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“Ozempic® Face” and Facial Plastic Surgery Considerations

The term “Ozempic® Face” has been widely circulated and commented on on the internet. Its popularity parallels the increased popularity of the use of Ozempic® and its family of medications for weight loss. The term likely refers to the changes in the appearance of the face after the often significant, rapid weight loss associated with the use of these medications.

The following blog post is not a comment on the clinical effectiveness or safety of the Ozempic® family of medications for weight loss or diabetes, its original indicated treatment. Internal medicine physicians and endocrinologists are the experts who should be consulted with regarding the use of these medications. Rather, this blog post discusses the likely features referred to as “Ozempic® Face” as well as the possible surgical and/or non-surgical treatment options for these features. This blog post also considers the potential concerns of this family of medications during anesthesia.

As with all facial plastic surgery procedures, it is important to seek a consultation with a fellowship-trained specialist in the surgical and non-surgical care of the face and neck when you have cosmetic concerns about your face or neck.

Ozempic® (Semaglutide) is a GLP-1 Activator

Ozempic® is the trade name for semaglutide, one member of a family of medications called GLP-1 agonists. GLP-1 agonists bind and activate GLP-1 receptors all over the body, resulting in delayed emptying of the stomach, increased insulin release, decreased glucagon release, and increased pancreatic β cell growth (1).

Ozempic® (Semaglutide) was Originally Used to Treat Type 2 Diabetes

One effect of GLP-1 agonists is a decrease in the level of sugar (glucose) circulating in the blood (1). That is why Ozempic® is used to treat type 2 diabetes. One potentially beneficial side effect of this family of medications is weight loss.

Ozempic® is Now also Prescribed for Weight Loss

It is unclear what the primary mechanism of weight loss is, though the medication has been demonstrated to decrease food intake overall. It is possible the medication works to decrease appetite in the brain. It is also possible that the slowed emptying of food from the stomach makes patients feel full more quickly.

“Ozempic® Face” is a Flashy Term Applicable to Any Individual Who Experiences Significant, Rapid Weight Loss

The term “Ozempic® Face” simply refers to changes that can occur on the face of any individual who experiences significant, rapid weight loss, whether from the use of medications such as Ozempic® or through bariatric surgery.

The loss of a large amount of fat in the face very quickly can make the face appear more aged due to loosening skin, a loss of volume in the temples and cheeks, and the development of more prominent folds in the face such as the melolabial fold and marionette lines. These changes can extend into the neck where loosening neck muscle and skin become much more visible.

The Features Attributable to “Ozempic® Face” Can be Addressed with Facial Plastic Surgery

The above features can be addressed with surgical and non-surgical procedures, though surgery is typically the most effective and longest lasting treatment approach. Surgical procedures that may be beneficial for patients who have experienced significant, rapid weight loss from medications such as Ozempic® or bariatric surgery include the extended deep plane facelift, neck lift, lateral temporal lift, and lip lift. As always, it is important to seek a consultation with a fellowship-trained facial plastic surgeon prior to considering any surgical or non-surgical procedure on the face and/or neck.

The Potential for Delayed Clearance of Stomach Contents is an Important Peri-Operative Consideration

What is more relevant specifically to treatment with GLP-1 agonists such as Ozempic® for weight loss is the known effect of delayed gastric emptying with use of the medication. Delayed gastric emptying means that food is slower to leave the stomach and move into the intestines. This has many beneficial effects for blood glucose maintenance and also decreases appetite by making people feel fuller, which is beneficial for weight loss. However, one peri-operative concern about delayed gastric emptying is the risk of regurgitating food while under anesthesia, resulting in aspiration. It is currently not clear how severe of a risk this is and what the considerations should be for patients, especially those using the medication only for weight loss who are also seeking elective cosmetic plastic surgery under IV sedation.

Update 06/29/2023: New Consesus-Based Guidance from the American Society of Anesthesiologists (ASA)

The ASA has recently release guidelines on preoperative fasting for patients who are being treated with GLP-1 agonists for diabetes mellitus type 2 and weight loss. The panel specifically refers to the risk of aspiration in patients undergoing IV sedation in addition to general anesthesia in their guidance. They highlight the fact that additional research is required to improve guidance on taking the medication peri-operatively. They recommend holding a GLP-1 agonist dosed daily one day prior to the procedure and holding a GLP-1 agonist dosed weekly one week prior to the procedure, regardless of the condition being treated with the medication (2).

More Research is Required to Determine Universal Peri-Operative Recommendations in Plastic Surgery

An article in the British Journal of Anaesthesia recommends against withholding GLP-1 agonists such as Ozempic® peri-operatively for patients with diabetes mellitus type 2. They argue that the benefits of blood glucose control peri-operatively outweigh the possible side effects. Moreover, they argue that long-acting GLP-1 agonists such as Ozempic® (once weekly dosing instead of once daily dosing) demonstrate less delayed gastric emptying, an effect which can also fade over time with use of the medication, called tachyphylaxis (3). Tachyphylaxis is the same process that occurs when patients become accustomed to the application of Retin-A (tretinoin) on the face and develop temporary redness and skin flaking.

However, as with most subject matters in the world of plastic surgery - and as recommended by the ASA - more research is required to determine the peri-operative recommendations regarding the use of Ozempic® and other GLP-1 agonists in patients who are trying to lose weight in addition to undergoing plastic surgery procedures. For example, the fact that many patients undergo facial plastic surgery procedures under IV sedation may result in recommendations that the medication be withheld temporarily to reduce the risk of aspiration during the procedure, especially because the patients who receive GLP-1 agonists for weight loss likely do not have problems regulating their glucose. This is especially relevant because many of the studies evaluating gastric emptying with GLP-1 agonist treatment utilize a method that is not considered the gold standard and may, in fact, underappreciate the extent of delayed gastric emptying, especially with solid foods (1).

It is important to have a discussion with the provider prescribing the GLP-1 agonist as well as the anesthesiologist administering anesthesia to determine the safest plan for any plastic surgery procedure.

Trust Your Face to a Facial Plastic Surgeon

It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck.

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Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon’s credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching “plastic surgery near me.” Get in touch with us to learn more.

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This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.