In the new era of GLP-1 medications, rapid weight loss is more common than ever before. And while the results can be transformative and life-changing, the resulting changes in skin quality have created a new sub-category of aesthetic patients seeking to tighten loose skin. At the same time, first-timers to GLP-1s are looking for ways to prevent those facial changes in the first place, to stop “Ozempic face” before it happens. And they’re exploring everything from lower doses of GLP-1s to compound versions to slow the rate of weight loss without losing the drug’s effectiveness. But does it work?
Featured Experts
- Caroline Messer, MD is an endocrinologist in New York
- Dr. Spencer Nadolsky is an obesity and lipid specialist in Portage, MI
- Orit Markowitz, MD is a board-certified dermatologist in New York
- George Sanders, MD is a board-certified plastic surgeon in Encino, CA
- Jill Hessler, MD is a board-certified plastic surgeon in Palo Alto, CA
What Are Compound GLP-1s?
According to the FDA, compounding is when a pharmacist or manufacturer combines, mixes or alters ingredients of a drug to create a medication that fits the needs of an individual patient. “Compounded drugs are not FDA approved, which means the agency does not verify their safety, effectiveness or quality before they are marketed,” the FDA states.
In the case of compounded GLP-1s, additions to the formula, like B-12 to combat fatigue, are not uncommon. And it’s important to note, they aren’t using the FDA-approved version of semaglutide.
“Compounding pharmacies use the salt forms of semaglutide, including semaglutide sodium and semaglutide acetate,” explains New York endocrinologist Caroline Messer, MD. “These are different active ingredients than those used in the approved drugs. This alteration may change the bioavailability and strength of the medication.”
“Compounded GLP-1s raise concerns over the quality and potential impurities that occur during the manufacturing process that may increase a risk of immunogenicity and change how your body reacts to it,” adds obesity and lipid specialist Dr. Spencer Nadolsky.
Could Compound GLP-1s Prevent ‘Ozempic Face’?
While this might be the goal of some compounded GLP-1s, we have no way of knowing how effective they really are.
“This is the thought, although I’m not aware of any studies that have looked directly at this,” Dr. Nadolsky says. “It likely has more to do with the magnitude or total amount of weight loss than the rate at which it happens. That said, the rate could matter for muscle retention, which may play a role in this. It’s possible that rate may affect collagen in skin and elasticity, but again I’m not sure this has been studied.”
Alongside formula additions, some compound GLP-1s are packaged with lower doses as a benefit, helping to drive the price down. And taking a smaller dose may be useful when trying to stop skin laxity during and after weight loss, as the more rapid the loss, the more severe the impacts to the face.
“This loss of volume also contributes to significant skin sagging in the face,” says Palo Alto, CA plastic surgeon Jill Hessler, MD. “With more rapid weight loss, we see more significant skin sagging as the facial skin cannot adapt to the rapid shifts. If patients aren’t very intentional about eating proper protein and nutrients, then there can be changes in the health and quality of the skin.”
Encino, CA plastic surgeon George Sanders, MD explains that if compound GLP-1s are also lower doses, this could help prevent extreme skin sagging. “We really don’t see too much of that profound ‘Ozempic Face’ in my area anymore, because patients have realized that they don’t have to lose so much weight so quickly,” he says. “Instead they can take lower doses or even microdose. And that certainly has a tremendous impact on your skin’s ability to bounce back, allowing you to prevent that extreme volume loss and skin sagging in most cases.”
What Can You Do to Prevent ‘Ozempic Face’?
If you haven’t yet started your weight loss journey, Dr. Nadolsky suggests starting low and slow. “Shoot for a maximum of 1% total body weight loss per week,” he says. “If you’re 200 pounds, this would be a loss of two pounds per week max. This can help with minimizing muscle loss (along with resistance training and sufficient protein intake) and help reduce risks of gallstone formation.”
Dr. Sanders agrees. “After the initial surge of patients who have taken full doses and lost weight rapidly, I think we’re starting to see course-correction, as patients opt to lose the weight more slowly and aesthetic practitioners offer more supportive therapies to keep the skin in good shape during that weight loss,” he says.
New York dermatologist Orit Markowitz, MD, has been looking for ways to support skin while patients are on GLP-1s, compounded or not. “The main goal is collagen stimulation,” she says. “That could be through treatments like microneedling with PRP or fractionated lasers. I happen to like Sculptra for deeper volume loss. Brands are now looking for ways to plump skin via elastin and collagen stimulation. And we’re also really addressing the fat loss through ultrasound heating, to try and stimulate from below instead of just on the surface.”
“The good news is that if you do lose the weight more slowly, and you’re taking good care of your skin and your body, the skin has a remarkable way of coming back into place,” Dr. Sanders adds.
