Aug. 22, 2023
Ozempic Face
Historically used for diabetes, Ozempic and Wegovy are now wildly popular for weight loss. But with substantial weight loss comes volume loss, which needs cosmetic treatment.
While injectable fillers can restore shape and volume in the face, laxity in the neck and jawline from weight loss can call for energy treatments, and in more extreme cases, face and neck lift surgery.
Listen to learn how glucagon-like peptides work as a weight loss treatment and whether the pros of losing weight outweigh the cons of the skin laxity it causes.
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
1
00:00:00,930 --> 00:00:03,960
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:03,960 --> 00:00:07,560
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:07,560 --> 00:00:10,020
surgery. I'm your co-host Doreen Wu,
4
00:00:10,230 --> 00:00:13,410
a clinical assistant at Bass
Plastic Surgery in New York City.
5
00:00:13,890 --> 00:00:18,330
I'm excited to be here with Dr. Lawrence
Bass Park Avenue plastic surgeon,
6
00:00:18,630 --> 00:00:20,730
educator, and technology innovator.
7
00:00:21,450 --> 00:00:25,920
The title of today's episode
is "Ozempic Face." Okay.
8
00:00:26,070 --> 00:00:27,720
This time I've heard part of the title,
9
00:00:27,930 --> 00:00:31,500
but I'm not sure I understand the
wheres and hows of Ozempic face.
10
00:00:31,860 --> 00:00:34,290
I'm not intimately familiar
with all of the details.
11
00:00:34,320 --> 00:00:36,060
Can you start me off with some background?
12
00:00:37,470 --> 00:00:42,300
Before we get to the face itself,
let's talk a little about Ozempic,
13
00:00:42,660 --> 00:00:45,060
what it's used for and how it works.
14
00:00:45,900 --> 00:00:49,740
This medication is one of
a few medications in use,
15
00:00:49,770 --> 00:00:53,580
which are something called
glucagon-like peptides.
16
00:00:54,330 --> 00:00:56,850
These have multiple metabolic effects,
17
00:00:56,880 --> 00:01:00,120
including stimulating
secretion of insulin,
18
00:01:00,780 --> 00:01:04,920
delaying gastric emptying
and inhibiting appetite.
19
00:01:05,880 --> 00:01:10,500
The medications are used to treat
people with type 2 diabetes as a weekly
20
00:01:10,500 --> 00:01:12,690
injection performed at home.
21
00:01:13,710 --> 00:01:18,660
These effects also work to
limit caloric intake and
22
00:01:18,660 --> 00:01:21,570
showed significant weight
loss in these patients.
23
00:01:22,410 --> 00:01:24,030
What kind of weight loss
are we talking about?
24
00:01:24,540 --> 00:01:28,110
Typically 15%,
25
00:01:28,140 --> 00:01:30,360
with some of the newer options,
26
00:01:30,810 --> 00:01:33,240
even 20% of body weight.
27
00:01:33,840 --> 00:01:36,750
So that means if you weigh 200 pounds,
28
00:01:36,750 --> 00:01:41,490
you could slim down to 160
pounds over a typical six
29
00:01:41,490 --> 00:01:43,500
month course on the medicines.
30
00:01:43,560 --> 00:01:48,120
And picture what you would have
to do with diet and exercise
31
00:01:48,120 --> 00:01:52,740
alone to lose 40 pounds in six months.
32
00:01:53,610 --> 00:01:57,600
That sounds like a dream come true for
so many Americans. So what's the catch?
33
00:01:58,500 --> 00:02:01,530
Well, there's some side
effects like mild nausea,
34
00:02:01,530 --> 00:02:05,190
which often clears after a
few weeks on the medicine.
35
00:02:05,880 --> 00:02:07,470
but remember the,
36
00:02:07,650 --> 00:02:12,450
the main use up until now
is to help diabetics control
37
00:02:12,450 --> 00:02:13,560
their glucose.
38
00:02:14,490 --> 00:02:18,000
That doesn't sound too bad so far.
Anything else I should be aware of?
39
00:02:19,170 --> 00:02:20,730
Well, there are a couple of other things.
