Anthony Rossi, MD, explains how rapid fat loss in the midface and infraorbital region is influencing aesthetic treatment strategies and patient counseling.
As the popularity of GLP-1 medications for weight loss continues to grow, aesthetic providers are increasingly encountering patients concerned about the facial changes that can accompany rapid and significant weight reduction. While many patients achieve substantial improvements in overall health and body weight, the resulting loss of facial fat volume—particularly in the midface—can create a more hollow, gaunt, or prematurely aged appearance. These changes have fueled growing discussion within aesthetic medicine around so-called “Ozempic face” or “GLP-1 face” and how best to address the unique structural and skin-quality concerns associated with this patient population.
A recent study published in the Aesthetic Society journal ASJ Open Forum explored the facial aging patterns associated with GLP-1–related weight loss and outlined considerations for treatment planning. The paper highlighted the central role of midface volume loss, infraorbital hollowing, skin laxity, and diminished light reflectivity in creating an aged appearance, while also emphasizing the importance of patient selection, timing, and multimodal treatment approaches. In this interview with Plastic Surgery Practice, Anthony Rossi, MD, FAAD, FACMS, a board certified dermatologist practicing in New York, discusses how these patients differ from traditional aging and post-bariatric surgery cases, why restoring structural support is often more important than simply adding volume, and how clinicians can balance patient expectations with safe, natural-looking outcomes.
Plastic Surgery Practice: Clinically, how do the facial aging patterns you see in GLP-1 patients differ from typical age-related changes or post–bariatric surgery weight loss?
Anthony Rossi MD, FAAD, FACMS: The midface fat is so important because not only is it central in the face, but it is also an area of light reflectivity. The deep and superficial fat pads waste quickly in GLP-1 users who lose a significant amount of weight. This along with the buccal cheek area hollowing gives an aged appearance.
PSP: The paper emphasizes midface volume loss as a central issue—why is this region such a priority, and how does treating it influence overall facial balance?
Rossi: Mid-face fat also supports the tear trough infraorbital area, so when we lose this fat power, the tear trough and infraorbital area often look even more accentuated and aged. In replacing this deep mid-faced compartment, we can help support not only the midface, but also the infraorbital hollow and restore the convexity and light reflectivity, especially when animating and smiling. Common obstacles include unrealistic patient expectations, ongoing weight loss, poor skin elasticity, and treating too much before weight has stabilized.
PSP: You highlight multimodal treatment as essential. What does an effective combination approach usually include, and why isn’t a single modality enough?
Rossi: Clinicians also need to recognize when fillers are not the best answer. Some patients need collagen stimulation, laser resurfacing, tightening procedures, or even surgical consultation for significant laxity. Also, if a GLP-1 user is not taking in enough calories or nutrients, they often look malnourished, and biologically, they will not make collagen because they don’t have enough protein intake.
PSP: What unique safety or durability considerations should surgeons keep in mind when treating this population?
Rossi: The best outcomes come from restraint. GLP-1 patients often do not want to look “filled”; they want to look like themselves again. They often like the initial gaunt look and need to understand how this ages them paradoxically. Initially, I approach this slowly until they understand what we are trying to achieve. PSP
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