Ozempic for Weight Loss: What is Ozempic Face?

This image cannot and should not be taken seriously, and does not constitute medical advice. "Ozempic face" is a cultural phenomenon, not a disease. It is also known as mild facial wasting, which is a well-understood and treatable condition." should be placed below the opening photo, which i hope is tagged with lots of metadata, and not at the end.

BACKGROUND: MY FACIAL SLIMMING

In December 2022, I released a video about the prospect of nonsurgical facial slimming by sharing my own three-dimensional facial changes after a 7.4-pound weight loss. Using three-dimensional stereoscopic camera technology, I could quantify and localize specific fat compartments that seemed to change the most. In the Fall of 2022, my weight approached 192 pounds, which is close to the heaviest I have ever weighed (2^nd only to my chief residency year). Because I tend to carry my weight in my midsection, close friends and family were the first to recognize my weight gain. To many others, I always appeared slender despite being overweight. When I first started tracking in November, my BMI was 27.5. I was reliant on ibuprofen for lower back pain and left hip pain, and I had a hard time chasing after my little girls.

As I mentioned in that same YouTube video, a close friend from my surgical residency visited me from New York City last November. I should mention that this friend trained with me in surgery, but recently took a detour and is now studying weight loss medicine at Cornell. From time to time, this doctor pal criticized my lifestyle habits including a delight of sugar-rich soda (drinking my calories), eating a large pizza in one sitting, and for having an absurd sweet tooth. But during this visit, he sat down with me, looked me straight in the eye, and advised me to improve my diet and explore medications traditionally reserved for diabetics, namely metformin and Ozempic. I was late to the party; this was the first time I ever heard of Ozempic besides those catchy commercials. The risk profile of these diabetes drugs for weight loss seemed acceptable, and the side effects (though potentially unpleasant) were not life-threatening. Risks of certain cancers like thyroid cancer have been reported but remain acceptably low- so it was worth a shot (pun intended).

At first, I was on metformin only. Metformin works by decreasing your liver’s production of glucose (sugar). There are risks and benefits of any medication and you should never take medication without dependable physician oversight. I started with 500 mg of metformin at night and worked my way up to 1000 mg after work and first thing in the morning. After the video was recorded, I received a shipment of 3 Ozempic pens intended to last 6 months. Ozempic is semaglutide, a medication that works by curbing appetite and increasing energy. Hence, it leads to weight loss. I started slowly at 0.25 mg per week. After 4 weeks, I increased the dose as prescribed, to 0.5 mg. Although these doses are not homeopathic, they pale in comparison to treatment doses for diabetic patients. And they were shockingly effective in allowing me to continue my weight loss journey. As my weight began to decline, I felt better overall. Initially, I felt nimbler and required less ibuprofen. In fact, for the first time in 20 years, I stopped taking ibuprofen in the morning for hip and back pain associated with a ski injury in 2002. My clothes fit better, and I felt better.

My father-in-law recognized that I literally consumed one-third as much food as I used to eat. Not that I was abstaining from eating, but I would eat normal human portions instead of as much is humanly possible. I no longer craved desserts or snacks before bedtime, and I consumed only one box of lunch at lunchtime, not 2 or 3. My bad food habits disappeared as fast as my belly. My daily caloric intake decreased to about 3000 calories a day, instead of the 5000-6000 calories I used to consume, and I seldom experienced the discomfort of hunger. I was very open about my medication regimen to friends and family, because I truly felt that it was impacting my health and quality of life in a substantially positive way. I have a family history of cardiovascular disease and a personal history of high cholesterol, and this medication combination was meaningfully reducing the risk for cardiovascular events, risks of chronic NSAID use, and stroke.

