If you have questions you would like Dr. Gregg to answer, please email them to info@cynthiagreggmd.com, and we will include them in a future Ask The Surgeon Column.

Q: I have been using GLP-1 for weight loss, and I am concerned about the sagging and wrinkles appearing on my face. I am really unhappy with my appearance due to this and want to know if there is anything that can be done to make my face look fuller/healthier?

A: We do have some options for treating these signs of facial aging.

The use of glucagon-like peptide-1 receptor agonists, such as semaglutide (Wegovy, Ozempic), tirzepatide (Mounjaro, Zepbound), and liraglutide (Victoza), is expected to continue to grow in the US. Currently, up to 12% of Americans report using a GLP-1 for weight loss.

The desired weight loss achieved by patients on GLP-1s is often accompanied by an increase in their facial aging due to volume loss and increased sagging and wrinkling in the skin. This appearance has been called “Ozempic Face.”

Studies are now confirming what clinicians have long noted: the resulting facial aging is not just due to loss of volume in the face, but also to accelerated skin aging. This increased skin aging is attributed to a decrease in the dermal white adipose tissue (DWAT). This superficial layer of adipose tissue can compromise up to 10-20% of the total body weight in lean adults, with the thickness of the layer varying across different regions of the body. Studies suggest that this fat layer is a significant source of adipose-derived stem cells (ADSC). ADSCs play a crucial role in skin regeneration by secreting various essential growth factors and peptides. The possible depletion of this DWAT layer may lead to the reduction of skin integrity by negatively affecting skin rejuvenation.

Treatment of the facial changes that occur with the use of GLP-1s should not only replace volume loss but also target the stimulation of ADSCs in this fat layer. Non-surgical treatments to address this include dermal fillers, biostimulator injectables microneedling, and PDGF+. Those procedures can not only add volume but also stimulate the ADSCs to release growth factors, helping to rejuvenate the skin. PDGF+ placed in the dermis is another way to increase the concentration of growth factors to achieve facial skin rejuvenation.

Studies show that injecting fat in the form of Nanofat is a surgical option to stimulate the creation of new collagen and elastin, leading to improved skin texture, reduced wrinkles, and a rejuvenated appearance. Nanofat is an emulsified microfat harvested from the inner thigh or abdomen and processed in a sterile manner before being injected under the facial skin. Because it is derived from the patient’s own body, it is biocompatible, reducing the risk of allergic reactions and providing a natural-looking result. Additionally, surgical procedures such as a lower facelift or necklift can help improve facial appearance by repositioning and removing any skin and muscle laxity that occurs after weight loss.

Each patient has unique facial anatomy and skin quality. For a patient seeking to reduce the facial aging effects of rapid weight loss, a thorough assessment is needed to determine which option can help meet their aesthetic goals. Our Aesthetic Nurse Injectors are all highly experienced in working with patients who want to address the effects of the “Ozempic Face” to restore their appearance. Call our office or use the Appointment Request Form on our website to schedule a consultation with one of our Aesthetic Nurse Injectors to begin your journey in eliminating the visible effects of rapid weight loss. Should they determine that non-surgical methods will not successfully address your concerns, they will refer you to me to discuss surgical intervention.

– Cynthia Gregg, MD, FACS