'Ozempic face' may be driving a cosmetic surgery boom in US

RNZ News

6 days ago

By
Oscar Holland
, CNN
Ozempic medication boxes, an injectable antidiabetic drug, in a pharmacy in Riedisheim, eastern France on 23 October, 2023.
Photo:
AFP / Sebastien Bozon
About two years ago, celebrity cosmetic dermatologist Dr Paul Jarrod Frank noticed a new type of patient arriving at his New York practice.
Amid an explosion in the number of Americans losing weight with drugs like Ozempic, he saw a "dramatic spike" in clients experiencing unwelcome side effects.
"Although they felt much better losing weight, in some ways they felt they looked older," he said via a voice note.
"And this was due to the loss of volume in their face."
Frank started using the term "Ozempic face" - a label he believes he coined - to describe the phenomenon.
It has since become a social media byword for the sagging skin and hollowed-out appearance that can accompany the use of GLP-1 medications like semaglutide (the active ingredient in branded drugs such as Ozempic and
Wegovy
).
"Usually, with people from their mid-40s and above, once you start losing 10-plus pounds (4.5 kilograms), you can get this kind of deflated look," said Frank, who is the founder of aesthetic health care brand PFRANKMD and the author of "The Pro-Aging Playbook."
"Certainly, people losing 20 or 30-plus pounds (9 or 14 kilograms) are going to have this problem.
"You can only refill a deflated balloon so much, and often surgical intervention is necessary.
Semaglutide works by stimulating the pancreas to trigger insulin production, curbing users' appetite, and contributing to feelings of fullness.
Although the US Food and Drug Administration approved Ozempic to treat type 2 diabetes, doctors now commonly prescribe it off-label for weight management. About one in eight adults in the US has used a GLP-1 drug, and of those, around two in five did so solely to lose weight, according to health policy non-profit KFF in 2024.
Today, more than 20 percent of Frank's patients are using GLP-1s as part of what he called their "longevity regimen." The treatments sought after their weight loss include injectable dermal fillers to help restore facial volume, facelifts, and fat transfers.
"You can only refill a deflated balloon so much, and often surgical intervention is necessary," he said. But for many patients, he added, "just upping the dosage of their volume replacement is more than enough.
"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 trends, recently found that two in five of its members' GLP-1 patients were considering undergoing cosmetic surgery - and one in five already had.
Among the patients opting for a facelift was Kimberly Bongiorno, a local government land use administrator from Mount Arlington, New Jersey.
Having lost weight after gastric sleeve surgery in 2019, she regained 40 pounds (18 kilograms) during the Covid-19 pandemic, and was prescribed Wegovy last year. Despite describing the drug's impact as "almost a miracle" - taking her weight from 170 to 125 pounds (77 to 57 kilograms) - the 55-year-old faced new concerns over her appearance.
"Everything just kind of hung and was very loose," she said over Zoom, recalling seeing her face in a photo shared by a friend. "I no longer felt like I had cheeks, and I had a lot of loose skin under 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 office, Bongiorno underwent a deep plane facelift that lifted her skin and repositioned some of the deeper muscles and connective tissues. She also opted for a neck lift that refined and smoothed her neck contours while addressing excess skin left by her weight loss.
"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 said, adding: "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 number of facelifts performed in the US jumped 8 percent between 2022 and 2023, according to ASPS data. The use of hyaluronic acid fillers has meanwhile doubled from 2.6 million Americans in 2017 - the year Ozempic was first cleared for diabetes - to over 5.2 million in 2023.
The organisation could not attribute these upticks exclusively to GLP-1 use, but its former president, Dr Steven Williams, said the medications have had "a global effect on aesthetic surgery."
"Now we have a brand-new tool that actually has efficacy for so many patients," said Williams, a board-certified plastic surgeon and founder of California's Tri Valley Plastic Surgery, over Zoom. He noted that GLP-1s come "without substantial drawbacks" when 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 (9 or 23 kilograms) slimmer is going to be.'"
The term "Ozempic face" may speak to our times, but its symptoms - caused by a decrease in the subcutaneous fat that makes our faces plump - are nothing new. Cosmetic surgeons have long been treating the side effects of significant weight loss. In fact, one popular brand of dermal filler, Sculptra, was originally developed in the 1990s for HIV patients.
As an adult, "your body actually doesn't make more fat cells," Williams said. "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 determine how patients' faces react to weight loss. People in their 20s and 30s, for instance, are far less likely to experience the appearance of aging due to GLP-1 use, Frank said.
"Because they have good skin elasticity, the skin rebounds much better," he said.
Patients aged 20 to 39 accounted for 14 percent of hyaluronic acid filler use in the US and just 2 percent of facelift procedures last year, according to the ASPS. But both figures are on the rise.
Gabriela Vasquez, 29, is among the younger patients using GLP-1 to undergo cosmetic procedures after rapid weight loss. An employee of one of Williams' Tri Valley Plastic Surgery clinics, she has dropped around 50 pounds (23 kilograms) since starting Ozempic in November.
Although Vasquez is still working toward her target weight, she sought preventative Botox injections (more visible lines and wrinkles are, along with thinning lips, among the other side effects of GLP-1 use). She has also recently undergone microneedling, a procedure used to stimulate collagen production.
"One of my concerns was my jowls, because I felt I saw them when I was a little heavier," she said over Zoom from the Bay Area. "I think the microneedling definitely 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 did not rule out further cosmetic procedures as she continues losing weight - and not only 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 said, referencing the appearance of excess skin under 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, noted that "Ozempic face" may be accompanied by a phenomenon he dubbed "Ozempic body," adding: "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 (0.5 to 1 kilogram) a week, is muscle loss. And we see this all over the body."
The ASPS similarly notes the emerging term "Ozempic makeover," a suite of procedures that might also include tummy tucks, breast lifts and arm, thigh and buttock lifts.
For instance, Bongiorno, the New Jersey facelift patient, has also undergone several other procedures with Dr Berlet, including arm and thigh lifts, to address her excess skin. She estimates that after her upcoming breast lift, fat grafting and lower eyelid surgery, she will have spent about US$80,000 (NZ$135,600) on cosmetic procedures.
"Skin is heavy and uncomfortable," she said. "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 effect of GLP-1 medications on cosmetic medicine is yet to be fully understood. The assumption they might reduce demand for liposuction, for instance, has not come to bear: It remains the most common cosmetic surgical procedure in the US, growing in popularity by 1 percent last year, per ASPS data.
What also remains to be seen is the effect that "Ozempic rebound" - when patients regain weight after stopping the drugs - has on people who sought cosmetic procedures.
A recent peer-reviewed study found that most people using the drugs for weight loss quit within a year. Data presented at this year's European Congress on Obesity meanwhile suggested that patients typically returned to their original weight within 10 months of stopping use, with University of Oxford researchers calling the findings a "cautionary note" about using medication "without a more comprehensive approach" to weight loss.
For Williams, this further demonstrates why he and his plastic surgeon colleagues must take responsibility for their patients' "entire journey," not just 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 said, adding: "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."
- CNN