
According to ASPS, younger patients comprised just a small percentage of facelift and filler procedures last year, but that number is increasing. Gabriela Vasquez, a 29-year-old, has seen weight loss success with Ozempic and is already considering preventative cosmetic treatments.
Although still working towards her target weight, Vasquez sought Botox for more visible lines and microneedling to stimulate collagen production.
“I noticed my jowls when I was a bit heavier, so I thought I’d try microneedling,” she shared during a Zoom call. “It definitely helped.” She expressed surprise at her newfound jawline after recent photos.
As she continues losing weight, Vasquez remains open to more cosmetic treatments for her body, mentioning some areas that catch her attention for potential tightening procedures.
Frank also pointed out the appearance of “Ozempic body,” referring to muscle loss that often accompanies rapid weight loss.
The ASPS notes the rising notion of the “Ozempic makeover,” encompassing various procedures, including tummy tucks and lifts.
Bongiorno herself has undergone multiple surgeries to combat excess skin, estimating a total expenditure close to $80,000 on cosmetic enhancements.
“This wasn’t about becoming a supermodel; it was about comfort and feeling good in my skin,” she added, addressing the discomfort of excess skin.
The long-term effects of GLP-1 medications on cosmetic procedures are still unclear. Interestingly, liposuction remains the most performed surgical cosmetic procedure, showing a slight year-on-year increase.
It’s also uncertain how “Ozempic rebound,” when patients regain weight after stopping the medication, might impact those who have had cosmetic work.
A recent study indicated many discontinuing the drugs within a year, and findings noted a tendency to revert to previous weights after about ten months of stopping. This serves as a reminder of the need for more comprehensive approaches to weight loss.
For Williams, this highlights a shared responsibility in ensuring patients’ overall well-being, rather than just focusing on their cosmetic desires.
“We don’t want patients to rely on these medications forever. It should be a temporary support toward healthier living,” he concluded, emphasizing the importance of guiding them toward lifestyle changes, nutrition, and exercise.
