Approximately two years ago, Dr. Paul Jarrod Frank, a well-known cosmetic dermatologist in New York, began noticing a significant change in his patient demographic. With the surge of Americans using weight loss medications like Ozempic, he observed a notable increase in patients facing unexpected side effects. “Although they felt much better losing weight, in some ways they felt they looked older,” Frank explained in a voice note. “And this was due to the loss of volume in their face.”
Dr. Frank coined the term “Ozempic face” to describe this phenomenon, which has become a mainstream reference on social media for the sagging skin and hollowed features that can accompany the use of GLP-1 medications, such as semaglutide, found in branded drugs like Ozempic and Wegovy. He pointed out that individuals over 40 who lose significant weight—10 pounds or more—often experience this deflation, noting, “Certainly, people losing 20 or 30-plus pounds are going to have this problem.”
With the increasing number of patients using GLP-1s as part of their “longevity regimen,” more than 20% of Frank’s clientele are now seeking treatments to restore facial volume. This includes injectable dermal fillers, facelifts, and fat transfers. “You can only refill a deflated balloon so much, and often surgical intervention is necessary,” he stated, although he added that for many, simply increasing their volume replacement can suffice.
The American Society of Plastic Surgeons (ASPS) recently reported that 40% of its members’ GLP-1 patients are considering cosmetic surgery, with 20% having already undergone such procedures. One of those patients is Kimberly Bongiorno, a government land use administrator from Mount Arlington, New Jersey. After gastric sleeve surgery in 2019, she regained 40 pounds during the COVID-19 pandemic and began using Wegovy last year. While she described the weight loss as “almost a miracle,” going from 170 to 125 pounds, it brought unexpected changes to her appearance.
“Everything just kind of hung and was very loose,” Bongiorno recalled, describing her reaction to a photo shared by a friend. “It looked like I had melted. It was horrifying.”
After consulting with plastic surgeon Dr. Anthony Berlet, she underwent a deep plane facelift and neck lift to address the excess skin. “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,” she noted. The ASPS recorded an 8% increase in the number of facelifts performed in the U.S. from 2022 to 2023. Moreover, the use of hyaluronic acid fillers has doubled from 2.6 million in 2017 to over 5.2 million in 2023.
While the ASPS could not directly attribute these increases to GLP-1 use, former president Dr. Steven Williams expressed that these medications have had a notable impact on the field of aesthetic surgery. “Now we have a brand-new tool that actually has efficacy for so many patients,” he said, emphasizing the connection between weight loss medications and aesthetic outcomes. “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 term “Ozempic face” reflects ongoing societal dilemmas, but the symptoms associated with rapid weight loss are not new. Surgeons have long managed the side effects of significant weight loss, with certain dermal fillers initially developed for HIV patients in the 1990s. As patients lose or gain weight, the volume of existing fat cells simply increases or decreases, whereby reduced fat volume can lead to a less youthful appearance.
Age plays a crucial role in how individuals respond to weight loss. Younger patients—those in their 20s and 30s—are less likely to display signs of aging due to GLP-1 treatments, as their skin typically has better elasticity. Gabriela Vasquez, 29, who lost about 50 pounds since starting Ozempic in November, has also pursued cosmetic procedures, seeking preventative Botox injections and microneedling to stimulate collagen production.
“I think the microneedling definitely helped. I never had a jawline,” she stated, expressing satisfaction with her results. She hinted at future cosmetic endeavors as she continues her weight loss journey, noting, “I could see myself doing something to kind of tighten everything up.”
Dr. Frank identified another side effect termed “Ozempic body,” related to muscle loss due to rapid weight loss, suggesting that surgical solutions may be needed for this as well. The ASPS mentioned a growing trend towards an “Ozempic makeover,” involving a range of procedures aimed at enhancing appearance. Bongiorno herself has invested approximately $80,000 into various cosmetic surgeries, focusing on comfort rather than vanity.
As the long-term effects of GLP-1 medications on cosmetic practices continue to develop, the demand for traditional procedures like liposuction remains steady. A recent study indicated a significant number of patients discontinue weight loss drugs within a year, returning to their previous weights, raising questions about the sustainability of these treatments.
Dr. Williams emphasized the necessity for plastic surgeons to address the broader journey of their patients: “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 reiterated, “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.”
