What is "Ozempic Face" & Why Does it Occur? Separating Fact From Fiction

Ozempic and other GLP-1 medications for weight loss are still surging in popularity, with new discoveries rapidly emerging in relation to their numerous benefits in addition to weight loss as well as new GLP-1 weight loss medications and supplements to support GLP-1 weight loss treatments. Ozempic is the most searched weight loss drug, outpacing Wegovy, its closest competitor, by 300%. The total prescriptions for Ozempic in 2022 reached 2.2M, marking a staggering 857% growth since 2019. Approximately one-quarter of all Ozempic prescriptions were issued for individuals not diagnosed with diabetes even though the drug is not yet officially approved for weight loss.¹  

Ozempics impact on the medical aesthetics industry is also going strong, leading to ever-faster innovations in skin tightening and facial and body contouring treatments. While loose skin is a typical side effect of weight loss procedures, Ozempic's effect on facial skin has been significant enough that the effect is now referred to as "Ozempic Face."

What is "Ozempic Face"?

The term “Ozempic Face” refers to the noticeable loss in facial volume and related premature signs of aging resulting from rapid and significant weight loss induced by Ozempic and other GLP-1 medications. Patients have reported changes to their facial appearance that include a hollowed or gaunt appearance, sunken eyes, sagging around the jawline and neck, the formation of jowls, the appearance of wrinkles and more prominent facial lines as well as other alterations to facial contours and overall appearance.²

While the characteristics attributed to “Ozempic Face” are similar to those in a naturally aging face, they occur in patients far younger than is generally observed in the natural aging process. The key difference lies in the loss of elastin and collagen, loss of facial fat and volume and excessive skin laxity and sagging.

“This is also why people often say that “Ozempic face” ages people—the skin is no longer as taut. People get face filler to look young and avoid wrinkles,” says Andrew Kraftson, M.D., “but losing tissue in the face has the opposite effect.”³ 

How Ozempic & Rapid Weight Loss Affects Facial Aesthetics

The emergence of the “Ozempic Face” phenomenon and this new cohort of aesthetic patients highlights the negative impact extreme weight loss can have on facial aesthetics.⁴ In particular, the rapid weight loss induced by Ozempic that leads to the face appearing more gaunt or sunken demonstrates the effect of semaglutide medications on facial volume loss and redistribution of fat. GLP-1 agonists induce metabolic changes that can impact adipose and muscle tissue, the primary factor behind the changes in facial contour and overall appearance tied to the “Ozempic Face” phenomenon.²

Female patients may be more likely to experience facial aesthetic concerns than men, as women seem to lose more weight than men when taking Ozempic, which may result in a higher prevalence of facial sagging and other side effects among women.⁵ Signs of “Ozempic Face” and noticeable facial sagging and skin laxity tends to most commonly appear after losing around 10-20% (roughly 15-20 pounds) of an individual’s total body weight.⁹ When taking Ozempic, this significant amount of weight loss generally happens within 2-6 months, a considerably rapid pace of fat loss. It is this rapid and extreme weight loss, particularly the rapid loss of fat in the face, that leads to the sagging and prematurely aged appearance associated with “Ozempic Face.”  

“Facial fat serves a protective and aesthetic function,” says Michael Steppie, M.D. “Any sudden loss of volume can cause changes because the fat that stretches and cushions the skin is no longer in place.”⁶

While the changes in facial appearance may look similar to premature signs of aging, they are a separate aesthetic issue tied specifically to rapid, significant weight loss. In addition, these facial changes are unique in their rapid appearance, increasing at a much faster rate than those caused by the natural aging process.

“Losing a substantial amount of weight can lead to sagging and aged facial skin,” Dr. Steppie explains. “The loss of facial fat, which contributes to aesthetics and elasticity, can result in rather sudden dermatologic change. It can alter the skin’s cushioning effects that reduce chubby cheeks in some patients, but may cause a hollow facial appearance in others due to the loss of volume.”

"Ozempic Face" Misconceptions 

Ozempic Myth #1: "Ozempic Face" is Unique to GLP-1 Weight Loss

Ozempic and other GLP-1 Treatments are not in and of themselves uniquely responsible for the reduction in facial volume that causes the skin to sag and appear gaunt. The same side effects can occur when an individual loses a significant amount of weight in a short period of time, whether that be through medications like Ozempic or bariatric surgery.

“[It also] happens in folks who have bariatric surgery or go through more intensive dietary efforts,” Dr. Kraftson said. “That would be no different than with medication.”

Ozempic Myth #2: Ozempic Targets Facial Fat Loss

The term “Ozempic face” in and of itself is misleading. Ozempic and other GLP-1 medications aren’t distinctly tied to the loss of facial fat. It is the overall decrease in body fat that causes the loss of volume, thinning of the skin and increases skin laxity in facial areas such as the cheeks, temples and jawline. The primary factor at play is the loss of subcutaneous fat just beneath the skin, which is crucial to preserving facial contours and skin elasticity. Losing body weight results in losing this underlying facial fat that fills out and helps plump the face and maintain its youthful contours.    