40
00:02:20,730 --> 00:02:24,270
There's some rebound back
towards your starting weight,
41
00:02:24,330 --> 00:02:27,090
and that's where the real mischief starts.
42
00:02:27,420 --> 00:02:32,190
Current studies differ on how much
rebound and how fast it occurs,
43
00:02:32,610 --> 00:02:36,990
so I think we'll have to wait and see
what the data shows when larger number of
44
00:02:36,990 --> 00:02:41,700
patients are using the medication
just to facilitate weight
45
00:02:41,700 --> 00:02:45,390
loss and not trying to treat diabetes.
46
00:02:45,870 --> 00:02:49,770
The diabetic patients tend to continue
on the medication or something
47
00:02:49,770 --> 00:02:54,060
similar, so they haven't
really given us enough data to
48
00:02:54,300 --> 00:02:56,250
understand this clearly.
49
00:02:57,150 --> 00:03:02,050
People going on course of weight
loss medication and then coming
50
00:03:02,050 --> 00:03:06,250
off it are really the group of patients
that's going to answer that question for
51
00:03:06,250 --> 00:03:09,190
us. In any event,
52
00:03:10,180 --> 00:03:15,070
as the patients lose weight,
skin can be looser as well.
53
00:03:15,130 --> 00:03:17,020
And that's the big issue.
54
00:03:17,140 --> 00:03:20,320
And we see this with
every form of weight loss.
55
00:03:20,320 --> 00:03:22,630
It's not specific to Ozempic,
56
00:03:23,110 --> 00:03:27,280
but with dieting with massive
weight loss after bariatric
57
00:03:27,280 --> 00:03:32,020
surgery. Procedures like gastric
banding and gastric bypass,
58
00:03:32,920 --> 00:03:37,270
the large change in fat volume
in the in the body produces skin
59
00:03:37,270 --> 00:03:41,770
laxity in many areas
after bariatric surgery,
60
00:03:41,780 --> 00:03:46,510
patients often need skin tailoring
in areas like the thighs,
61
00:03:46,660 --> 00:03:51,160
buttocks, waist, and
arms, just to name a few.
62
00:03:52,480 --> 00:03:53,560
Yes, so I've heard that,
63
00:03:53,740 --> 00:03:57,610
but this episode is called "Ozempic
Face." What happens to the face?
64
00:03:58,360 --> 00:04:01,810
The face is an area that's
very sensitive to weight loss.
65
00:04:01,870 --> 00:04:06,370
We love losing weight because it helps
us fit into our clothes and gives us the
66
00:04:06,370 --> 00:04:10,240
body shape we want. But
it hurts us in the face,
67
00:04:10,690 --> 00:04:13,180
especially the aging face.
68
00:04:13,900 --> 00:04:18,700
We start losing volume in the
face in our mid to late twenties,
69
00:04:18,700 --> 00:04:22,510
and we continue to lose volume as we age.
70
00:04:23,300 --> 00:04:28,150
But this starts to be at a tipping
point where it really hurts us in
71
00:04:28,150 --> 00:04:30,100
our forties and beyond.
72
00:04:31,780 --> 00:04:36,760
If weight loss is overlayed
on this aging volume loss
73
00:04:36,760 --> 00:04:40,300
and accumulation of skin laxity,
74
00:04:40,600 --> 00:04:45,130
the effect is further
amplified for some individuals.
75
00:04:45,790 --> 00:04:48,710
They'll be, especially if
they have obvious visible
76
00:04:50,230 --> 00:04:52,150
skin laxity to start with,
77
00:04:52,240 --> 00:04:56,890
that will be worsened or they'll reach
a tipping point where they start to
78
00:04:56,900 --> 00:05:01,600
show visible skin laxity
where they weren't quite there
79
00:05:01,610 --> 00:05:04,000
before. So in this way,
80
00:05:04,000 --> 00:05:07,750
Ozempic face is really no different
than what can happen to anyone with
81
00:05:07,750 --> 00:05:12,430
significant weight loss that
occurs by any means. Diet,
82
00:05:12,440 --> 00:05:15,670
exercise, bariatric surgery,
it really doesn't matter.
