Ozempic Face

Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Doreen Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is "Ozempic Face." Okay. This time I've heard part of the title, but I'm not sure I understand the wheres and hows of Ozempic face. I'm not intimately familiar with all of the details. Can you start me off with some background?

Dr. Lawrence Bass (00:37):
Before we get to the face itself, let's talk a little about Ozempic, what it's used for and how it works. This medication is one of a few medications in use, which are something called glucagon-like peptides. These have multiple metabolic effects, including stimulating secretion of insulin, delaying gastric emptying and inhibiting appetite. The medications are used to treat people with type 2 diabetes as a weekly injection performed at home. These effects also work to limit caloric intake and showed significant weight loss in these patients.

Doreen Wu (01:22):
What kind of weight loss are we talking about?

Dr. Lawrence Bass (01:24):
Typically 15%, with some of the newer options, even 20% of body weight. So that means if you weigh 200 pounds, you could slim down to 160 pounds over a typical six month course on the medicines. And picture what you would have to do with diet and exercise alone to lose 40 pounds in six months.

Doreen Wu (01:53):
That sounds like a dream come true for so many Americans. So what's the catch?

Dr. Lawrence Bass (01:58):
Well, there's some side effects like mild nausea, which often clears after a few weeks on the medicine. but remember the, the main use up until now is to help diabetics control their glucose.

Doreen Wu (02:14):
That doesn't sound too bad so far. Anything else I should be aware of?

Dr. Lawrence Bass (02:19):
Well, there are a couple of other things. There's some rebound back towards your starting weight, and that's where the real mischief starts. Current studies differ on how much rebound and how fast it occurs, so I think we'll have to wait and see what the data shows when larger number of patients are using the medication just to facilitate weight loss and not trying to treat diabetes. The diabetic patients tend to continue on the medication or something similar, so they haven't really given us enough data to understand this clearly. People going on course of weight loss medication and then coming off it are really the group of patients that's going to answer that question for us. In any event, as the patients lose weight, skin can be looser as well. And that's the big issue. And we see this with every form of weight loss. It's not specific to Ozempic, but with dieting with massive weight loss after bariatric surgery. Procedures like gastric banding and gastric bypass, the large change in fat volume in the in the body produces skin laxity in many areas after bariatric surgery, patients often need skin tailoring in areas like the thighs, buttocks, waist, and arms, just to name a few.

Doreen Wu (03:52):
Yes, so I've heard that, but this episode is called "Ozempic Face." What happens to the face?

Dr. Lawrence Bass (03:58):
The face is an area that's very sensitive to weight loss. We love losing weight because it helps us fit into our clothes and gives us the body shape we want. But it hurts us in the face, especially the aging face. We start losing volume in the face in our mid to late twenties, and we continue to lose volume as we age. But this starts to be at a tipping point where it really hurts us in our forties and beyond. If weight loss is overlayed on this aging volume loss and accumulation of skin laxity, the effect is further amplified for some individuals. They'll be, especially if they have obvious visible skin laxity to start with, that will be worsened or they'll reach a tipping point where they start to show visible skin laxity where they weren't quite there before. So in this way, Ozempic face is really no different than what can happen to anyone with significant weight loss that occurs by any means. Diet, exercise, bariatric surgery, it really doesn't matter. It's about the amount of weight loss, the degree of preexisting laxity, and maybe to a lesser extent, the rate of weight loss. It's not the medicine itself causing it, it's the weight loss causing it. So unfortunately this is an example of where you have to take the bad with the good.

Doreen Wu (05:37):
What have plastic surgeons been seeing with patients on these glucagon-like peptides, like Ozempic?

Dr. Lawrence Bass (05:43):
A range of skin laxity problems in the face and neck. Of course, this doesn't happen in every patient. It's more likely in older patients or patients with preexisting laxity. For some patients, the effects enough to notice, but they're still mild. Other patients actually show pronounced volume loss with obvious hanging skin in the neck, a turkey waddle or something like that.

Doreen Wu (06:11):
That sounds unfortunate. What can be done to counteract these unwanted effects?

Dr. Lawrence Bass (06:16):
So plastic surgeons actually have a lot of experience dealing with facial volume loss, both in chasing aging changes and in treating patients who are treated with certain kinds of medications that cause lipoatrophy. So typically this is done with injectable fillers to restore shape and fullness in areas that have flattened or hollowed out. It's not clear if fat grafting would be a worthwhile approach because the fat grafts themselves could undergo further degradation if you continue the medication. You know, we see that when we fat graft the face and someone gains weight, their face gets heavier, and when they lose weight, they lose some of the volume of the fat graft. So that may not be a good approach. Some patients actually need lifting procedures and face areas usually are going to respond pretty well to fillers. But in the neck, if we really are at the point where there's hanging skin, that's going to mean surgery.

Doreen Wu (07:32):
Lastly, Dr. Bass, can you give our listeners some parting takeaways?

Dr. Lawrence Bass (07:37):
Well, the health benefits of good glucose control and weight loss are so important they eclipse the limitations of possible volume loss and laxity in the face. As I said, there are other medicines like antiretrovirals, which have lipoatrophy as a direct effect of the medication, which doctors have been treating with FDA approved therapies for almost two decades. So this is something we know how to do. The incidence is unclear, but there's some risk of effects like this with medicines like Ozempic. Again, I think it depends on how much preexisting laxity, how much weight loss is involved. The effect can be mild or more severe. So facial areas are usually going to respond to injectable fillers and that's going to correct contour changes. Mild laxity along the jawline or neck is going to respond to energy treatments, or some have suggested treatments like MyEllevate. But if there's significant hanging skin under the jawline and chin, then face and neck lift surgery are occasionally needed. The final point that I think is important because of that issue of rebound, just like when you go off a diet, weight sometimes rebounds, if you're discontinuing the medication, wait to judge the rebound effects before undertaking a surgical procedure. But treatments like fillers might be a good temporary fix for facial issues, even if you do rebound to some extent on the weight loss.

Doreen Wu (09:27):
Thank you Dr. Bass for sharing your insight and shedding light on this very hot topic. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram at @drbassnyc.