Ozempic Is Changing People’s Skin, Say Plastic Surgeons

If it seems like everybody is on Ozempic, it’s because a lot of people are on Ozempic—about six percent of U.S. adults (that’s about 15.5 million people) have taken the drug, according to a recent Gallup poll. And a decent number of those Ozempic patients are becoming plastic surgery patients—getting a nip, a tuck, or even a full-body lift to address the other changes, like excess skin, that can come with rapid weight loss. About 10 to 15 percent—or “one person per day”—of the people walking into his Beverly Hills practice have taken a semaglutide like Ozempic for weight loss, says Jason Diamond, MD, FACS, a double board-certified facial plastic surgeon.

But that’s not what this story is about.

It’s about what the plastic surgeons—who are getting up-close views of Ozempic patients’ tissues—are noticing while they are operating: These patients’ skin doesn’t always seem to behave like skin normally does.

One of the country’s top facelift surgeons was the first to bring this to our attention: Julius Few, MD, a board-certified plastic surgeon in Chicago and Beverly Hills, told one Allure editor that he’d been noticing a marked difference in skin quality in patients who were on a GLP-1 versus those who weren’t. (When we say Ozempic, we’re really talking about GLP-1s; Ozempic is colloquially used as an umbrella term for all GLP-1s like Botox is for neuromodulators.)

In the months since, I’ve reached out to 15 other board-certified plastic surgeons and dermatologists across the United States for their insights. What exactly happens in the skin and other facial layers when you take Ozempic—and could that mean that your skin acts, and maybe even looks, older?

There’s still a lot to be learned about Ozempic and other GLP-1s, like Wegovy, as the medications themselves are relatively new—but here’s what plastic surgeons have been noticing so far.

In this story:

• What the pros are seeing

• Where they’re seeing it

• Why it’s happening

• What we don’t know yet

What the pros are seeing

Plastic surgeons have an interesting perspective because they’re working in and under the skin.They are uniquely positioned to see changes that a primary care doctor or weight loss specialist may not. Their work requires them to pull, shape, and redrape both the skin and the tissues underneath.

While operating on Ozempic patients, Dr. Few started to notice a trend: The skin quality of someone on a GLP-1 was reminding him of an “old, overused rubber band.” Mark Mofid, MD, a board-certified facial plastic surgeon in San Diego and La Jolla, makes a similar comparison—it’s like the elastic waistband on a pair of underwear that has stretched out over time.

Dr. Diamond, who specializes in facelift surgeries, has noticed the SMAS layer is “definitely thinner and weaker” on people who have been using GLP-1s for weight loss. (SMAS is an acronym for subcutaneous musculoaponeurotic system, a layer of connective tissues that supports the face.) Usually, the SMAS thins naturally as you get older, which can contribute to facial aging, like sagging around the cheeks, according to a study published in Aesthetic Surgery Journal Open Forum. And if an Ozempic patient has plans to become a facelift patient, it’s worth noting that the SMAS layer is also essential for natural-looking results. “The success of the facelift is really based on the strength of the muscle layer,” says Dr. Diamond. “You’re not pulling out the skin and using that to get the lift. The muscle layer being thin can definitely affect facelift results.”

Dr. Few estimates that about 25 to 30 percent of his patients are currently taking a GLP-1, and finds that their skin “doesn’t hold its elastic recoil the way it did.” Based on his experience, using a GLP-1 “almost seems to age the quality of the skin, like the skin takes on an appearance of an older person.” He’s seen the skin look more worn and lose its ability to retain its shape around the structures of the face, which might lead to sagging around the jawline, for example. These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.

We asked Novo Nordisk, the makers of Ozempic and Wegovy, about what some plastic surgeons are noticing, and they sent the following comment: “At Novo Nordisk, patient safety is a top priority. We work closely with the U.S. Food and Drug Administration to continuously monitor the safety profile of our medicines. We are not aware of any studies looking at the effect of semaglutide specifically on facial fat. We recommend that any patients experiencing side effects while taking Wegovy or Ozempic contact their healthcare provider.” Novo Nordisk also noted that, “although Wegovy and Ozempic both contain semaglutide, they are different products with different indications, dosages, prescribing information, titration schedules, and delivery forms. The products are not interchangeable and should not be used outside of their approved indications. Novo Nordisk is committed to the responsible use of our medicines. We are taking multiple steps to ensure responsible use of our semaglutide medicines which are detailed on semaglutide.com.” These approved indications, they continued, are as follows: “Wegovy 2.4 mg is FDA approved in combination with a reduced calorie diet and increased physical activity to reduce the risk of major cardiovascular events such as death, heart attack, and stroke in adults with known heart disease and either obesity or overweight; and to help adults and children aged ≥ 12 years with obesity, or some adults with overweight with weight-related medical problems, lose excess body weight and keep it off. Ozempic is FDA-approved for the treatment of type 2 diabetes, to improve blood sugar, along with diet and exercise, and reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease. Ozempic is not approved for chronic weight management.”