83
00:05:16,270 --> 00:05:18,610
It's about the amount of weight loss,
84
00:05:18,640 --> 00:05:23,560
the degree of preexisting laxity,
and maybe to a lesser extent,
85
00:05:23,920 --> 00:05:28,030
the rate of weight loss. It's not
the medicine itself causing it,
86
00:05:28,090 --> 00:05:29,650
it's the weight loss causing it.
87
00:05:31,070 --> 00:05:35,920
So unfortunately this is an example of
where you have to take the bad with the
88
00:05:35,920 --> 00:05:36,753
good.
89
00:05:37,690 --> 00:05:40,930
What have plastic surgeons been seeing
with patients on these glucagon-like
90
00:05:40,930 --> 00:05:42,370
peptides, like Ozempic?
91
00:05:43,330 --> 00:05:47,350
A range of skin laxity
problems in the face and neck.
92
00:05:48,100 --> 00:05:50,530
Of course, this doesn't
happen in every patient.
93
00:05:50,530 --> 00:05:54,910
It's more likely in older patients
or patients with preexisting laxity.
94
00:05:55,600 --> 00:05:59,480
For some patients, the
effects enough to notice,
95
00:05:59,480 --> 00:06:00,860
but they're still mild.
96
00:06:01,250 --> 00:06:06,230
Other patients actually show
pronounced volume loss with obvious
97
00:06:06,230 --> 00:06:10,280
hanging skin in the neck, a turkey
waddle or something like that.
98
00:06:11,030 --> 00:06:15,500
That sounds unfortunate. What can be done
to counteract these unwanted effects?
99
00:06:16,490 --> 00:06:20,900
So plastic surgeons actually
have a lot of experience dealing
100
00:06:20,900 --> 00:06:23,090
with facial volume loss,
101
00:06:23,090 --> 00:06:27,860
both in chasing aging changes and in
102
00:06:27,860 --> 00:06:32,060
treating patients who are treated with
certain kinds of medications that cause
103
00:06:32,360 --> 00:06:33,290
lipoatrophy.
104
00:06:34,280 --> 00:06:38,780
So typically this is done
with injectable fillers
105
00:06:39,680 --> 00:06:44,630
to restore shape and fullness
in areas that have flattened or
106
00:06:44,630 --> 00:06:45,560
hollowed out.
107
00:06:46,770 --> 00:06:50,510
It's not clear if fat grafting would
be a worthwhile approach because
108
00:06:52,430 --> 00:06:57,260
the fat grafts themselves could undergo
further degradation if you continue the
109
00:06:57,260 --> 00:06:58,820
medication. You know,
110
00:06:58,820 --> 00:07:03,530
we see that when we fat graft
the face and someone gains
111
00:07:03,530 --> 00:07:06,170
weight, their face gets heavier,
112
00:07:06,530 --> 00:07:09,380
and when they lose weight,
113
00:07:09,470 --> 00:07:12,020
they lose some of the
volume of the fat graft.
114
00:07:12,350 --> 00:07:15,080
So that may not be a good approach.
115
00:07:15,590 --> 00:07:20,270
Some patients actually
need lifting procedures
116
00:07:20,570 --> 00:07:24,740
and face areas usually are going
to respond pretty well to fillers.
117
00:07:24,740 --> 00:07:28,910
But in the neck, if we really are at
the point where there's hanging skin,
118
00:07:29,240 --> 00:07:30,890
that's going to mean surgery.
119
00:07:32,450 --> 00:07:35,810
Lastly, Dr. Bass, can you give our
listeners some parting takeaways?
120
00:07:37,100 --> 00:07:37,610
Well,
121
00:07:37,610 --> 00:07:42,140
the health benefits of good
glucose control and weight
122
00:07:42,140 --> 00:07:46,880
loss are so important they eclipse
the limitations of possible
123
00:07:46,880 --> 00:07:50,840
volume loss and laxity
in the face. As I said,
124
00:07:50,840 --> 00:07:53,660
there are other medicines
like antiretrovirals,
125
00:07:53,660 --> 00:07:57,500
which have lipoatrophy as a
direct effect of the medication,
126
00:07:57,500 --> 00:08:02,150
which doctors have been treating with
FDA approved therapies for almost two
127
00:08:02,150 --> 00:08:05,300
decades. So this is
something we know how to do.
