Grab your coffee and cozy up. This is a longer read. The first time I heard the term “Ozempic face”, I chuckled. Because I had Ozempic face. So I published a video on YouTube about the changes in my face...
Grab your coffee and cozy up. This is a longer read.
The first time I heard the term “Ozempic face”, I chuckled. Because I had Ozempic face. So I published a video on YouTube about the changes in my face that occurred because of weight loss. Although I felt better after losing almost 30 pounds, and have kept some of this weight off, I opted to discontinue the medication for several reasons – ranging from side effects to ethical considerations. An unforeseen, but positive, outcome of my experience is that I am a surgeon with the technology to study the effects of weight loss on the face using sophisticated cameras and software. This gives me a unique perspective, both as a treating physician, patient and scientist, on diagnosing and treating so-called “Ozempic face”. In this article, I share my thoughts on the diagnosis, etiology (cause), anatomic considerations and treatment of an unofficial, but relevant, medical condition called Ozempic (or Mounjaro, or Wegovy) face.
DIAGNOSIS OF OZEMPIC FACE
Diagnosing Ozempic face would imply that Ozempic face is a true medical condition. And it is not. But what is Ozempic face? Simply put, this term is an informal, if not cheeky, expression that has become widely used in the media. As I mentioned in the previous YouTube video, allow me to reiterate: Ozempic face is not a medical condition, it is a cultural phenomenon. People are quick to deny using weight loss drugs, as social and ethical stigma exists, and just as many are quick to “accuse” celebrities of using these medications when observably rapid weight loss occurs. But there is no way of diagnosing Ozempic face based on anatomic features or measurements alone; such a diagnosis requires an “admission of guilt”. But when stereotypical patterns of weight loss in the face occur, and these changes occur quickly, they are more likely to be recognized by friends, family, and the public at large. In other words, Ozempic face is a catch-all phrase for recognizable facial fat loss or changes that occur because of weight loss resulting from medications that promote weight loss, and nothing more.
ETIOLOGY OF OZEMPIC FACE
Ozempic face is simply the recognition of weight loss as it impacts the face. It stands to reason that the faster weight loss occurs, the more likely changes will be recognized by outside observers. Similarly, the more recognizable a person is, the more likely those changes will be recognized. Therefore, the greatest risk factors for Ozempic face are rapid weight loss and celebrity. Celebrities and other prominent persons who are studied by the public on a nearly continuous basis are at the greatest risk for developing Ozempic face. Perhaps this is why celebrities like Mindy Kaling, Kim Kardashian, Kyle Richards, Chelsea Handler, Jameela Jamil, Elon Musk and Megan McCain, some of whom are open about their use of the drug, have brought much attention to this fictitious and otherwise trivial condition.
So how do Ozempic, Wegovy, and Mounjaro cause the stereotypical changes in the face? Simply put, they do not. There is nothing about these medications that targets the face or causes reproducible, specific facial changes. These medications simply promote weight loss, and in many cases they do so quickly. People lose weight in various ways, some in the face, some in the mid-section; the way weight loss affects our faces is as individual as we all are.
Furthermore, Ozempic face is not necessarily a bad thing. The cosmetic benefit of losing facial weight is subjective at best, and many people are thrilled with the impact of weight loss on their face. For example, in my YouTube video I noted that I was unhappy with the impact weight loss had on my face, but many reviewers commented that I actually looked better.
In the past, I published a video about youth, beauty, and facial fat. In that video, I reiterated conventional wisdom about why a youthful face is generally a beautiful face. I discussed gauntness, and specifically why buccal fat pad removal is not expected to promote gauntness. I attempted to distinguish the buccal fat pad from subcutaneous fat. Wherein, when the buccal fat pad is removed, there is no impact on the subcutaneous fat compartments. Therefore, contours in the midface can be enhanced without skeletonizing the face. Although rapid weight loss may impact buccal fat pad volume, there is no evidence that it does, and I have not personally recognized variations in fat pad volume across patients with varying BMIs.
Unlike the buccal fat pad, the subcutaneous fat compartments of the face are more likely to change because of rapid weight loss. By reducing these subcutaneous fat compartments, the bony framework of the face is revealed, including the malar eminences (cheek bones), temporal hollows, and the orbital framework (eye sockets). In the same way that snowfall obscures tree stumps, rocks, and other imperfections of a landscape, facial fat can soften unsightly shadows and prominences of the midface that are associated with a gaunt or aged facial appearance. Furthermore, when the rate of fat volume loss exceeds the skin envelope’s capacity to contract, loose skin may result. This tends to be most noticeable along the nasolabial folds, marionette lines, and under the chin.
TREATMENT ALGORITHM FOR OZEMPIC FACE [SEE TABLE]
- Do nothing at all. This is the best strategy! Ozempic face is not a real medical condition and therefore is neither a disease nor requires treatment. The fact that friends, family, and society recognize your weight loss is not necessarily – or often – a bad thing. If you like your new look, go flaunt it.
