About two years in the past, superstar cosmetic dermatologist Dr. Paul Jarrod Frank observed a new kind of affected person arriving at his New York follow. Amid an explosion within the variety of Americans losing a few pounds with medicine like Ozempic, he noticed a “dramatic spike” in purchasers experiencing unwelcome uncomfortable side effects.
“Although they felt much better losing weight, in some ways they felt they looked older,” he stated through a voice be aware. “And this was due to the loss of volume in their face.”
Frank began utilizing the time period “Ozempic face” — a label he believes he coined — to explain the phenomenon. It has since grow to be a social media byword for the sagging pores and skin and hollowed-out look that may accompany using GLP-1 medicines like semaglutide (the energetic ingredient in branded medicine corresponding to Ozempic and Wegovy).
“Usually, with people from their mid-40s and above, once you start losing 10-plus pounds, you can get this kind of deflated look,” stated Frank, who’s the founding father of aesthetic well being care model PFRANKMD and the writer of “The Pro-Aging Playbook.” “Certainly, people losing 20 or 30-plus pounds are going to have this problem.”
Semaglutide works by stimulating the pancreas to set off insulin manufacturing, curbing customers’ urge for food and contributing to emotions of fullness. Although the US Food and Drug Administration permitted Ozempic to deal with kind 2 diabetes, docs now generally prescribe it off-label for weight administration. About 1 in 8 adults within the US has used a GLP-1 drug, and of these, round 2 in 5 did so solely to drop some pounds, in response to well being coverage non-profit KFF in 2024.
How do weight reduction medicine work?
Today, greater than 20% of Frank’s sufferers are utilizing GLP-1s as a part of what he referred to as their “longevity regimen.” The remedies wanted their weight reduction embody injectable dermal fillers to assist restore facial quantity, facelifts and fats transfers.
“You can only refill a deflated balloon so much, and often surgical intervention is necessary,” he stated. But for a lot of sufferers, he added, “simply upping the dosage of their quantity alternative is greater than sufficient.
“Someone who may have used one syringe of filler in the past is now using two or three.”
The American Society of Plastic Surgeons (ASPS), which publishes an annual report on surgery tendencies, just lately found that 2 in 5 of its members’ GLP-1 sufferers have been contemplating present process cosmetic surgery — and 1 in 5 already had.
Among the sufferers choosing a facelift was Kimberly Bongiorno, a native authorities land use administrator from Mount Arlington, New Jersey. Having misplaced weight after gastric sleeve surgery in 2019, she regained 40 kilos throughout the Covid-19 pandemic and was prescribed Wegovy final 12 months. Despite describing the drug’s impression as “almost a miracle” — taking her weight from 170 to 125 kilos — the 55-year-old confronted new issues over her look.
“Everything just kind of hung and was very loose,” she stated over Zoom, recalling seeing her face in a picture shared by a pal. “I not felt like I had cheeks, and I had a lot of free pores and skin beneath my neck.
“It looked like I had melted. It was horrifying,” she added. “It was so disheartening to see how my face looked and how it had changed, I thought I looked a lot older than I am.”
After consulting plastic surgeon Dr. Anthony Berlet at his New Jersey workplace, Bongiorno underwent a deep airplane facelift that lifted her pores and skin and repositioned a number of the deeper muscle mass and connective tissues. She additionally opted for a neck elevate that refined and smoothed her neck contours whereas addressing extra pores and skin left by her weight reduction.
“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 am in my 40s,” Bongiorno stated, including: “People I haven’t seen in a while say, ‘You look so healthy and happy.’ And that’s nice to hear, because for a while, I didn’t look healthy and certainly wasn’t happy.”
The variety of facelifts carried out within the US jumped 8% between 2022 and 2023, in response to ASPS information. The use of hyaluronic acid fillers has in the meantime doubled from 2.6 million Americans in 2017 — the 12 months Ozempic was first cleared for diabetes — to over 5.2 million in 2023.
The group couldn’t attribute these upticks completely to GLP-1 use, however its former president, Dr. Steven Williams, stated the medicines have had “a global effect on aesthetic surgery.”
“Now we have a brand-new tool that actually has efficacy for so many patients,” stated Williams, a board-certified plastic surgeon and founding father of California’s Tri Valley Plastic Surgery, over Zoom. He famous that GLP-1s come “without substantial drawbacks” compared with invasive procedures like gastric bypass surgery.
“We can now have an honest conversation with patients about a nonsurgical tool that’s effective in weight loss,” he added. “And as part of that conversation, there’s an obligation to say, ‘Look, this is really going to work, so you have to be prepared for what looking 20 or 50 pounds slimmer is going to be.’”