Where they’re seeing it

You’ve probably heard about “Ozempic face,” a term for the sunken look that can result from rapid weight loss. In her practice, Umbareen Mahmood, a board-certified plastic surgeon in New York City, has noticed “accelerated aging in the face” of patients who have lost a considerable amount of weight on a GLP-1, noting “increased fine lines, jowling, periorbital hollowness, and crepiness of the skin.” But skin changes are also showing up on arms, legs, and stomachs. Dr. Mahmood has seen “marked increased laxity in the tissue of the breasts, abdomen, arms, and medial thighs [the part of the thigh that includes the hips]” on patients who have taken a GLP-1 to lose weight. In response, Dr. Mahmood has turned to tools like Galaflex mesh support, which is often referred to as an “internal bra,” when doing a breast lift or lift with implants. “The skin elasticity is weakened and needs additional support to hold up an implant or maintain a new shape on its own,” she says.

Dr. Mahmood is also seeing a “significantly greater number” of younger patients who have been on a GLP-1 asking for injectables and non-surgical collagen-boosting treatments like radiofrequency microneedling on the face and neck to help stimulate collagen and elastin production. “Patients on these medications often demonstrate accelerated signs of facial aging, such as laxity and wrinkles,” she says.

Because of the popularity of GLP-1s, doctors are seeing an uptick in patients requesting procedures that typically would be reserved for more dramatic weight loss and adjusting recommendations as needed. For example, Dr. Mofid typically recommends procedures like lower body lifts, brachioplasties (arm lifts), and inner thigh lifts for patients with “massive weight loss” but has found he “really struggles with” which procedures are right for patients on GLP-1s who may have only lost 20 to 50 pounds, but did it in a short amount of time and have the loose skin to show for it.

“Are these patients better off without those procedures that obviously leave you more scarring [like lower body lifts, inner thigh lifts, and brachioplasties], or are we better off using standard liposuction techniques and then adding some of the more recent skin tightening radiofrequency procedures like Body Tight or Morpheus?” he muses, calling it a “very delicate balance.”

According to Dr. Mofid, GLP-1 use has essentially created “a whole new category of patients” that just didn’t exist 15 years ago, and he has had to adapt procedures to meet their needs. “Fifteen years ago, I would never have done a lower body lift on a patient unless they had gastric bypass, a lap band, or a gastric sleeve,” he says.

Why it’s happening

We know what GLP-1s are doing to suppress appetite and cause weight loss—slowing down digestion and tricking your brain into feeling full by mimicking specific hormones— but what is happening on a biological level that could cause the skin to resemble that stretched-out waistband? The skin is composed of hundreds of factors that make it function, including collagen, elastin, and fat. When weight loss is gradual, says Dr. Mahmood, the skin can retract appropriately. But if weight loss is accelerated via extreme diet and exercise, weight loss surgery, or a GLP-1, the skin typically cannot respond the same way. “The skin's collagen and elastin fibers are unable to accommodate [that rapid change], and the skin sags,” Dr. Mahmood explains, adding that some studies have shown that “the skin in patients who have undergone massive weight loss is weaker due to the fact that the collagen and elastin fibers become damaged and are thinner overall.”

There have been some preliminary studies looking at the ways GLP-1s specifically might affect tissues, says Steven Dayan, MD, a board-certified facial plastic surgeon in Chicago who co-authored a recent review of the available data on GLP-1s and accelerated facial and skin aging, published in the Aesthetic Surgery Journal. Based on this research, Dr. Dayan believes GLP-1s are “turning off” adipose-derived stem cells, which sit within the upper dermal layers of skin. This matters because these stem cells release messengers that stimulate fibroblasts to produce collagen, elastin, and hyaluronic acid—the “good building blocks of your skin,” says Dr. Dayan. If a patient is using a GLP-1, it’s quite possible that the drug is essentially “turning off the engines that make our skin look healthier and youthful and [help it] regenerate,” says Dr. Dayan. He has also noticed that postmenopausal women who have lost weight on a GLP-1 look older faster because they’re losing fat, which produces estrogen. “Estrogen is good for the skin. It makes the skin look healthy and youthful,” he explains.