128
00:08:06,800 --> 00:08:08,660
The incidence is unclear,
129
00:08:08,660 --> 00:08:12,020
but there's some risk of
130
00:08:13,400 --> 00:08:18,350
effects like this with
medicines like Ozempic. Again,
131
00:08:18,350 --> 00:08:22,640
I think it depends on how much preexisting
132
00:08:22,640 --> 00:08:25,460
laxity, how much weight loss is involved.
133
00:08:25,820 --> 00:08:28,880
The effect can be mild or more severe.
134
00:08:29,450 --> 00:08:33,710
So facial areas are usually
going to respond to injectable
135
00:08:33,710 --> 00:08:38,060
fillers and that's going
to correct contour changes.
136
00:08:38,390 --> 00:08:43,010
Mild laxity along the jawline or
neck is going to respond to energy
137
00:08:43,010 --> 00:08:47,120
treatments, or some have suggested
treatments like MyEllevate.
138
00:08:48,290 --> 00:08:53,000
But if there's significant hanging
skin under the jawline and chin,
139
00:08:53,000 --> 00:08:57,210
then face and neck lift surgery
are occasionally needed.
140
00:08:58,740 --> 00:09:03,480
The final point that I think is important
because of that issue of rebound,
141
00:09:03,480 --> 00:09:07,050
just like when you go off a
diet, weight sometimes rebounds,
142
00:09:07,320 --> 00:09:09,840
if you're discontinuing the medication,
143
00:09:09,840 --> 00:09:13,530
wait to judge the rebound effects before
144
00:09:13,530 --> 00:09:15,990
undertaking a surgical procedure.
145
00:09:17,340 --> 00:09:21,900
But treatments like fillers might be a
good temporary fix for facial issues,
146
00:09:21,900 --> 00:09:25,950
even if you do rebound to some
extent on the weight loss.
147
00:09:27,210 --> 00:09:30,600
Thank you Dr. Bass for sharing
your insight and shedding
light on this very hot
148
00:09:30,600 --> 00:09:31,433
topic.
149
00:09:32,490 --> 00:09:36,120
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
150
00:09:36,600 --> 00:09:38,100
Follow us on Apple Podcasts,
151
00:09:38,110 --> 00:09:40,200
write a review and share
the show with your friends.
152
00:09:40,620 --> 00:09:43,710
Be sure to join us next time to avoid
missing all the great content that's
153
00:09:43,710 --> 00:09:47,220
coming your way. If you want to
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154
00:09:47,250 --> 00:09:48,150
we'd love to hear from you.
155
00:09:48,630 --> 00:09:53,130
Send us an email at podcast@drbass.net
or DM us on Instagram at
156
00:09:53,130 --> 00:09:53,760
@drbassnyc.
00:00:00,930 --> 00:00:03,960
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:03,960 --> 00:00:07,560
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:07,560 --> 00:00:10,020
surgery. I'm your co-host Doreen Wu,
4
00:00:10,230 --> 00:00:13,410
a clinical assistant at Bass
Plastic Surgery in New York City.
5
00:00:13,890 --> 00:00:18,330
I'm excited to be here with Dr. Lawrence
Bass Park Avenue plastic surgeon,
6
00:00:18,630 --> 00:00:20,730
educator, and technology innovator.
7
00:00:21,450 --> 00:00:25,920
The title of today's episode
is "Ozempic Face." Okay.
8
00:00:26,070 --> 00:00:27,720
This time I've heard part of the title,
9
00:00:27,930 --> 00:00:31,500
but I'm not sure I understand the
wheres and hows of Ozempic face.
10
00:00:31,860 --> 00:00:34,290
I'm not intimately familiar
with all of the details.
11
00:00:34,320 --> 00:00:36,060
Can you start me off with some background?
12
00:00:37,470 --> 00:00:42,300
Before we get to the face itself,
let's talk a little about Ozempic,
13
00:00:42,660 --> 00:00:45,060
what it's used for and how it works.
14
00:00:45,900 --> 00:00:49,740
This medication is one of
a few medications in use,
15
00:00:49,770 --> 00:00:53,580
which are something called
glucagon-like peptides.