The time period “Ozempic face” may communicate to our occasions, however its signs — attributable to a lower within the subcutaneous fats that makes our faces plump — are nothing new. Cosmetic surgeons have lengthy been treating the uncomfortable side effects of great weight reduction. In truth, one in style model of dermal filler, Sculptra, was initially developed within the Nineties for HIV sufferers.
As an grownup, “your body actually doesn’t make more fat cells,” Williams stated. “As we lose or gain weight, those fat cells aren’t multiplying or decreasing; they’re getting bigger or smaller. And so as we lose weight, those fat cells now have decreased volume, and there’s just less fullness.”
Age can decide how sufferers’ faces react to weight reduction. People of their 20s and 30s, as an example, are far much less more likely to expertise the looks of getting old as a result of GLP-1 use, Frank stated.
“Because they have good skin elasticity, the skin rebounds much better,” he stated.
Patients aged 20 to 39 accounted for 14% of hyaluronic acid filler use within the US and simply 2% of facelift procedures final 12 months, in response to the ASPS. But each figures are on the rise.
Gabriela Vasquez, 29, is among the many youthful sufferers utilizing GLP-1 to endure cosmetic procedures after fast weight reduction. An worker of one in all Williams’ Tri Valley Plastic Surgery clinics, she has dropped round 50 kilos since beginning Ozempic in November.
Although Vasquez remains to be working towards her goal weight, she sought preventative Botox injections (extra seen traces and wrinkles are, together with thinning lips, among the many different side effects of GLP-1 use). She has additionally just lately undergone microneedling, a process used to stimulate collagen manufacturing.
“One of my concerns was my jowls, because I felt I saw them when I was a little heavier,” she stated over Zoom from the Bay Area. “I believe the microneedling positively helped.
“I never had a jaw line,” she added. “And a couple weeks ago, someone took a picture of me, and I had one, and I was like, ‘Well, that’s new.’”
Vasquez didn’t rule out additional cosmetic procedures as she continues losing a few pounds — and never solely to her face and neck. “I’m seeing little things in my body that I’m like, ‘Whoa, that would be nice to take care of,’” she stated, referencing the looks of extra pores and skin beneath her arms. “I could see myself — later down the line, once I get to my goal weight — doing something to kind of tighten everything up.”
Frank, the cosmetic dermatologist, famous that “Ozempic face” may be accompanied by a phenomenon he dubbed “Ozempic body,” including: “One of the other major side effects of weight loss, particularly when it’s done at a rate of more than one to two pounds a week, is muscle loss. And we see this all over the body.”
The ASPS equally notes the rising time period “Ozempic makeover,” a suite of procedures which may additionally embody tummy tucks, breast lifts and arm, thigh and buttock lifts.
For occasion, Bongiorno, the New Jersey facelift affected person, has additionally undergone a number of different procedures with Dr. Berlet, together with arm and thigh lifts, to handle her extra pores and skin. She estimates that after her upcoming breast elevate, fats grafting and decrease eyelid surgery, she could have spent about $80,000 on cosmetic procedures.
“Skin is heavy and uncomfortable,” she stated. “This wasn’t something I did to go out there and be a supermodel. It was just to be comfortable, so I could get clothes on and not feel like I was dragging around all this extra weight.”
The long-term impact of GLP-1 medicines on cosmetic medication is but to be absolutely understood. The assumption they may scale back demand for liposuction, as an example, has not come to bear: It stays the commonest cosmetic surgical process within the US, rising in reputation by 1% final 12 months, per ASPS information.
What additionally stays to be seen is the impact that “Ozempic rebound” — when sufferers regain weight after stopping the medicine — has on individuals who sought cosmetic procedures.
A recent peer-reviewed study discovered that most individuals utilizing the medicine for weight reduction stop inside a 12 months. Data introduced at this 12 months’s European Congress on Obesity in the meantime steered that sufferers usually returned to their unique weight inside 10 months of stopping use, with University of Oxford researchers calling the findings a “cautionary note” about utilizing remedy “without a more comprehensive approach” to weight reduction.
For Williams, this additional demonstrates why he and his plastic surgeon colleagues should take accountability for his or her sufferers’ “entire journey,” not simply their cosmetic procedures.
“We don’t want these patients to be on these medications for a lifetime. We want it to be a temporary bridge to a healthier lifestyle,” he stated, including: “It’s our obligation to work harder with those patients, to talk about lifestyle changes, to get them plugged in to dietitians and to make sure that they’re building muscle and exercising.”