With the introduction of a new class of injectable diabetes drug that hit Australia in 2022, used off label for weight loss, the term “ozempic face” has really taken off in recent months.

The drug, which is injected weekly, is approved for the treatment of certain types of diabetes and is a game changer in terms of regulating appetite and resulting in rapid and sustained weight loss with continued use, which leads to improved diabetes control.

No wonder then, that when there is rapid weight loss well in excess of the safe limit of 1kg/week, a lot can happen.

As the saying goes, after 40, you choose between your face and your body, but you can’t have both.

As a general rule, I typically advise my regular patients against rapid, drastic weight loss/change, without a proper discussion first around the pros & cons - on their bodies & the biomechanics of weight loss as well as on their skin & face.

Rapid weight loss, at any age, leads to a dramatic loss of skin elasticity that often cannot be entirely corrected, often requiring surgery for function as well as aesthetics.

When pts ask me as part of treatment planning, my advice is always to undergo it as slowly as possible, aiming for a longterm, lifestyle change, rather than as a fad and to do it under supervision & to recognise that beyond a point, they WILL sacrifice the face for the body - they get to decide which based on their priorities.

As with any rapid weight loss methods such as lap band and gastric sleeve surgery and now this class of injectable drugs, the body is placed under immense stress, which results in several physiological mechanisms to protect itself during “starvation”, and it is important patients understand this. 

Common changes include but are not limited to :

• loss of fat in desired and undesired parts of the body, including the face.
• hair loss as a response to the stress of rapid weight loss which may be temporary or permanent
• loss of elasticity (ie spring) in the skin, leading to sagging
• since volume from skin quality and underlying fat is the main factor that contributes to a youthful appearance , fat loss results in a gaunt appearance, which can be very ageing

Depending on the amount of weight lost and baseline skin quality as well as the patient’s age at time of the weight loss, they may suffer from enough sag that surgery may be their best option. Even so, volume replacement via fat transfer is likely to be needed during surgery. 

If they’re younger, and not planning excessive, rapid weight loss, I suggest a plan we can follow to keep the worst of the effects at bay, even if they’re planning on eventually having surgery once their weight has stabilised and they’ve maintained it for 6-12 months, which is usually recommended prior to surgery. 

The treatment plan would usually encompass multiple treatment options in stages as they begin to lose weight, and include addressing lines and wrinkles that may become more pronounced, as well as replacement of volume loss in the face and neck, with different types of fillers, for rapid replacement as well as for stimulation of your own collagen for slower volume and skin quality replacement. 

Lastly, they may need measures to address hair loss, both maintaining what is left and helping regrowth of lost hair due to the weight loss, which may be temporary or permanent. 

As always, with adequate planning and collaboration, it is possible to support patients as they shed the weight with minimal effect, provided they’re motivated to keep showing up and budgeting appropriately.

Having said that, weight loss, if rapid, is not something to be taken lightly or entered into on a whim & requires planning to help patients navigate it well.