What GLP-1 Weight Loss Does to Your Face (And How to Fix It)

Announcer (00:02):
You're listening to Alabama the Beautiful.

Kirstin (00:05):
I'm Kirstin Jarvis and I'm here with Alabama Cosmetic Surgeons, Dr. James Koehler and Dr. Vincent Gardner. Hey, Dr. Koehler and Dr. Gardner.

Dr. Koehler (00:13):
Hey, Kirstin.

Dr. Gardner (00:15):
Hey, Kirstin.

Kirstin (00:16):
Everyone's talking about what GLP-1s do below the neck, but the thing that nobody warns them about is what happens above the deck, that a face can suddenly look a decade older than the body that it's attached to. What do we mean by that?

Dr. Koehler (00:30):
Well, I don't necessarily think it's a GLP-1 issue. I think it's something that we're just seeing with weight loss in general, but I guess because there's such a prevalence of the GLP-1s, we're seeing a lot of people with significant weight loss and it's especially true for the older patient. So we've seen in studies, and we've talked about this on previous episodes, the identical twin study, when you have identical twins and we look at factors like nutrition and lifestyle and all these things, but when they look specifically at weight, when you're over the age of 50, if you're heavier, you actually look younger in the face. And that's mainly because a fuller face tends to be a more youthful looking face. Whereas when people are older and they look more gaunt or less fat in their face, it tends to age them. But we're seeing that across the board with all age groups and just depending on how people and where they lose their weight, it can definitely affect their face.

(01:37):
In younger patients though, a thinner face can actually be attractive. So again, it just sort of depends on the circumstances, but certainly when we're talking about an aging face and an older patient and those on GLP-1s, it can really make them look a lot older. And I've heard this from patients where they're like, "Gosh, my face looks so much better when I was heavier. I feel better or my weight's down. I like all that, but I don't like how my face looks." So we're definitely seeing a lot more of that just because we're seeing a lot of people with significant weight loss these days.

Kirstin (02:12):
Is Ozempic face a real thing or is it just a catchy name for ordinary weight loss volume loss?

Dr. Koehler (02:19):
Yeah, I think it's a catchy name. I think we've seen that with weight loss of any kind, but I think it's really more prominent when we see significant weight loss. So a five or 10 pound weight loss, you're probably not going to notice a whole lot of difference in your face. But when people start losing 40, 50 plus pounds, we can see those differences and we can see the effects on their face more significantly. So it's not like Ozempic selectively targets your facial fat and if you lost it on your own, it wouldn't happen that way. I think it really comes down to the amount of weight loss. And then there's other factors too, like just your genetics and other things that come into play, which your skin elasticity and how that does with that kind of weight loss.

Kirstin (03:05):
So what is actually disappearing up there? Is it fat, collagen, both? And does your skin ever just catch up on its own without surgery?

Dr. Koehler (03:15):
Well, it's not going to catch up unless you put some weight back on and there could be a couple of factors here. If you've got reasonably good skin tone and just some volume loss in the face, then perhaps things like filler can be useful or fat grafting can be useful. But if it's a combination of some skin laxity and volume loss, well, then you have to address both of those things. So that would mean a facelift and maybe some volume addition like fat grafting.

Kirstin (03:44):
Are these the same people who would have probably come in for a facelift anyways or did the medicines like GLP-1s create a whole new kind of visit for them?

Dr. Koehler (03:55):
Well, it depends. If they had lost the weight on their own, then perhaps they would also come in. But if they were heavier, they probably wouldn't have had maybe those specific concerns about their face. So like I said, what we're seeing is more and more people who maybe couldn't do it on their own are now able to lose that weight with the help of things like GLP-1s. So we're seeing more volume of patients who've undergone fairly significant weight loss and they probably would never have done it on their own. The lifestyle changes and the commitment and the diet and all that kind of stuff, it's hard for some people. So it's hard to say whether they would come in because it's hard to say if they would've lost that weight. But what I can tell you is I've actually seen a lot of younger patients, like some in their early 40s that are really benefiting from a facelift surgery because they've had significant weight loss and it's showing in their face and they don't like that, especially at a young age like that, in your early 40s and they've got hanging skin underneath their chin. Yeah, I think we're just seeing a higher volume of people.

Dr. Gardner (05:03):
What's the youngest you've ever done a facelift on?

Dr. Koehler (05:07):
Well, I just recently did 39 years old and it's one of those things like when you say, "Oh, a 39-year-old having a facelift." I mean, she had jowels, she had laxity in her neck. We always try to do the most conservative procedure for the situation the patient's in. So if it's a younger patient, if we can get away with just doing an isolated neck or something like that, obviously we'd like to do that, but in this circumstance where there was way too much laxity and trying to do something a little more conservative would've really left the patient unhappy with the end result.

Kirstin (05:45):
When we talk about skin laxity in the face, we have a couple different choices, filler, fat transfer or facelift. How do you decide which choice is right for your patients?

Dr. Koehler (06:00):
Well, you have to separate the two things. There's the volume loss and then there's the skin laxity and those two things are kind of separate. So the analogy that I've used before is like if you're born a grape and we die as a raisin, you don't turn a raisin into a grape by just tightening the skin on the raisin. It's like, yeah, you have to tighten the loose skin, but you also need to address the volume. So each patient is different and some people have more significant volume loss. And so things like fillers and fat grafting may be more applicable. And other people, we can achieve a good result by just repositioning the skin and tightening the muscular layer and that can be sufficient. So each person's different and where their volume loss is and all that kind of stuff has to be treatment planned individually.

