Whether it’s that person you see in your hot yoga class who seemed to magically drop 15 pounds or the coworker who is on a more significant weight loss journey, the tool everyone seems to be buzzing about these days is semaglutide injections. Better known by the brand names Ozempic® and Wegovy®, the medications are helping people lose weight via both on- and off-label uses.
The successful slimming is not without side effects, however, and the aesthetic changes some patients see are sending them to their plastic surgeons and dermatologists for help. ‘Ozempic Face’ and ‘Ozempic Body’ are the buzzwords being used to describe everything from the loss of volume to skin laxity that may accompany the use of these drugs, and we spoke to top plastic surgeons to get a better understanding of why it happens and how to treat it.
What is Ozempic?
Ozempic® and Wegovy® are two of the best known semaglutide injections on the market today. Ozempic® was approved by the U.S. Food and Drug Administration (FDA) in 2017 to treat type II diabetes in adults. Wegovy®, meanwhile, was FDA approved in 2021 for chronic weight management in overweight or obese adults. More recently, there has been an uptick in people using semaglutide off label to lose smaller amounts of weight.
Both Ozempic® and Wegovy® involve a once-weekly injection of a specific dose under the skin of the thigh, upper arm, or abdomen. Semaglutide is part of a class of medications that ensure the pancreas releases sufficient insulin when blood glucose levels are high. Additionally, the glucagon-like peptide 1 (GLP-1) drugs make a person feel fuller longer and delay gastric emptying. The result? Fewer calories consumed. When coupled with diet and exercise, the effects can be dramatic.
Aesthetic providers are increasingly treating patients who are on the drugs for various reasons. “There are several new weight loss peptides and one of the most popular is Ozempic® or semaglutide,” says David Shafer, MD, a double board certified plastic and reconstructive surgeon and founder of Shafer Clinic in New York City. “We were ahead of the curve on this trend, as I started our metabolic aesthetic center at Shafer Clinic several years ago.”
Patients taking semaglutide injections for significant weight loss may incorporate aesthetic medicine into their treatment plan. “We see patients who use them in our practice and actually promote use of this and other semaglutides for weight loss, when indicated, under the care of a primary care provider to optimize overweight patients for flap surgery,” says Joseph Zakhary, MD, board certified plastic and reconstructive surgeon and co-founder of Southwest Breast & Aesthetics in Arizona.
Why Everyone’s Talking About Ozempic
If semaglutide has been on the market for a few years now, you may be wondering what all the recent fuss is about. “Ozempic® has been around for a while,” says Jennifer Levine, MD, a double board certified facial plastic and reconstructive surgeon in NYC. “The weight loss aspect of the medication has been more prevalent for the past year.”
For one thing, it started gaining attention on social media due to celebrities and influencers subtly or not-so-subtly talking about it as a weight loss trick of sorts. “I don't think ‘trick’ is the right word to describe this given that Ozempic® is an effective drug used for type II diabetes and/or obesity,” notes Oren Tepper, MD, a board certified plastic and reconstructive surgeon and director of aesthetic surgery Montefiore Medical Center in NYC. “What has happened over recent years is that the criterion for its use is becoming somewhat less strict.”
As he explains, semaglutide was initially intended for people with a body mass index (BMI) over 30 or for those with a slightly lower BMI who had other significant medical issues related to being overweight. While that is still the FDA-approved use of Wegovy® (which is a weekly 2.4 milligram dose), smaller doses of semaglutide are being prescribed off-label for more moderate weight loss.
At Dr. Shafer’s practice, patient’s receive a comprehensive examination and evaluation to see if they are candidates. “Ozempic® should not be taken as a standalone medication, but rather as a customized treatment plan,” he shares. “This is not something that you just call your doctor or find online and ask for a prescription without being seen or evaluated.”
It takes time to establish the right dosing that minimizes side effects and maximizes results, but Dr. Shafer says there is no secret as to why semaglutide injections have become popular. “First, it is very effective and people see quantifiable and visible results,” he explains. “Second, the side effect profile is very mild, and it is well tolerated when it is dosed correctly.” Another plus: “It is an easy once a week dosing,” he adds.
When it comes to treating patients who are obese, Dr. Zakhary says he has noticed the positive effects of semaglutide to “optimize weight loss” more and more in the last year or so. “This leads to patients who see us with a wide spectrum of weight loss… not dissimilar to the patients who had surgical procedures such as a gastric sleeve for weight loss,” he explains.
What Is So-Called ‘Ozempic Face’ and ‘Ozempic Body’?
If you are familiar with the old ass versus face dilemma, then you have a pretty good sense of what ‘Ozempic Face’ and ‘Ozempic Body’ refer to. “With any weight loss, there are positives and negatives,” Dr. Shafer explains. “When losing weight, we feel better, our clothes fit nicer, conditions like diabetes and hypertension and hypercholesterolemia can all improve.” Here comes the but. “However, with quick weight loss by any method – other weight loss medications, gastric bypass, lap band, etc. – we lose volume in our face and our skin can become looser,” he adds.