16
00:00:54,330 --> 00:00:56,850
These have multiple metabolic effects,
17
00:00:56,880 --> 00:01:00,120
including stimulating
secretion of insulin,
18
00:01:00,780 --> 00:01:04,920
delaying gastric emptying
and inhibiting appetite.
19
00:01:05,880 --> 00:01:10,500
The medications are used to treat
people with type 2 diabetes as a weekly
20
00:01:10,500 --> 00:01:12,690
injection performed at home.
21
00:01:13,710 --> 00:01:18,660
These effects also work to
limit caloric intake and
22
00:01:18,660 --> 00:01:21,570
showed significant weight
loss in these patients.
23
00:01:22,410 --> 00:01:24,030
What kind of weight loss
are we talking about?
24
00:01:24,540 --> 00:01:28,110
Typically 15%,
25
00:01:28,140 --> 00:01:30,360
with some of the newer options,
26
00:01:30,810 --> 00:01:33,240
even 20% of body weight.
27
00:01:33,840 --> 00:01:36,750
So that means if you weigh 200 pounds,
28
00:01:36,750 --> 00:01:41,490
you could slim down to 160
pounds over a typical six
29
00:01:41,490 --> 00:01:43,500
month course on the medicines.
30
00:01:43,560 --> 00:01:48,120
And picture what you would have
to do with diet and exercise
31
00:01:48,120 --> 00:01:52,740
alone to lose 40 pounds in six months.
32
00:01:53,610 --> 00:01:57,600
That sounds like a dream come true for
so many Americans. So what's the catch?
33
00:01:58,500 --> 00:02:01,530
Well, there's some side
effects like mild nausea,
34
00:02:01,530 --> 00:02:05,190
which often clears after a
few weeks on the medicine.
35
00:02:05,880 --> 00:02:07,470
but remember the,
36
00:02:07,650 --> 00:02:12,450
the main use up until now
is to help diabetics control
37
00:02:12,450 --> 00:02:13,560
their glucose.
38
00:02:14,490 --> 00:02:18,000
That doesn't sound too bad so far.
Anything else I should be aware of?
39
00:02:19,170 --> 00:02:20,730
Well, there are a couple of other things.
40
00:02:20,730 --> 00:02:24,270
There's some rebound back
towards your starting weight,
41
00:02:24,330 --> 00:02:27,090
and that's where the real mischief starts.
42
00:02:27,420 --> 00:02:32,190
Current studies differ on how much
rebound and how fast it occurs,
43
00:02:32,610 --> 00:02:36,990
so I think we'll have to wait and see
what the data shows when larger number of
44
00:02:36,990 --> 00:02:41,700
patients are using the medication
just to facilitate weight
45
00:02:41,700 --> 00:02:45,390
loss and not trying to treat diabetes.
46
00:02:45,870 --> 00:02:49,770
The diabetic patients tend to continue
on the medication or something
47
00:02:49,770 --> 00:02:54,060
similar, so they haven't
really given us enough data to
48
00:02:54,300 --> 00:02:56,250
understand this clearly.
49
00:02:57,150 --> 00:03:02,050
People going on course of weight
loss medication and then coming
50
00:03:02,050 --> 00:03:06,250
off it are really the group of patients
that's going to answer that question for
51
00:03:06,250 --> 00:03:09,190
us. In any event,
52
00:03:10,180 --> 00:03:15,070
as the patients lose weight,
skin can be looser as well.
53
00:03:15,130 --> 00:03:17,020
And that's the big issue.
54
00:03:17,140 --> 00:03:20,320
And we see this with
every form of weight loss.
55
00:03:20,320 --> 00:03:22,630
It's not specific to Ozempic,
56
00:03:23,110 --> 00:03:27,280
but with dieting with massive
weight loss after bariatric
57
00:03:27,280 --> 00:03:32,020
surgery. Procedures like gastric
banding and gastric bypass,
58
00:03:32,920 --> 00:03:37,270
the large change in fat volume
in the in the body produces skin
59
00:03:37,270 --> 00:03:41,770
laxity in many areas
after bariatric surgery,
60
00:03:41,780 --> 00:03:46,510
patients often need skin tailoring
in areas like the thighs,
61
00:03:46,660 --> 00:03:51,160
buttocks, waist, and
arms, just to name a few.
