Semaglutide, which is marketed under the brand name Ozempic, is an injectable medication that has been approved for the treatment of type 2 diabetes. In recent times, it has been introduced as Wegovy, specifically to help obese individuals in their weight loss efforts. This medication is given as a weekly injection and is available in several countries including the USA, Canada, the UK, the European Union, Japan, and Australia.
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What is the Ozempic face?
The term “Ozempic face” has been making rounds on social media and refers to the aged and gaunt appearance that some individuals experience after taking semaglutide for weight loss. This is especially common among those who take the medication off-label for weight loss purposes without proper medical supervision, particularly in non-obese individuals. It’s important to note that the use of semaglutide should only be under the guidance of a healthcare professional and with a clear understanding of its potential benefits and risks.
Why does semaglutide cause the “Ozempic face”?
The Ozempic face is not directly caused by the medication, but rather by the weight loss itself: any substantial and relatively rapid weight loss can potentially result in loose and droopy skin, wrinkles, and other features that may make it look like a person has aged. Besides modern technologies for targeted fat loss or surgeries, no diet or weight loss medication can target just a single area of the body like the face, so the same changes noticed in the Ozempic face are likely to be affecting all other areas of the body as well.
The loss of facial fat leads to a loss of volume, which is a major aspect of facial aging. The resulting loose skin and wrinkles further contribute to the phenomenon. A decrease in caloric intake can also result in a decrease in protein intake, which is crucial for maintaining healthy and youthful-looking skin as proteins make up over 80% of the skin’s dry weight.
Middle-aged and older individuals are more likely to experience noticeable aging with weight loss as the fat in their body may have partially counteracted the loss of volume from the decrease in dermal proteins that occurs naturally with aging.
Finally, those who take semaglutide off-label to “shed a couple of pounds” more easily and starting from an already ideal BMI, are more at risk of decreasing fat reserves in areas where fat loss does not occur until body fat percentage drops below a certain limit like Bichat’s fat pad, deep in the cheek, that can cause a gaunt look.
How to avoid the Ozempic face?
First and foremost, it is important to be followed by a trained medical professional when weight loss is aided by medications and to follow a proper diet to avoid nutritional imbalances such as lack of protein. A gradual weight loss gives the body more time to adjust to the changes and allows for skin resorption to some extent, although excess skin is generally unavoidable in obese patients who experience significant weight loss.
Additionally, staying hydrated, avoiding smoking, protecting against direct sun exposure, and using the appropriate cosmeceuticals and skincare products may also help mitigate the aging effect of semaglutide to some extent.
Engaging in physical activity and building muscle mass may help replace some of the volume loss and give more structure and some lifting to many areas of the body, although this will not affect the face.
How to treat the Ozempic face?
Treating the Ozempic face can be quite expensive! There are several ways both non-invasive, minimally invasive and surgical to counteract the effects of the rapid and substantial weight loss. Among the many options there are:
- Replacing volume with hyaluronic acid dermal fillers
- Replacing volume and stimulating collagen production with biostimulatory fillers, like Radiesse (CaHA) or Sculptra (PLLA).
- Replacing volume with an autologous fat transfer.
- Stimulating the fibroblasts to produce more dermal proteins like elastin, collagen and hyaluronic acid by injecting platelet-rich plasma (PRP) or PDRN like Rejuran.
- Lifting the skin with medical devices like Ulthera (ultrasound) or Thermage (RadioFrequency)
- Lifting and tightening the skin, with fractional lasers or with Ellacor, the latest minimally invasive medical device that removes micro-cores of excess skin, resulting in something like a “fractional facelift”.
- In more severe skin and tissue laxity cases, a surgical face lift may be required.
How does semaglutide work? Ozempic – Wegovy
Semaglutide improves glycemic control in adults with type 2 diabetes by telling the pancreas to release insulin when blood sugar levels rise. In clinical studies, Ozempic has been proven effective in lowering glycated hemoglobin levels (HbA1C) by 1.4-2.1 percentage points, with the majority of patients (56-73% depending on the dose) reaching an A1C level below 7%. With its action, Ozempic also lowers cardiovascular risk in individuals with type 2 diabetes and heart disease, decreasing the chances of suffering a stroke or heart attack and lowering the risk of death.