BUT NOT ALL THAT GLIMMERS IS GOLD

I was convinced for weeks that these diabetes drugs for weight loss were true wonder drugs and would revolutionize American healthcare by reducing chronic disease and the need for risky surgeries intended to achieve similar outcomes. I was quick to promote these medications to friends and family, but just as open about the unpleasant side effects that were initially symptomatic in nature. I was told that metformin increases the risk of diarrhea and that Ozempic for weight loss increases the risk of constipation. Perhaps not surprisingly, the combination led to severe constipation that was punctuated by medication-provoked diarrhea episodes. Milk of magnesia was my savior. I will not share more personal information than that, but perhaps the audience might envision this grim picture. As I continued to lose weight, I felt better and more balanced overall. If there was a way of measuring systemic inflammation, I am sure those markers would have been low. Life was good.

And after losing 10 pounds, towards the end of November, someone told me I looked thinner for the first time. I was sort of flattered by this, as 10 pounds was significant and 5.6% of my total body weight. It was a motivator to continue to lose weight and track my physical changes both qualitatively and quantitatively. Early feedback was that I was looking better overall, and certainly fitter. As I tend to hold my weight in my midsection, my shirts felt better and scrubs fit better. With day-to-day changes, it was difficult to appreciate my own transformation, but with 3D imaging the impact on my midface, jawline and overall facial fullness was evident and I even touted controlled weight loss as the best nonsurgical facial slimming method available.

Okay, I already mentioned that I carry my weight on my midsection, twice. In contrast, I have a relatively slender, if not gaunt, face with decent cheekbones and a sharp jawline. I would soon discover that rapid weight loss may not pair well with faces like mine. I saw this as my own twin brother, who went from a chubby kid in college to an ultra-marathoner. I used to brag that my twin brother looked 10 years older than me and chalked it up to excessive sun exposure, the fact that he never tried Botox or retinol-based skin care, and never moisturized his skin. Not to mention, he used to smoke cigarettes and party. I ignored the reality that he was just a lot thinner than I. In December, after losing 15 pounds, my neighbor joked that I looked awful, and I thought he was just teasing me. But that same month, I ran into a patient of mine at an ice cream shop who told me that I looked like a chemo patient.

Fast forward to 20 pounds, 25 pounds, and 30 pounds of weight loss and I quickly reached a target BMI of 23. This is a healthy BMI. There is no doubt I am healthier. But during a FaceTime call with my brother, he just looked at me and chuckled. “You look just like Jonah Hill,” he quipped, “you look terrible”. Others shared similar sentiments stating that I have lost too much weight and was starting to look gaunt and unhealthy. I called my Doctor Pal who prescribed these medications, and he recommended keeping my weight stable at this point and weaning from the Ozempic. I would continue the metformin because of its antineoplastic, anti-inflammatory, and antiaging potential. Somewhat ignoring his advice, I decided to stop the Ozempic completely. My objective was to keep my BMI below 25 with metformin alone and accept the impact that rapid weight loss imposed on my face. Today, I discovered there is a name for my condition: “Ozempic face”.

DEFINING OZEMPIC FACE

Diabetes drugs like Mounjaro, Ozempic, and Wegovy were created with diabetics in mind, but have skyrocketed and popularity because of the impact they have on weight loss. In fact, a less understood and underreported consequence of the same drugs includes rapid weight loss that has a consistent, if not stereotypical impact on facial appearance. Unlike equally popular trendy surgical procedures such as buccal fat pad reduction and facial sculpting, rapid weight loss appears to target subcutaneous fat reserves globally, and this can make people look gaunt. A gaunt appearance is not necessarily beautiful, and can be associated with facial aging, and certain medical conditions.

THE EXPERIMENT: DIABETES DRUG OZEMPIC WEIGHT LOSS

On January 23, 2023, 2 months and 2 weeks after initiating a metformin regimen, I hit my nadir of 160 pounds. Fortunately, I am beginning to gain some of that weight back steadily. I took an updated set of three-dimensional photos at 165 pounds and will use these as a basis for comparison in this piece.