62
00:03:52,480 --> 00:03:53,560
Yes, so I've heard that,
63
00:03:53,740 --> 00:03:57,610
but this episode is called "Ozempic
Face." What happens to the face?
64
00:03:58,360 --> 00:04:01,810
The face is an area that's
very sensitive to weight loss.
65
00:04:01,870 --> 00:04:06,370
We love losing weight because it helps
us fit into our clothes and gives us the
66
00:04:06,370 --> 00:04:10,240
body shape we want. But
it hurts us in the face,
67
00:04:10,690 --> 00:04:13,180
especially the aging face.
68
00:04:13,900 --> 00:04:18,700
We start losing volume in the
face in our mid to late twenties,
69
00:04:18,700 --> 00:04:22,510
and we continue to lose volume as we age.
70
00:04:23,300 --> 00:04:28,150
But this starts to be at a tipping
point where it really hurts us in
71
00:04:28,150 --> 00:04:30,100
our forties and beyond.
72
00:04:31,780 --> 00:04:36,760
If weight loss is overlayed
on this aging volume loss
73
00:04:36,760 --> 00:04:40,300
and accumulation of skin laxity,
74
00:04:40,600 --> 00:04:45,130
the effect is further
amplified for some individuals.
75
00:04:45,790 --> 00:04:48,710
They'll be, especially if
they have obvious visible
76
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skin laxity to start with,
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00:04:52,240 --> 00:04:56,890
that will be worsened or they'll reach
a tipping point where they start to
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00:04:56,900 --> 00:05:01,600
show visible skin laxity
where they weren't quite there
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00:05:01,610 --> 00:05:04,000
before. So in this way,
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00:05:04,000 --> 00:05:07,750
Ozempic face is really no different
than what can happen to anyone with
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00:05:07,750 --> 00:05:12,430
significant weight loss that
occurs by any means. Diet,
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00:05:12,440 --> 00:05:15,670
exercise, bariatric surgery,
it really doesn't matter.
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00:05:16,270 --> 00:05:18,610
It's about the amount of weight loss,
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00:05:18,640 --> 00:05:23,560
the degree of preexisting laxity,
and maybe to a lesser extent,
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00:05:23,920 --> 00:05:28,030
the rate of weight loss. It's not
the medicine itself causing it,
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00:05:28,090 --> 00:05:29,650
it's the weight loss causing it.
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00:05:31,070 --> 00:05:35,920
So unfortunately this is an example of
where you have to take the bad with the
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00:05:35,920 --> 00:05:36,753
good.
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00:05:37,690 --> 00:05:40,930
What have plastic surgeons been seeing
with patients on these glucagon-like
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00:05:40,930 --> 00:05:42,370
peptides, like Ozempic?
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00:05:43,330 --> 00:05:47,350
A range of skin laxity
problems in the face and neck.
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00:05:48,100 --> 00:05:50,530
Of course, this doesn't
happen in every patient.
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00:05:50,530 --> 00:05:54,910
It's more likely in older patients
or patients with preexisting laxity.
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00:05:55,600 --> 00:05:59,480
For some patients, the
effects enough to notice,
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00:05:59,480 --> 00:06:00,860
but they're still mild.
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00:06:01,250 --> 00:06:06,230
Other patients actually show
pronounced volume loss with obvious
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00:06:06,230 --> 00:06:10,280
hanging skin in the neck, a turkey
waddle or something like that.
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00:06:11,030 --> 00:06:15,500
That sounds unfortunate. What can be done
to counteract these unwanted effects?
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00:06:16,490 --> 00:06:20,900
So plastic surgeons actually
have a lot of experience dealing
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00:06:20,900 --> 00:06:23,090
with facial volume loss,
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00:06:23,090 --> 00:06:27,860
both in chasing aging changes and in
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00:06:27,860 --> 00:06:32,060
treating patients who are treated with
certain kinds of medications that cause
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00:06:32,360 --> 00:06:33,290
lipoatrophy.
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00:06:34,280 --> 00:06:38,780
So typically this is done
with injectable fillers
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00:06:39,680 --> 00:06:44,630
to restore shape and fullness
in areas that have flattened or
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00:06:44,630 --> 00:06:45,560
hollowed out.