For many patients losing smaller amounts of weight, the face is where you notice it. “When we start getting up to 15 to 20 pounds of weight loss, you'll definitely start to see the changes,” explains Amir Karam, MD, a double board certified facial plastic and reconstructive surgeon and founder Carmel Valley Facial Plastic Surgery and Aesthetic Center in San Diego, CA. “But even as little as five to 10 pounds can have a noticeable effect on the face.”
The most common impact is on facial volume, which can lead patients to feel like they look tired or older, Dr. Karam shares. This is especially true, he says, in people over 40. “Anytime somebody loses weight in their forties and fifties – with Ozempic® or without – their face is going to lose weight in a more accelerated way than their body,” he notes. “Therefore, even small amounts of weight loss will affect one’s face more than their handles.”
Facial skin laxity is also a concern, particularly in patients losing large amounts of weight in a relatively short period of time. “What is often surprising to patients is the impact that this may have on the face,” Dr. Tepper notes. “The impact of semaglutide to the face includes loss of volume in key structural areas like the cheek, or temples, as well as sagging skin along the jawline and neck.”
But it’s not just the face. Semaglutide injections can lead to rapid weight loss, which means the effects are not dissimilar to what is seen after a bariatric surgery. “These procedures, much like Ozempic®, can lead to weight loss that occurs very quickly,” Dr. Tepper explains. “With rapid weight loss, it is often difficult for the overlying skin to contract at the same rate, thus resulting in the skin being quite loose.” This most commonly affects the abdomen, breasts, upper arms, or upper thighs.
The Best Procedures for Treating ‘Ozempic Face’
As we’ve discussed, ‘Ozempic Face’ refers to the loss of facial volume and skin laxity that may accompany weight loss. “When it comes to the face, changes caused by rapid weight loss are best treated with a two-pronged approach,” Dr. Tepper shares. The first is removal and tightening of the skin and the second is the replacement of volume.
The best way to address these concerns is with “procedures that help with lifting and laxity and promote collagen and elastin production,” Dr. Levine notes. Below are the best surgical and non-surgical solutions for ‘Ozempic Face’:
For Restoring Volume
If your weight loss has resulted in a more gaunt appearance in the cheeks, temples, or other areas of the face, volume can be restored with dermal fillers and fat grafting.
Dermal Fillers: Depending on your aesthetic goals, either hyaluronic acid (HA)-based fillers (think: Juvederm®) or biostimulatory fillers (i.e. Sculptra® and Radiesse®) can effectively sculpt the face. “Biolstimulatory fillers such as Sculptra® or hyperdiluted Radiesse® also help to produce collagen, improving laxity, skin quality and texture,” Dr. Levine shares. The results take longer to see but are more lasting than HA fillers.
Fat Grafting: For patients who have unwanted fat on the body, fat transfer can be an alternative to synthetic fillers. “In my opinion, fat is a much better option for this because it is long-lasting and can more safely be replaced in larger volumes without additional risks,” Dr. Tepper explains. Fat is harvested via liposuction from a donor site like the flanks or thighs and transferred to areas of the face that have lost volume. Dr. Tepper’s ‘Boomerang Lift’ restores upper cheek volume in – you guessed it – a boomerang-like shape. “This technique works very well for Ozempic-type weight loss because it targets the sagging of the cheek and loss of volume that is caused by this medication,” he says.
It’s important to remember that fillers address volume, not laxity. Depending on your age and skin quality, fillers or fat transfer might be enough to address your concerns. For others, skin tightening may also be needed. “If somebody is in their thirties and they lose some weight, it's unlikely they're going to have significant sagging,” Dr. Karam says. “They might look a bit more gaunt, and, in that case, they would only require some volume from either a fat transfer or some fillers in very select areas.”
For Non-Surgical Skin Tightening
There are many modalities on the market that have the ability to firm the skin without cutting. They include, radiofrequency, microneedling, ultrasound, energy, and laser to name a few. “Renuvion® skin tightening is a great alternative to help tighten skin without large incisions,” Dr. Shafer says. “For non-invasive treatments, Ultherapy® helps tighten deeper tissues, while helps tighten more superficial skin and is great for lower eyelids.”
Dr. Levine likes Ultherapy® because it “uses microfocused ultrasound to treat the SMAS – which is the layer lifted during a facelift – and helps the body produce new and healthy collagen and elastin.” EmFace® (from the makers of EmSculpt®) is another one of her go-tos. “It combines radiofrequency with electrical stimulation of the facial muscles,” she explains. “It works on the muscles of elevation to tone and increases the density of the facial muscles for natural volume.” She says it also helps with wrinkles and skin quality.”