Dr. Dayan believes facial fat loss—in GLP-1 patients of any age—is mostly happening in the dermal fat and subcutaneous fat layers of the face; the subcutaneous fat layer gives the face volume and when that volume is lost, that contributes to an “aged” or hollow look. (“We see a similar pattern in other causes of rapid weight loss, including gastric bypass surgery, he says.) In some cases, the loss of subcutaneous fat is significant enough that it impacts a patients’ ability to get injectables: “With a lot of the fillers—whether they're biostimulatory or hyaluronic acid fillers—you need a certain degree of tissue integrity,” Dr. Few explains, sharing a story about a patient who lost a substantial amount of weight for her frame on a GLP-1 and inquired about what she could do to reduce her “gaunt” appearance. “In this case, she had lost all of her subcutaneous fat, especially down in her lower cheeks and jawline, so it really was skin on muscle.” According to Dr. Few, injecting a biostimulatory filler like Sculptra or Radiesse—designed to prompt collagen production over time—would put the patient at a higher risk for “lumps, bumps, and irregularities.” She asked about thread lifts, and “ultimately, I couldn't do thread lifting on her because her skin was so thin, [the threads would] show through,” says Dr. Few. He recommended that this patient gain a little weight back before proceeding with any fillers or threads.

For his part, Igor Sapozhnikov, MD, an obesity medicine doctor in Los Angeles, believes skin changes are less about GLP-1 medications themselves and more about how quickly a patient is losing weight. In his practice, Dr. Saopozhnikov sees patients lose about 10 to 15 percent of their weight on a GLP-1 over a period of six months—and he’s had patients who have to force themselves to eat and even drink water because they just don’t have an appetite at all. “There's almost like a starvation that happens … when people are on Ozempic or other medications like it, not only do they not want to eat, they also don't want to drink any water, so there's an element of dehydration,” says Dr. Sapozhnikov.

He also notes that when a patient is losing weight via medication versus traditional diet and exercise, the body is “metabolizing” other parts of itself for energy, which he says could contribute to the changes in tissue and muscle quality. Patients are losing muscle mass on a GLP-1, not just fat, which can lead to loose skin, says Dr. Sapozhnikov. “You’re basically breaking down your own muscle for energy,” he says.

The reverse can be true too; if a patient gains a lot of weight over a short amount of time, their skin may behave in much the same way—again, like that stretched-out elastic waistband, says Dr. Mofid. “Both significant weight gain and loss can and do change the inherent characteristics of skin, making both facial and body contouring procedures a challenge,” he says. When it comes to significant weight gain, he says, skin can develop “an altered collagen structure or framework and elastin production, and impedance of lymph channels,” which can contribute to “doughy”-looking skin.

What we don’t know yet

Because GLP-1s haven’t been around for very long—Ozempic was FDA-approved for use in adults with type-2 diabetes in 2017 and is not currently FDA-approved for weight loss, while Wegovy was approved for weight loss in 2021—there are no concrete answers yet about the implications of these drugs on the skin. “We’re still waiting to find out,” says Dr. Few. “I don't think anybody can tell you definitively that there's not an inherent change to the skin.” And if there is an inherent change, will it be permanent? That’s also a big TBD, and could depend on just how much a patient’s body changes on a GLP-1—losing more than 50 pounds is quite different than losing 20.

And not all surgeons have seen a change in the skin condition of patients taking GLP-1s. “I operate on a lot of weight loss patients and I don’t notice a difference,” says Steven Teitelbaum, MD, a board-certified plastic surgeon in Los Angeles. “I don’t see that there is a unique anatomical consequence of losing weight because of taking one of these drugs.” Dr. Teitelbaum says he is curious to see if patients on a GLP-1 regain weight after tapering off the drug, which could change skin quality. Dr. Dayan thinks that if a patient goes off the medication and keeps their weight stable via diet and exercise, the skin would eventually return to “normal.” Dr. Few, on the other hand, says there is “concerning anecdotal evidence” that the skin may not return to its normal appearance over time. No one knows for sure at this point in the GLP-1 game.

Dr. Saphozhnikov has seen some skin changes, but considers them to be in the minority of patients. “I would say maybe five to 10 percent of patients who have been treated with Ozempic or medications like it, who have really big success very early on, start seeing a little bit of a sunken face and extra wrinkles,” he says. “The skin is just not elastic.”