I took the opportunity to compare two three-dimensional photos taken on 11/17/22 when I weighed 187 pounds and hadn’t taken Ozempic, and on 1/25/23 when I weighed 165 pounds and stopped Ozempic (10 doses in total). The most significant changes occurred over the anterior and posterior thirds of the lower half of my face, and along my jawline and neck. Interestingly, my earlobes also lost value as did my chin. There was temporal hollowing. My eyes did not change much. The naturally occurring vertical folds in my cheeks were more prominent with smile and speech, but also at rest. The projection of my buccal fat pad decreased but the overall shape stayed the same, leading me to believe that the fat pad may not have decreased in volume (perhaps this was no surprise). A platysmal band became more visible. I looked older.

Ozempic-related facial volume changes: Orange areas represent volume loss after 22 lb weight loss, which is seen across the nasolabial fold, temporal fat pad, earlobes, lateral superficial fat pad, and submental region.

A review of 2-dimensional images paints a similar picture: sharper jawline, coarser features, more prominent shadows, improvement of a gentle double chin, and a narrower face. These are not surprising results and are not specific to Ozempic, but to rapid weight loss and reduction of subcutaneous fat volume. We used to call Ozempic face “facial wasting”. In summary, I have Ozempic face, AKA moderate facial wasting. What distinguishes Ozempic face (or Mounjaro face or Wegovy face, if you will) from other conditions is that it is a predictable side effect of induced weight loss and not a harbinger of something else, like cancer or HIV therapy. In summary: Ozempic face is simply the deflation of subcutaneous fat in the face. It is well known that facial fat preservation is inextricably linked to youth and beauty. Therefore, in those with slender faces and those concerned with facial aging, understand that despite all the good that medications like Ozempic confer, you may look older as a result.

This image cannot and should not be taken seriously, and does not constitute medical advice. “Ozempic face” is a cultural phenomenon, not a disease. It is also known as mild facial wasting, which is a well-understood and treatable condition.

TREATMENT FOR OZEMPIC FACE

So you have Ozempic face. If you are anything like me, the pros of maintaining a healthy weight and BMI are worth the possibly deleterious influence on your facial appearance. Sure, you can regain your weight and Ozempic face may be cured. But that’s not ideal for most, either. If Ozempic-related facial changes are unacceptable to you, and you intend to keep your weight stable, know that these changes are correctable. Fortunately, plastic surgeons have been treating aging and deflated faces for years. The “lift and fill” facelift relies on both skin tightening and volumization with your own fat to both correct volume-related changes and age-related skin laxity. Of course, fat transfer becomes a special consideration in patients who lose weight rapidly with medications like Ozempic. For example, what happens if you regain the weight that was lost with medication? Fat transfer is a tried-and-true cornerstone of my facelift practice, but that assumes that weight has been and will remain stable in patients who undergo fat transfer.

If weight fluctuations are anticipated, alternatives to fat transfer including hyaluronic acid fillers, Sculptra, facial implants, or avoiding line position altogether may be considered. Another special consideration is the nutritional status of patients undergoing rapid weight loss. As with any elective cosmetic procedure, weight stability and nutritional status must be confirmed to ensure adequate reserves for healing and recovery. Patients suffering from diarrhea and constipation may become orthostatic due to medication-mediated volume losses per rectum and warrant a thorough examination and workup prior to surgery. Because the buccal fat pad is probably spared, buccal fat pad removal may be safe and predictable in patients with Ozempic face.

DIABETES DRUGS FOR WEIGHT LOSS: ETHICAL CONSIDERATIONS

Because of its widespread popularity as a weight loss drug, and recent popular sedation due to celebrity endorsements, semaglutide medications like Ozempic have fallen in short supply. They are very expensive medications due to the supply and demand phenomenon in the unavoidable economics of the healthcare industry. My medication was prescribed and delivered in November 2022; at that time, I was unaware of the low global availability. It is my understanding that metformin is not in short supply. Therefore, the real risks of these medications go beyond a gaunt facial appearance, premature facial aging, constipation and diarrhea. In contrast to what you may have heard, the global medication shortage is multifactorial and not attributable to hoarding Hollywood elites. Still, do please note that you may be taking medication from those who need it most.