Are you seeing ‘Ozempic Face’ in your clinic?

A patient presenting for facial aesthetic treatment may have a hollowed-out appearance. Demonstrating sunken eyes and cheeks, a loss of mid-face volume, generalised skin laxity around the neck and jawline, an overall increase in signs of ageing, and more lines and wrinkles than you would expect for their date of birth. But have you thought about asking if they are using prescribed weight loss medication? You may well be looking at a case of ‘Ozempic Face’.

This new buzzword has been attributed to a New York-based dermatologist who noticed the ‘gaunt facial appearance’ amongst Hollywood stars. The trivial term perhaps detracts from its more serious nature, but concerns are being raised in published studies and at scientific meetings.

Ozempic®, (generic name, Semaglutide) is a long-lasting glucagon-like peptide-1 receptor agonist (GLP-1 RA), originally developed to treat type 2 diabetes that has gone on to be dubbed the must-have, ‘miracle’ weight loss drug, now also licensed in the UK for obesity as Wegovy®.

Volume from fat is a key marker of a youthful face. Any rapid weight loss will cause fat loss in the face, but the rising use of GLP-1 RAs has made this presentation more noticeable in some cohorts. In patients taking GLP-1 RAs or similar weight loss medication, wrinkles become more prominent, and the skin starts to sag in areas such as the temples, cheeks, tear troughs, jawline, marionette lines, and nasolabial folds. GLP-1 RAs can also cause changes in the size of the lips, cheeks, and chin that disrupt the balance of facial features. Patients appear gaunt not only due to volume loss but also resulting from changes in the facial skin where there is a loss of collagen, elastin, and essential nutrients. Additionally, the loss of fatty acids can affect the skin barrier, leading to dryness and a lacklustre appearance. Rapid depletion of vitamins and nutrients during weight loss can cause malnutrition, exacerbating the issues.

Clinical trials assessing GLP-1 RAs for weight loss rarely report facial fat loss as an adverse effect. Because of this, providers prescribing these medications are unlikely to counsel their patients about the potential for undesirable changes in facial appearance. It has been noted that, ‘…the plastic surgery community faces a challenge in managing the facial changes associated with rapid weight loss.’[i]

Ozempic’s popularity with celebrities, influencers, and the public alike has seen demand spiral, taking the manufacturer by surprise and leading to worldwide shortages. The appetite for weight loss medication including Semaglutide, Saxenda (Liraglutide), and Mounjaro (Tirzepatide) is indeed out of control.

Despite strict indications for use - a BMI ≥ 30 or ≥27 with one comorbidity for Semaglutide - prescribing guidelines are often overlooked, and many individuals are actively and inappropriately taking the medications with little monitoring of their diet and nutritional supplementation, alongside ignorance of the potential side effects. 

Recent announcements have seen the pharmacy regulator, the General Pharmaceutical Council (GPhC) tighten its rules to crack down on online pharmacies performing inappropriate remote prescribing of these drugs using online questionnaires to people who do not meet the required criteria or who have falsified information to illicit a prescription. The lack of oversight and ease with which individuals can ‘game the system’ when there is no in-person or even face-to-face video engagement, nor referral from another healthcare provider, has highlighted the failings in the current prescribing of these powerful medications.[ii] Reports abound of those with a healthy weight, underaged individuals, and those with eating disorders easily getting hold of these so-called ‘skinny jabs’.

Also popular with high-profile celebrities, the influence of weight loss drugs across social media platforms is undeniable; yet, the tabloids are now casting negative views on the apparent fixation with medication-driven body transformations.[iii] Headlines grab attention describing the shock as fans see how ‘skinny’ their favourite celebrities have become – many of whom showcase visible ‘giveaways’ or ‘tell-tale signs’ with prominent bones and tendons, or disproportionate head-to-body ratios, highlighting their inappropriateness for initial prescribing.

Rapid weight loss, a lack of clinical follow-up, and long-term continued use of GLP-1 RAs have hastened the publication of reported side effects and clinical observations of facial fat redistribution, volume loss, and noticeable premature ageing. Unlike natural ageing, the Ozempic Face has manifested in a much younger patient cohort, as characterised by loss of fat, elastin and collagen, muscle atrophy, and excessive skin laxity, leading to changes in facial contours and overall appearance.[iv] The aesthetic sector is responding by offering cosmetic treatments to patients as a solution to restore volume, manage excess skin, and mitigate the hollowed facial appearance with dermal fillers, energy-based skin-tightening, and surgical intervention.

Galderma has recently presented positive three-month interim data from its first-of-its-kind U.S. clinical trial to evaluate the synergistic effects of Restylane® Lyft™ or Contour™ in combination with Sculptra® for cheek augmentation and correction of contour deficiencies, in patients experiencing facial volume loss following treatment with one of four brands of GLP-1 RAs.[v] No doubt this will be the first of many findings published this year related to dermal filler efficacy in patients with medication-driven weight loss.

According to another U.S. study, practitioners have an important role in spotting this trend and counselling patients on their options. They must ask about concomitant medication use when consulting patients requesting facial fillers and consider recent weight loss with GLP-1 RAs, explaining realistic expectations when combining medication use and dermal fillers. They should ensure patients taking GLP-1 RAs are aware that cessation will likely lead to weight regain. This includes the hypothetical need to dissolve fillers after GLP-1 RA cessation as they regain natural adipose tissue around the face to prevent compounded fullness of facial features. This is an even more important consideration for patients electing to have semi-permanent facial filler products that cannot be dissolved with hyaluronidase.[vi] With media and public interest in GLP-1 RAs ceasing to wane, the ‘Ozempic Face’ is something you must have on your radar.