- Discontinue weight loss medications.* There are numerous reasons, from unpleasant Ozempic side effects to cost to ethics for discontinuing medications that promote weight loss, especially when they are used off-label. It is possible and likely that some, all, or even more weight will return when said medication is discontinued. The weight that has been lost in facial fat compartments is likely to return, and therefore “cure”, Ozempic face.
- Targeted volumization (micro).* In many cases, the impact of losing facial fat is both good and bad. It is possible that mid-facial slimming and jawline enhancement are favorable, but temporal hollowing and visualization of the facial skeleton is less desirable elsewhere. For example, I was happy with the impact of weight loss on the lower half of my face, but it accentuated my nasolabial folds and highlighted the bony prominences in my cheek bones. This was easily identifiable, and treatable with three-dimensional imaging and a single syringe of filler. Unlike traditional cheek fillers, targeted volumization with fat graft or filler is intended to obscure bony prominences, not enhance them.
- General facial volumization (macro). Persons with thin faces, prominent cheekbones, thin skin, and those who are aging may complain of looking gaunt because of rapid weight loss. Gauntness may or may not be accompanied by loose skin. When gauntness occurs in isolation, targeted volumization may not be enough. Multiple subcutaneous fat compartments may warrant re-volumization in these cases. In these cases, specialized fillers (i.e Sculptra) can be used to volumize broad areas of the face. The good news is these fillers were designed for facial lipoatrophy, may have long-lasting effects, are often classified as “semi-permanent”, and are typically very forgiving. In contrast, they are not easily reversible (there is no dissolver for Sculptra), typically need to be maintained every year or so, and can be costly over time. Fat grafting is an excellent surgical solution for improving facial shadows, replacing like with like, and is intended to be a more permanent solution.
- Minimally invasive skin tightening. Technology exists that is designed to tighten skin without the risks, scars, and downtime of a facelift. Since 2017, I have offered FaceTite (radiofrequency assisted lipolysis and targeted micro-liposculpture) to patients seeking modest improvement of skin laxity, jowls, and stubborn fat pockets that do not respond to weight loss. Lasers, radiofrequency micro-needling, and other technologies may similarly confer benefit to patients with mild skin laxity and compromised skin quality.
- Facialplasty (facelift). Ozempic face doesn’t appear to discriminate by age. When volume loss and skin laxity coexist because of weight loss, and when minimally invasive procedures fail or are not expected to achieve desired results, surgical procedures like the lift-and-fill facelift (facelift plus targeted fat grafting) can uniquely and most effectively address skin laxity and volume related changes. The trend of “early intervention” facelifts is expected to gain momentum because of the widespread popularity of medications that promote rapid weight loss.
* This is what I did. I treated my own Ozempic face by stopping Ozempic, regained some weight, and targeted areas of volume loss that I did not like with filler.
- Avoid cheekbone and jawline fillers. Gauntness is qualitative; it is better described than measured. To me, gauntness is best described as the skeletonization of the face, exposing deeper anatomic structures like bony prominences, muscles, and veins. A gaunt face can come across as sickly, aged, or unattractive. Because rapid weight loss (unlike buccal fat pad removal) targets subcutaneous fat reserves, it has the potential to expose bony prominences and other features of the facial skeleton. Cheek and jawline fillers are often placed along the cheekbones and jawline to augment the facial skeleton. This is often attractive beneath the veil of the healthy cutaneous (skin and fat) envelope but may accentuate the skeletal appearance of someone with “Ozempic face”.
- Avoid certain facial implants. Unlike many fillers, prosthetic implants like cheek and jawline implants are not expected to go away with time and cannot be reversed with dissolver. Although they can be removed, many implants are more powerful than fillers and should be avoided in hollowed or gaunt faces when the subcutaneous fat reserves are not repleted. Facial implants may be considered in those with facial skeletal deficiencies or in conjunction with fat grafting.
- Consider the future. Ozempic face is just an expression, not a real medical condition. It is a buzzword that relates to a medication that is being prescribed and used off-label by many. Medications like Ozempic, Wegovy, and Monjouro may not be around forever, as supply chain issues already exist, and awareness of risks, increased legislation and oversight may limit their widespread availability. Alternatively, if you are like me, you may find it’s just not worth it. Before considering any drastic or risky surgical treatments, you need to think about your future and the likelihood of maintaining a stable weight before considering treatment for Ozempic face.
- Consult with a board-certified plastic surgeon with a med spa or a med spa with close ties to a plastic surgeon. Nonsurgical treatment options for Ozempic face will become widely available as this condition gains momentum. Be wary that when all you have is a hammer, everything starts to look like a nail. Because many nonsurgical treatment options may be ineffective in treating, or even exacerbate perceived gauntness, you deserve unbiased access to the full spectrum of surgical and nonsurgical treatment options. You are more likely to find this at a plastic surgeon’s office that offers med spa services, or med spa with close ties to a plastic surgeon.