For Surgical Skin Tightening
Non-surgical skin tightening can only go so far, and patients experiencing more significant skin laxity concerns would benefit from a facelift and/or neck lift. “A neck lift or facelift can help with the sagging skin around and below the and jowling associated with loss of facial volume,” Dr. Zakhary says. “Some, but not all, of these procedures can be performed at the same time.”
Surgical intervention is usually the most effective course of treatment for patients over 50, Dr. Karam shares. “If someone is in their late forties to fifties, it is likely that their weight loss will lead to sagging or unveil the level of sagging that the person already had due to aging,” he explains. “When someone’s face is fuller due to fat, it actually camouflages and hides facial sagging. But when the weight comes off, the underlying sagging is revealed.” In such cases, a facelift and/or neck lift is the only treatment option, he adds.
For patients who also have concerns about volume loss, fillers can be coupled with surgery – but fillers alone will not necessarily be enough. “In my practice, I would suggest a vertical restore because fillers in this age group will not improve sagging,” Dr. Karam says. “The important point to make here as far as treatment is: If you have laxity, the treatment is going to be surgical; if you simply have volume loss, but your jawline and neck are pretty taut, the treatment is going to be fillers.”
For Improving Skin Quality
All of these surgical and non-surgical procedures are for naught, if you are not taking care of your skin. “The best thing you can do now or at any point along the aging continuum is to get serious about sun protection and be consistent with cleansing, vitamin C, retinol, as well as additional active ingredients,” Dr. Karam shares. “This was where the concept of the KaramMD Trifecta came from.” The most important rule of skincare: “Consistency is key,” he emphasizes.
Dr. Levine is also a proponent of skincare and is a fan of SkinMedica TNS Advanced+ Serum or Neocutis Bioserum for the face.
The Best Procedures for Treating ‘Ozempic Body’
Much like the face, the treatments for ‘Ozempic Body’ depend on the amount of pounds shed and the aesthetic concerns of the patients. “There are no reliable non-surgical options to address significant skin laxity after massive weight loss,” Dr. Zakhary notes. Excess skin surgery is the only treatment option for such cases, and he says patients must be weight stable for six months at their final goal. “For ideal results, we should agree in consultation that the patient's current weight is where we need it to be to achieve the best postoperative outcome for the patient,” he adds.
There are, however, some non-surgical modalities that can improve tone and firmness following less significant weight loss. Below is an overview of both surgical and non-surgical treatment options for ‘Ozempic Body’:
For Non-Surgical Skin Tightening
Energy, laser, and ultrasound-based treatments can be used on the body to tone and firm the skin and, in some cases, aid in additional fat reduction. “A great non-invasive treatment is TruBody® by Cutera which uses radiofrequency technology which can actually help tighten skin, reduce fat, and strengthen muscle,” Dr. Shafer says. He is also a fan of NuEra® by Lumenis, which is another RF technology.
While Dr. Levine likes EmFace® for the face, she is a proponent of EmSculpt® Neo combined with Emtone® for below the neck because it “really helps for laxity and toning of the body,” she says. “Ultherapy® can also be used on the body for laxity and crepiness.”
For Surgical Skin Tightening
Just as surgical lifts are the best ways to address more advanced skin laxity on the face and neck, so too are they best for most areas of the body. “Arms and legs can be treated with an arm lift or thigh lift, while the trunk benefits from an abdominoplasty or – more ideally – a lower body lift,” Dr. Zakhary says.
For Restoring Volume
Volume loss doesn’t just impact the face, it can also be a concern on the body – especially when it comes to the breasts and buttocks. “For loose buttocks, either a Brazilian Butt Lift (BBL) transferring fat from other areas of the body into the buttocks to lift the skin or using dermal fillers such as Juvederm®, Sculptra®, or Radiesse® is great for replacing lost volume,” Dr. Shafer shares.
When it comes to the breasts, breast augmentation with implants or fat transfer can increase the size and improve the shape of the chest. In some cases, a breast lift may also be needed to restore perkiness. “A combination breast procedure can be needed in females but is very exam and goal specific,” Dr. Zakary notes.
For Improving Skin Quality
We’ve said it before and we’ll say it again, the best cosmetic surgery in the world can’t disguise poor skin quality. “A nice treatment for loose skin of the arms and chest is hyperdiluted Radiesse® plus Ultherapy® to help stimulate collagen and tighten the deeper tissues,” Dr. Shafer says.
Dr. Levine also likes using diluted biostimulatory injectables on the body (think: chest and decollete), in addition to skincare. For the skin below the neck, she recommends Alastin TransFORM Body Treatment.
For the right patient, semaglutide can be a transformative weight loss tool. But dropping those lbs can lead to unwanted aesthetic side effects including lost volume and skin laxity on the face and body. Depending on your aesthetic goals, there are surgical and non-surgical procedures that can help plump, smooth, and tighten from head to toe. Consulting with a board certified dermatologist or plastic surgeon can help you get a better sense of the treatment options that are best for you.
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