Kirstin (06:52):
When you do decide to do a facial fat transfer, tell us about that and what the process looks like and where do you take the fat from? Where do you put it? How does that work?

Dr. Koehler (07:04):
First of all, usually when we're taking the fat, the one thing I commonly hear is please don't stop and take as much as you can, but we're really not taking that much fat when it comes to facial fat grafting. But a lot of times we harvest it from the lower abdomen or sometimes we'll harvest it from the thighs. It just sort of depends on where they have easily accessible fat and where we can get what we need. We're typically not using excessive volumes of fat. So a small fat grafting case might be 10 or 15 ccs, but you could have maybe up to 30 or more ccs of fat. It just sort of depends. And then a lot of times we'll combine that fat grafting with platelet rich plasma, which is where we take 60 milliliters of your blood from your vein and we spin it down and we get the platelet rich fraction of that and that has the growth factors and we'll mix that in with the fat so that we can hopefully get a little bit better fat take.

(08:02):
And one of the questions we sometimes get from patients is like, well, because we talk about it in consultation that not all the fat's going to take. And so then the question is, well, are you going to put more in there because you know some of it's not going to go away? And the answer to that is, well, not really. Because it is a little bit unpredictable, if we overgraft, that could look weird as well. So we just kind of graph to what we feel is necessary to achieve the result we want. And then in some patients it may require additional sessions of fat grafting, but we don't purposely overcorrect because we can't accurately estimate what that percent of fat loss will be with the fat grafting.

Kirstin (08:47):
We've talked about this before with Dr. Gardner with patients in the middle of their weight loss journey, but let's talk about a facelift candidate. If somebody comes in unhappy with the volume loss in skin laxity from losing weight, particularly maybe on a GLP-1 or not, you've determined them a facelift candidate, but they're still in the middle of their weight loss journey. Are you going to do a facelift on them or do they need to weight?

Dr. Koehler (09:11):
That's kind of a patient discussion issue. It depends on how much more weight we're talking about them losing. If they're like, "Oh, I'm going to lose five or 10 more pounds," it's probably not significant enough to say, "Hey, let's hold off on the facelift." But if they're like, "I'm going to plan to lose another 20 pounds or 30 pounds." Absolutely. Ultimately, ideally we want them where they're at a stable weight. So if the patient is patient and is willing to wait, well then it's no problem waiting. But if they're like, "I really don't like this now. If I do it now, will it wreck my result?" I mean, unfortunately we don't have the crystal ball, but if people are fairly close to their ideal weight, I don't feel like it's a need to hold off, but it's something we talk about. So if the weight's significant, yes, you want to be closer to your goal weight. So we can make that accurate assessment and do the most appropriate treatment.

Kirstin (10:08):
So if someone plans to stay on their GLP-1 for long-term, how does that change what recommendations you might make for their face or does it?

Dr. Koehler (10:19):
It doesn't as long as they're using it in a maintenance type fashion where they're not trying to actively lose more weight. If they're just using it as a maintenance, then no, it shouldn't affect anything that we're doing there.

Kirstin (10:33):
Okay. If there's someone at home washing their face change month over month over month and they are starting to panic, what's the next move for them?

Dr. Koehler (10:44):
Well, I mean, you got to weigh out your options, right? If you don't like the changes on your face, but if you are liking what you're seeing in terms of your body, you have to make a decision. Do you continue the GLP-1 or do you say, "Okay, this is unfavorable to me. I looked better when I was 10 pounds heavier." Okay, well then maybe you need to go back. I mean, you have to make those choices. I don't have any sort of magic fix that I can say, "Okay, continue to lose your weight. And by the way, we can protect your face." The changes are going to be what they are. If it's mild, I mean, okay, maybe you could temporize that by saying, "Okay, well, let's do some filler while you're continuing to lose weight to sort of offset some of that volume loss that you've had, that might be an option." And one thing we didn't talk about too, but sometimes in really severe cases of volume loss, it may not be fat grafting.

(11:46):
It might be something more significant like a facial implant, like a cheek implant or something like that because we can more predictably give higher amounts of volume in that fashion. But anyhow, yeah, there's not any preventive thing that you can do. There's not an exercise or something that you can do to prevent that loss. It's just going to happen the way it is. So either continue the medicine or not.

Kirstin (12:09):
Do you think that the whole Ozempic face thing is going to reshape what facial surgery looks like over the next few years?

Dr. Koehler (12:17):
I don't think it's going to reshape how we do the surgery or how we make our assessments. I think on one hand, we know we have an epidemic of obesity in this country and it's year after year we have more and more obese people, but now that there's more access to these medications, we're seeing more and more people lose weight. And so I think it's just a byproduct of what's happening. I don't think it's going to change. It's certainly not going to change how we approach patients or how we do our surgery. I just think we're going to see maybe a larger volume of people seeking out those cosmetic enhancements due to the side effects of weight loss.

Kirstin (12:59):
All right. Do you have a burning question for Dr. Koehler or Dr. Gardner or me? You can leave us a voicemail on our podcast website at alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks, Dr. Koehler and Dr. Gardner.

Dr. Koehler (13:12):
Thanks, Kirstin.

Kirstin (13:13):
Go back to making Alabama beautiful.

Announcer (13:18):
Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.