Below, Deepak Dugar, MD, a facial plastic surgeon specializing in closed scarless nose rhinoplasty, discusses how GLP-1 medications like Ozempic impact body composition. He highlights concerns about rapid weight loss causing sagging and volume loss in the buttocks, breasts, and face, posing challenges for both patients and physicians.
Plastic Surgery Practice: What specific changes have you observed in patients’ buttocks after losing weight with GLP-1 medications like Ozempic?
Deepak Dugar, MD: After losing weight with GLP-1 medications like Ozempic, specific changes observed in patients include significant deflation of the upper poles of the buttocks, leading to a sagging appearance. This volume loss affects not only fat but also the upper and lateral gluteus muscles, which normally maintain definition and contour. Significant excess skin is common in these areas, particularly along the lower pole of the buttocks, due to volume loss from both fat and muscle.
PSP: Can you elaborate on the Ozempic breast concerns and the types of changes in breast tissue that patients are experiencing?
Dugar: Similar to, but not as drastic as, breast feeding, I’ve noticed a loss of volume in breast tissue among patients who have taken Ozempic-like medications. While breast feeding causes this appearance due to subsequent shrinkage of the glands from breast milk reduction, with these medications there is a loss of volume due to fat and muscle tissue loss, which leads to increased sagging of the breast tissues. I’ve also noticed excess skin commonly found around the inner poles of the breast due to a loss of volume in the global breast tissues, which is caused by fat and muscle loss.
PSP: How does the rapid loss of baby fat in the face from GLP-1 medications differ from the natural weight loss process in terms of facial appearance and skin elasticity?
Dugar: Rapid weight loss does not allow the skin to contract naturally, as skin contraction occurs more slowly than fat shrinkage from GLP-1 medications. When fat is lost naturally, it happens gradually, allowing the skin to shrink and wrap appropriately alongside the tightening of collagen and elastin fibers. However, fat loss with Ozempic-like medications surpasses the body’s ability to shrink the skin, leading to excess skin and a sagging appearance, especially when used aggressively.
PSP: What procedures or treatments do you recommend for patients experiencing facial drooping or sagging due to rapid weight loss from medications like Ozempic?
Dugar: Prevention is the best cure. However, if a patient does develop these symptoms, I recommend facial volumizing procedures, such as fillers with hyaluronic acids or fat injections in layering with liposuction and reinjection techniques to volumize the face. Additionally, there are other medications, such as hydroxyapatite injections, that can be used. Although I personally would not recommend them in the face, I see many patients receive benefits from them when treating facial drooping and sagging.
PSP: Are there other body parts besides the buttocks and breasts that GLP-1 users should monitor for significant changes, and what preventative measures can they take?
Dugar: Especially in older men and postpartum females, I monitor the lower-abdominal skin. I’ve also noticed significant changes in the hips and love handle areas. Any body area that has or has had excess fat is at risk for sagging after taking GLP-1 medications. Given patients’ desire for skin tightness following the use of these medications, I’m seeing an increase in procedures like tummy tucks, thigh lifts, and abdominal etching to balance their significant weight loss with overall muscle and fat junction tightness.
PSP: Could you discuss the broader implications of rapid weight loss on overall skin health and the potential need for plastic surgery interventions?
Dugar: Generally, you don’t want to do anything with your body too fast or too slow. Pacing is key, even with functions such as your immune and endocrine systems, so your body has time to catch up and normalize progress. Rapid weight loss with GLP-1 medications often causes skin side effects, as the skin’s elasticity cannot contract as quickly as the weight loss occurs, potentially leading to excess skin.
I always tell my patients that GLP-1 medications are intended for those with significant health and wellness needs. The risks of these medications must be balanced with the benefits, individualized for each person. If someone is only looking to lose 5-10 pounds, GLP-1 medications are likely not the answer.
However, I believe it’s a reasonable choice for someone looking to lose 50-100 pounds. A balance of diet, exercise, and overall lifestyle should be considered before starting these medications. It’s also important to understand both the short-term and long-term side effects. Do you want to be on these medications for life? What happens if you stop? Would you prefer to change your lifestyle to match the weight loss, with or without the GLP-1 medications? These are all questions to discuss with your physician before beginning any GLP-1 medication.
