What is the "Ozempic Face" and How to Combat It

Face Enhancement Expert Dr. Peter Lee, board-certified plastic surgeon in Los Angeles explains the effects of glucagon-like peptide-1 receptor agonist medication like Ozempic on the face and recommended treatments to combat volume loss in the face.

Ozempic is a brand name of the generic medication semaglutide manufactured by the Danish pharmaceutical company Novo Nordisk.  Semaglutide is one of a class of medications known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs).  These medications mimic the actions of GLP-1.

GLP-1 is a hormone produced in the human gut that plays an important role in regulating appetite and circulating blood sugar levels. It does this by affecting our physiology in three different ways.  

At the level of the central nervous system, GLP-1 can cause a reduction in appetite.  At the level of the gut itself, GLP-1 increases the transit time of digested food from the stomach to the small intestine, creating a feeling of early satiety that curbs consumption of food.  At the cellular level, GLP-1 encourages the breakdown of stored fat so it can be used metabolically for energy.

Because of these effects, particularly its ability lower blood sugar levels, Ozempic was developed as a medication to treat type 2 diabetes.  However, it was quickly noted by clinical researchers, that many of the diabetic patients prescribed Ozempic were also losing significant amounts of weight.  It is because of this effect that Ozempic has entered the public consciousness, and its brand name has become a stand-in for the whole class of GLP-1 receptor agonists in the same way that Botox has become synonymous with neuromodulators. It is because of its side-effect of weight loss, the off-label prescription of Ozempic for this purpose has exploded.  

While some patients who are using Ozempic, which we will henceforth use as a stand in for the category of GLP-1 receptor medications generically, for relatively small tweaks of their weight, a great many adopt it to achieve more aggressive degrees of weight loss over a relatively short period of time.  While patients often hope that their weight loss can be targeted to their “problem areas”, the reality is that weight loss of any sort in humans tends to be global, i.e., patients tend to lose fat, and some muscle mass as well, simultaneously from multiple parts of the body.  

Volume loss in the face can occur with any significant degree of weight loss (which we define as greater than ten percent of total body mass), whether or not it is associated with the use of Ozempic.  The loss of this volume can cause descent of the soft tissues, as well as redundancy of skin, in the face and neck.

With the appearance in our practice in recent years of increasing numbers of patients who have experienced significant levels of weight loss on Ozempic, we have adapted techniques from our practice of aesthetic surgery to specifically treat the effects of rapid, significant weight loss on facial aesthetics caused by use of Ozempic.

The workhorse of these techniques is fat transfer to the face of such a patient,  Fat transfer is the harvesting of fat from one part of the body, frequently the abdomen or flanks, and the reintroduction of the harvested fat to another part of the body, typically the face, including the tear troughs, temples, nasolabial folds, cheeks, chin and forehead. 

We perform fat transfer quite frequently, because we use it as a freestanding surgery to add volume and reshape the faces of younger patients, and we use it adjunctively in patients who are undergoing facelifts, browlifts and blepharoplasties. The majority of patients in our practice currently undergoing fat transfer are receiving it for the reasons cited above, but as the use of Ozempic becomes more widespread, and the long-term effects of weight loss from the use of Ozempic become more evident to patients,  we are seeing an increase in the number of patients seeking fat transfer to the face to restore loss of facial volume due to the rapid weight loss precipitated by the administration of Ozempic.

In younger patients who have experienced weight loss from the use of Ozempic, fat transfer, perhaps combined with an energy-based skin-tightening treatment, such as Ulthera, may be sufficient by itself to address the loss of volume that they experience in the face.  However, older patients who have experienced a significant amount of weight loss taking Ozempic may also have sufficient redundancy and laxity of the skin of the face and neck such that excisional surgeries, performed in concert with fat transfer, will offer the optimal aesthetic result.  The most common of these surgeries are browlifts (we usually perform them endoscopically), upper and/or lower blepharoplalsties, facelifts and necklifts,

Lastly, I should add that on social media, in addition to the surgeries mentioned above, the most common treatments that are trending for what is termed “Ozempic Face”, include collagen and elastin oral supplements, hyaluronic fillers and energy-based skin tightening procedures.  While none of these are harmful individually, the loss of facial structural support and volume that can occur with significant weight loss over a relatively short period of time is better addressed by the facial rejuvenation surgeries described above combined with fat transfer.