Sarmela Sunder, MD, a Beverly Hills-based double board-certified facial plastic surgeon, explains to Plastic Surgery Practice how GLP-1 medications like Ozempic can lead to skin laxity and collagen loss. She highlights Sofwave as an effective solution and shares tips on preserving skin firmness during weight loss.

Plastic Surgery Practice: How does rapid weight loss from GLP-1 medications like Ozempic impact skin laxity and collagen levels?

Sarmela Sunder, MD: When it comes to our GLP-1 patients—using medications like Ozempic or Wegovy for weight loss—one of the big concerns we’re seeing in clinic is skin laxity and collagen loss. Weight loss from these medications can occur so rapidly that the skin doesn’t have time to catch up, leading to sagging and a loss of firmness.

Sunder: Sofwave really shines for our GLP-1 patients. Sofwave uses ultrasound technology to target the deeper layers of the skin, specifically the mid-dermis, to stimulate collagen production. And for someone on a GLP-1, that’s huge because it helps rebuild what they’re losing at a rapid pace. The ultrasound waves essentially ‘wake up’ the fibroblasts in the skin to produce more collagen, which tightens up everything over time.

Prevention is key here. If you start Sofwave while the skin is still firm, you can prevent some of that noticeable sagging later. Sofwave stimulates collagen production, so getting a jump on it helps the skin stay tighter as the weight comes off. Since weight loss with these medications can happen quickly, you want to get ahead of any skin laxity before it really sets in. 

PSP: What areas of the body are most affected by skin changes due to rapid weight loss, and how does Sofwave specifically help with those areas?

Sunder: When we talk about Sofwave for neck and arm laxity, it’s about using ultrasound technology in a precise and targeted way. What it does is send ultrasound waves into the deeper layers of the skin—about 1.5mm deep—without affecting the surface. This is where the magic happens because that’s where our fibroblasts live. These are the cells responsible for making collagen. Collagen is what gives us structure, firmness, and a smooth appearance on the surface of the skin.

The ultrasound energy heats the mid-dermis to around 60°-70°C, which is the sweet spot for stimulating collagen production. This controlled heat essentially wakes up the fibroblasts, signaling them to start producing new collagen and remodeling the existing collagen. Over time, this process tightens and firms the skin.

For areas like the neck and arms, which can be challenging when it comes to sagging skin, Sofwave is great because it’s non-invasive and works beneath the surface. On the neck, it helps lift and tighten areas like the jowls, jawline, and under the chin, smoothing out any sagging. On the arms, it’s especially effective for areas like the triceps, where loose skin often appears after weight loss or with age. The best part is, there’s no downtime.

PSP: At what stage in a patient’s weight loss journey do you recommend starting Sofwave treatments to minimize skin issues?

Sunder: Again, prevention is key. In our practice, we recommend that patients start with one treatment at the initiation of their GLP-1 medication, then return in one to two months for evaluation and possibly a second treatment, depending on the rate of weight loss and each patient’s unique skin quality. It’s really about being proactive and treating early to maintain the skin’s tone and elasticity before sagging becomes more difficult to address.

Ultimately, it’s all about timing treatments to match the patient’s individual weight loss progress. Being proactive and starting early will help preserve skin tone and elasticity before sagging becomes harder to treat

PSP: Could you explain how Sofwave’s SUPERB Synchronous Ultrasound Technology stimulates collagen and elastin production?

Sunder: Sofwave is a safe, fast, and effective treatment for building collagen and elastin in the skin, which we start losing as early as our 20s. Using its advanced SUPERBâ„¢ technology, Sofwave heats collagen to the optimal temperature to trigger a healing response that promotes the production of new collagen and elastin.

What sets Sofwave apart is its use of intense ultrasound beam technology, which delivers energy in precise, controlled bursts. This ensures that only the specific areas needing treatment are targeted, stimulating natural collagen, elastin, and hyaluronic acid production. During the procedure, the skin is heated to between 60°-70°C, triggering the body’s natural healing response, leading to firmer, smoother skin—all without a single needle.

The treatment uses targeted ultrasound energy that focuses on the mid-dermal layer of the skin, where collagen and elastin are most abundant. Since Sofwave operates at a more superficial depth, the procedure is more comfortable for patients, with less discomfort compared to deeper treatments.

Before treatment, we apply a topical numbing cream for added comfort, and the procedure itself typically lasts 30-45 minutes, depending on the area being treated. With minimal to no downtime, patients may experience mild redness that usually subsides within minutes, allowing them to return to regular activities immediately.

PSP: How safe is Sofwave for different skin types, and what kind of results can patients expect after one treatment?

Sunder: This treatment is safe for all skin types and can be done year-round, including during the summer months. You’ll start to see gradual tightening as your body builds new collagen over a few months, making it ideal for people looking to firm up without surgery.

After one 30- to 45-minute session, most patients notice results, with improvements continuing for up to 12 weeks. For those with more skin laxity, two sessions are recommended. Some patients may opt for an additional treatment to achieve even better results or to target specific areas as needed.