The most comparable shift in modern weight-loss treatment is probably the peak of gastric bypass or gastric sleeve surgeries in the ‘90s and early 2000s. These procedures permanently reduce the size of the stomach to encourage weight loss—about 50 percent of your overall weight in one year. At the time, those surgeries were typically reserved for patients who were “morbidly obese,” according to Dr. Mofid, not 30 to 50 pounds overweight. But there are other ways in which the GLP-1s and gastric bypass surgeries differ as weight-loss treatments: A GLP-1 is an injectable that works to decrease blood sugar levels and suppress a patient’s appetite, while gastric bypass actually changes the structure of the stomach.

Dr. Few never noticed a marked difference in skin quality in patients who lost significant weight via gastric bypass and sleeves. “With gastric bypass, you did have a small subset of patients who ended up becoming malnourished because of it, and then their skin did change,” he shares. “But for the most part, gastric bypass patients who were not malnourished and just had large weight loss, their skin still behaved like skin. Whereas in this [GLP-1] setting, it almost seems to age the quality of the skin, like the skin takes on the appearance of an older person.”

Twenty years ago, Dr. Few saw an uptick in post-gastric bypass plastic surgery procedures designed to remove and lift skin, especially tummy tucks, arm and leg lifts, and breast lifts, and he believes we’re in for even more of a boom with GLP-1s. “At its high point, there was a massive boom of post bariatric plastic surgery,” he says. “I think that's going to pale in comparison to what we're going to see with post-GLPs.” He has begun doing his own research regarding skin changes post-Ozempic usage, but for now, there are no formal clinical studies to refer to yet.

“Whenever a new medication comes out, a lot of people are hesitant to jump on the bandwagon, because no one really knows the long-term effects of a medication until it’s been around a long time,” says Dr. Mofid. “I think that no one's gonna know what the truest profile of these medications is until a generation passes. How many patients are gonna wind up with gastroparesis or slow motility [of digestion] that never really recovers?” (Gastroparesis is a disorder that slows the movement of food from your stomach to your small intestine, which can make you feel full shortly after you start eating or long after you’ve finished, or cause vomiting or nausea.)

Dr. Few believes potential GLP-1-induced skin changes are significant and common enough that they could lead to a new “subspecialty” among surgeons: “I think we're going to find that the skin doesn't behave exactly the same, which means there's going to be a real question of, ‘Is that skin more likely to have complications? Is that skin going to be more likely to behave badly with surgery? Are there going to be special things you need to do in anticipation of it?’”

As with most drugs, the GLP-1s come with side effects and tradeoffs. Will patients have to accept the potential of more rapidly aging, lax skin along with their weight loss? Will future plastic surgery, should they ever consider it, be more complicated? Doctors who’ve had a window into the skin tissues of Ozempic users aren’t sounding an alarm just yet but they are certainly standing at attention as this new era of weight loss takes hold. As Dr. Few said—a sentiment echoed by many of his colleagues: “Only the future will tell.”

Thank you to all of the doctors who shared insights into what they're noticing in their own patients who are taking, or have taken, GLP-1s for weight loss: Jason Diamond, MD, FACS, a double board-certified facial plastic surgeon in Beverly Hills; Julius Few, MD, a board-certified plastic surgeon in Chicago and Los Angeles; Mark Mofid, MD, a board-certified facial plastic surgeon in San Diego and La Jolla, and clinical assistant professor of plastic surgery at the Johns Hopkins School of Medicine; Umbareen Mahmood, MD, a board-certified plastic surgeon in New York City; Steven Teitelbaum, MD, a board-certified plastic surgeon in Los Angeles; Igor Sapozhnikov, MD, an obesity medicine doctor in Los Angeles; Steven Dayan, MD, a board-certified facial plastic surgeon in Chicago; Doris Day, MD, a board-certified dermatologist in New York City; Ava Shamban, MD, a board-certified dermatologist in Beverly Hills; Peter Lee, MD, a board-certified plastic surgeon in Los Angeles; Steven Williams, MD, a board-certified plastic surgeon in the Bay Area; Theda Kontis, MD, a board-certified facial plastic surgeon in Baltimore; David Shafer, MD, a board-certified plastic surgeon in New York City; Ben Talei, MD, a board-certified facial plastic surgeon in Beverly Hills; Lyle Leipziger, MD, a board-certified plastic surgeon in New York; Norman Rowe, MD, a board-certified plastic surgeon in New York and New Jersey; and Konstantin Vasyukevich, MD, a board-certified plastic surgeon in New York City.

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Originally Appeared on Allure