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00:06:46,770 --> 00:06:50,510
It's not clear if fat grafting would
be a worthwhile approach because
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00:06:52,430 --> 00:06:57,260
the fat grafts themselves could undergo
further degradation if you continue the
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00:06:57,260 --> 00:06:58,820
medication. You know,
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00:06:58,820 --> 00:07:03,530
we see that when we fat graft
the face and someone gains
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00:07:03,530 --> 00:07:06,170
weight, their face gets heavier,
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00:07:06,530 --> 00:07:09,380
and when they lose weight,
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00:07:09,470 --> 00:07:12,020
they lose some of the
volume of the fat graft.
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00:07:12,350 --> 00:07:15,080
So that may not be a good approach.
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00:07:15,590 --> 00:07:20,270
Some patients actually
need lifting procedures
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00:07:20,570 --> 00:07:24,740
and face areas usually are going
to respond pretty well to fillers.
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00:07:24,740 --> 00:07:28,910
But in the neck, if we really are at
the point where there's hanging skin,
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00:07:29,240 --> 00:07:30,890
that's going to mean surgery.
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00:07:32,450 --> 00:07:35,810
Lastly, Dr. Bass, can you give our
listeners some parting takeaways?
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00:07:37,100 --> 00:07:37,610
Well,
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00:07:37,610 --> 00:07:42,140
the health benefits of good
glucose control and weight
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00:07:42,140 --> 00:07:46,880
loss are so important they eclipse
the limitations of possible
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00:07:46,880 --> 00:07:50,840
volume loss and laxity
in the face. As I said,
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00:07:50,840 --> 00:07:53,660
there are other medicines
like antiretrovirals,
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00:07:53,660 --> 00:07:57,500
which have lipoatrophy as a
direct effect of the medication,
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00:07:57,500 --> 00:08:02,150
which doctors have been treating with
FDA approved therapies for almost two
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00:08:02,150 --> 00:08:05,300
decades. So this is
something we know how to do.
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00:08:06,800 --> 00:08:08,660
The incidence is unclear,
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00:08:08,660 --> 00:08:12,020
but there's some risk of
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00:08:13,400 --> 00:08:18,350
effects like this with
medicines like Ozempic. Again,
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00:08:18,350 --> 00:08:22,640
I think it depends on how much preexisting
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00:08:22,640 --> 00:08:25,460
laxity, how much weight loss is involved.
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00:08:25,820 --> 00:08:28,880
The effect can be mild or more severe.
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00:08:29,450 --> 00:08:33,710
So facial areas are usually
going to respond to injectable
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00:08:33,710 --> 00:08:38,060
fillers and that's going
to correct contour changes.
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00:08:38,390 --> 00:08:43,010
Mild laxity along the jawline or
neck is going to respond to energy
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00:08:43,010 --> 00:08:47,120
treatments, or some have suggested
treatments like MyEllevate.
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00:08:48,290 --> 00:08:53,000
But if there's significant hanging
skin under the jawline and chin,
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00:08:53,000 --> 00:08:57,210
then face and neck lift surgery
are occasionally needed.
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00:08:58,740 --> 00:09:03,480
The final point that I think is important
because of that issue of rebound,
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00:09:03,480 --> 00:09:07,050
just like when you go off a
diet, weight sometimes rebounds,
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00:09:07,320 --> 00:09:09,840
if you're discontinuing the medication,
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00:09:09,840 --> 00:09:13,530
wait to judge the rebound effects before
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00:09:13,530 --> 00:09:15,990
undertaking a surgical procedure.
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00:09:17,340 --> 00:09:21,900
But treatments like fillers might be a
good temporary fix for facial issues,
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00:09:21,900 --> 00:09:25,950
even if you do rebound to some
extent on the weight loss.
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00:09:27,210 --> 00:09:30,600
Thank you Dr. Bass for sharing
your insight and shedding
light on this very hot
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00:09:30,600 --> 00:09:31,433
topic.
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00:09:32,490 --> 00:09:36,120
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:09:36,600 --> 00:09:38,100
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00:09:38,110 --> 00:09:40,200
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