According to Aoife Egan, M.B., B.Ch., Ph.D., whether it is Ozempic or another GLP-1 treatment, “there is nothing specific in the medications that’s targeting fat loss in the facial area.”⁷         

Ozempic Myth #3: Ozempic Impacts Skin Quality

Another misconception about Ozempic’s role in the appearance of premature signs of facial aging is that the medication itself directly impacts skin health negatively. Once again it is the rapid loss of a substantial amount of weight that can cause visible changes in the skin as the body is depleted of vital nutrients, which in turn affects skin’s elasticity and texture. The fat supporting the face’s underlying structure can end up disappearing faster than the skin can adapt to this change and shrink at the same pace. Thus, the excess loose skin lacks the volume to fill it and results in the facial sagging and prematurely aged appearance commonly linked to the dramatic weight loss experienced with Ozempic.

Gediminas Samulenas, M.D., a surgeon at Nordesthetics clinic in Kaunas, Lithuania, explains, “The active substance of Ozempic is semaglutide, which has absolutely zero direct impact on the skin. It acts by altering insulin-glucose metabolism. Therefore, it leads to weight loss followed by a reduction of facial volume and a relative increase of loose skin. But there is no actual effect on the skin, its laxity/looseness is a consequence of weight loss."

“Particularly as we get older, our skin and subcutaneous tissue is less able to adjust well to large changes in subcutaneous fat,” adds Dr. Egan.

Key Characteristics of "Ozempic Face"

Individuals taking Ozempic and other GLP-1 medications that have experienced significant rapid weight loss most commonly complain about the following dermatological symptoms:⁶        

• Hollowed or Gaunt Face: The depletion of facial fat can cause cheeks and other areas of the face to lose their youthful fullness, leading to a gaunt or hollowed-out appearance. Decreased levels of elastin and collagen, essential for structural integrity, reduce the skin’s ability to retract after rapid weight loss.
• Sunken Eyes: This rapid loss of subcutaneous fat around the cheeks and eyes can also make eyes look sunken and more deep-set.         
• Sagging, Loose Skin: The loss of subcutaneous facial fat can lead to increased skin laxity and sagging.
• Deeper Wrinkles & Facial Lines:  Substantial weight loss and the subsequent loss of volume in the face can cause nasolabial folds, marionette lines and wrinkles to become more pronounced and result in a more aged appearance.         
• Lipolysis: GLP-1 receptor agonists boost metabolic effectiveness by releasing fatty acids from stored fat deposits, increasing fat burning through a process called beta-oxidation of the fatty acid sidechain.
• Jowling & Neck Skin Laxity: Loss of facial fat and increased skin laxity can lead to drooping skin around the jawline. This drooping around the jawline and increased skin laxity in the neck can result in creases and banding forming and loss of sharper, more youthful contours.
• Overall Loss of Facial Fullness:  An overall loss of facial fullness and youthful contours can result from rapid loss of subcutaneous facial fat.         

Is "Ozempic Face" Permanent?

Thankfully, the facial sagging associated with “Ozempic Face” may be a common side effect of Ozempic weight loss, but that does not mean it has to be permanent. Depending on a patient's age, this sagging and skin laxity can gradually adjust to the face’s slimmer shape, retracting and regaining some of the lost fullness over time. This is more likely to occur in younger patients with greater collagen and elastin production and skin elasticity. Older patients with less skin elasticity may not experience this same rebound effect and facial sagging could persist even after they stop losing weight.⁸       

The undesirable aged appearance of the face experienced while using Ozempic has the potential to partially or fully resolve after treatment. In cases where older patients are unable to regain a more youthful facial appearance and facial sagging persists, there are other options in the form of preventative lifestyle modifications and both surgical and nonsurgical cosmetic treatments to contour and tighten facial skin to achieve a more youthful appearance during and after their Ozempic weight loss journey.  

References:

1. Track Drugs - Ozempic Statistics and Trends in 2024

2. Montecinos, K., Kania, B. and Goldberg, D.J. (2024), Semaglutide “Ozempic” Face and Implications in Cosmetic Dermatology. Dermatological Reviews, 5: e70003. https://doi.org/10.1002/der2.70003

3. 'Ozempic Butt' and 'Ozempic Face': How Weight Loss Drugs May Affect Skin

4. Mansour, M. R., Hannawa, O. M., Yaldo, M. M., Nageeb, E. M., & Chaiyasate, K. (2024). The rise of "Ozempic Face": Analyzing trends and treatment challenges associated with rapid facial weight loss induced by GLP-1 agonists. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 96, 225–227. https://doi.org/10.1016/j.bjps.2024.07.051 

5. Rentzeperi E, Pegiou S, Koufakis T, Grammatiki M, Kotsa K. Sex Differences in Response to Treatment with Glucagon-like Peptide 1 Receptor Agonists: Opportunities for a Tailored Approach to Diabetes and Obesity Care. Journal of Personalized Medicine. 2022; 12(3):454. https://doi.org/10.3390/jpm12030454

6. Ozempic Face: Managing Skin Sag | Michael Steppie M.D. 

7. Let's stop using the term "Ozempic face." - Mayo Clinic Press

8. Ozempic Face: Understanding and Treating Facial Drooping 

9. What to Know About ‘Ozempic Face’