For weight loss, Wegovy works by reducing the appetite mimicking the action of other hormones we produce and that target the brain to tell us when to stop eating. It also slows down digestion in the stomach, making patients feel full for longer. It is also possible that semaglutide can influence the food reward and attitude towards food by targeting certain areas of the brain, although exact mechanisms of action are not yet fully understood. Overall, by reducing hunger, helping have smaller portion, feeling full for longer and reducing cravings, Wegovy is a very effective pharmacological aid for weight loss.
In clinical studies, 83.5% of patients achieved at least a 5% weight loss at 68 weeks, with a mean weight loss of 14.9% and 30% of patients losing over 20% of their body weight.
What are the indications for semaglutide?
Ozempic is indicated only for adults with type 2 diabetes mellitus.
Wegovy is indicated for chronic weight management in obese adults (BMI over 30) or overweight adults with a BMI over 27 and a weight-related comorbidity like hypertension, T2DM, and dyslipidemia. Wegovy is also approved for weight management in pediatric patients 12 years and older with obesity (weight in the 95th percentile standardized for age and sex).
Both Ozempic and Wegovy should only be used under medical supervision and as an adjunct to diet, exercise and other lifestyle interventions.
Semaglutide is not indicated in patients with type 1 diabetes, those with a family history of medullary thyroid cancer (MTC), history of pancreatitis, pregnant women. Ask your GP for more details about the indications and contraindications.
What other side effects can be caused by Ozempic?
Semaglutide commonly causes adverse gastrointestinal events such as nausea, vomiting, diarrhea, abdominal pain, and constipation. In general, these symptoms occur in the first weeks of treatment and to minimize them it is suggested to start from the lowest dose (0.25 mg) and slowly increasing it every 4 weeks or every 8 weeks if the dose increase is not yet tolerated and causes GI symptoms.
The risk of hypoglycemia appears to be low in the general population due to the glucose-dependent action of this medication, but the risk is increased for diabetic patients also taking insulin or other drugs like sulfonylurea and analogues.
Semaglutide has also been linked to more serious adverse events such as acute pancreatitis, pancreatic cancer, and medullary thyroid cancer although it is not yet clear whether there was causation or not. Ask your GP more details about possible side effects.
Ozempic shortages and controversy
In the past, weight loss medications were limited in number, with potentially fatal side effects and limited effectiveness. However, with recent advancements in the field, drugs are becoming safer and more effective. Semaglutide, marketed as Ozempic, is the latest medication to gain popularity, especially among celebrities and wealthy individuals who take it off-label for cosmetic purposes or to prepare for the beach season. This trend has led to worldwide shortages, making it difficult for patients who require it for medical reasons to access the medication. While manufacturers are working to increase supply, it is crucial that healthcare professionals prioritize patients with type 2 diabetes and/or obesity when prescribing semaglutide.
It’s important to understand that medications are not trendy, and they can have adverse effects. Diet and exercise should always be the first steps for weight loss, and medications should only be used in more severe cases or as directed by drug manufacturers and regulatory agencies. The “Ozempic face” should not be stigmatized or viewed negatively. Overweight individuals have long been shamed for their weight, and now, due to social media trends, they risk being shamed for the result of an important and life-changing health intervention. We should be mindful of how we address this issue and support individuals in their journey towards better health.
Sources
- Product Information.
Novo Nordisk website for medical professionals
https://www.novomedlink.com/obesity/products/treatments/wegovy.html
https://www.novomedlink.com/diabetes/products/treatments/ozempic.html - Semaglutide Injection
MedlinePlus – US National Library of Medicine, Aug 2022
https://medlineplus.gov/druginfo/meds/a618008.html - Once-Weekly Semaglutide in Adults with Overweight or Obesity.
JPH Wilding – The New England Journal of Medicine, Mar 2021
DOI: https://doi.org/10.1056/nejmoa2032183 - Safety of Semaglutide.
MM Smits – Frontiers in Endocrinology, Jul 2021
DOI: https://doi.org/10.3389%2Ffendo.2021.645563 - Wegovy (semaglutide): a new weight loss drug for chronic weight management.
G Singh – Journal of Investigative Medicine, Jan 2022
DOI: https://doi.org/10.1136%2Fjim-2021-001952
