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You Lost the Weight—Now What?

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Semaglutide medications show no signs of slowing down as a bonafide way to lose weight, but what happens once you reach optimal skinniness? There’s more to the effects of Ozempic than just weight loss, like changes to the skin, hollowing of the face, deflated breasts and butts, and potentially pronounced cellulite. Doctors are combining nonsurgical treatments and plastic surgery to restore harmony to the face and body so that everyone will only notice a slimmer body.

Weight Loss + Skin Changes = What’s Happening to My Body?

Losing weight with the help of medication is a godsend for many, but with rapid weight loss comes skin and volume changes that not everyone expects. Pasadena, CA plastic surgeon Lily Lee, MD explains that unlike bariatric surgery patients, who undergo psychological testing and therapy to ensure they’re ready for the effects of weight loss, semaglutide- assisted weight loss has a different buy-in. “Sometimes, people who lose a lot of weight on semaglutide aren’t psychologically prepared for it, although they’re thrilled to lose it,” she says.

Weight loss results in decreased fat, which affects skin quality, contour changes and facial volume. New York dermatologist Jody Levine, MD says weight loss can cause collagen and elastin fibers to become less resilient, which can result in sagging skin. Houston dermatologist Jennifer Segal, MD adds that fat reduction diminishes the underlying support, increasing bone and muscle visibility and creating shadows and contour changes.

Irvine, CA plastic surgeon Andrew Smith, MD is seeing plenty of patients experiencing facial volumetric shifts from Ozempic. “I’m also witnessing significant changes in breast volume increasing ptosis and skin-related changes around the abdomen,” he shares. While many weight-loss patients are happy with how they look in clothing, Dr. Levine says she does see some who aren’t always as happy without it.

While preventing skin- and volume- related changes from weight loss is difficult, there are ways to slow the effects. Dr. Levine recommends establishing and maintaining a gradual, steady weight-loss plan to help the skin adapt more effectively. “Adequate hydration, a balanced diet, and strength training exercises can support skin elasticity.

Even preemptive treatments negate some consequences. “Patients started saying they wanted to lose 20 pounds but didn’t want it to affect their face,” says Dr. Lee. “So, we have played around with Ultherapy and Morpheus8 to help tighten the face, but I always explain that the skin is a moving target when losing weight,” she adds.

The Areas Most Affected by Weight Loss

The Face

“Ozempic face,” which occurs when fat loss leaves the face looking saggy and aged, is the most talked about aesthetic effect of semaglutide. “Patients using these medications for appropriate weight loss may be interested in cosmetic procedures to maintain a youthful appearance at their reduced body weight now that they’re feeling good and healthy,” Dr. Segal shares.

While a facelift addresses loose, hanging skin, which can result from substantial weight loss, filler or microfat grafts are necessary to restore volume to flat, fat-deficient areas. “Filler makes sense to use as the facial shape changes due to a loss of fat pads. Sometimes, a thinner face needs softening with appropriately placed volume,” Dr. Smith explains. “Relaxing certain muscles, like the glabella and forehead, with Botox makes for a nice combination approach,” he adds.

The Neck

The neck needs some fat to provide cushioning so the skin and underlying structures have something to cling to. Without adequate fat, the skin hangs and gives way to the dreaded turkey neck. Losing volume in the neck makes everything start to sag, which many patients feel ages them.

Dr. Lee says the knee-jerk reaction after slimming down is to get a necklift and, usually, a facelift since the two go hand-in-hand. “I’ve heard people say, ‘I went on Ozempic to lose weight, and now I look old and skinny.’” When enough loose skin on the neck bothers someone, and they feel like a different person, surgical intervention, usually consisting of a necklift with a facelift with volume restoration, is required.

The Butt

“Ozempic butt” is the newest terminology that doctors are starting to throw around. Dr. Segal explains that weight loss affects the butt like it does the face and other body parts. Loose skin and pronounced cellulite are typical, but a loss of volume, which causes the butt to look flat and shapeless, is also a common complaint. Plus, some patients notice a smaller backside after being on semaglutide medication.

Dr. Levine says various nonsurgical options, including Morpheus8 radio frequency microneedling and BodyTite, can improve the appearance of loose skin, but significant laxity can only be improved with surgical procedures. In some patients who lose a lot of fat, filler or fat transfer can revolumize the butt.

The Breasts

Since everyone holds weight differently in their breasts, some women see deflation following weight loss, whereas others see little or none. New York plastic surgeon Elie Levine, MD says breast augmentation restores a more youthful appearance to the breasts affected by a loss of volume and firmness.

Volume loss isn’t the only issue. In some patients, the position of the breasts changes and the skin becomes loose. “Usually, after weight loss, ptosis is common, so a mastopexy with or without augmentation is a good solution,” Dr. Smith adds.

Women aren’t the only ones to experience changes to their chest post-Ozempic. Men can, too, but correcting the metamorphosis is tough. “Men are not nearly as tolerant of scars that result from removing loose skin, so shrinking down the skin is a little trickier,” says Dr. Lee. “Traditionally, we would do liposuction and maybe a little skin resection, but nonsurgical options may suit them better since there aren’t any scars.”

The Stomach

Like the breasts and butt, weight loss affects the stomach similarly. If the body naturally carries a large percentage of fat in the abdomen, the skin can drape over the stomach once fat is lost. “Or, the upper abdominal skin becomes heavy and the extra skin covers the belly button,” Dr. Lee adds.

Dr. Elie Levine says that the abdominal area is one of the more stubborn areas to repair to the desired appearance after weight loss. “We can use Emsculpt NEO to address tone and fat and build muscle, and BodyTite to help tighten the skin,” he says. For cases of excessive skin and severely loose abdominal muscles (usually a side effect of pregnancy more than weight loss), a tummy tuck creates a flatter-looking stomach sans hanging skin.

The Arms

Losing weight in the arms is a big deal for many women, especially those who never felt comfortable wearing sleeveless tops. Since the skin on the arms doesn’t always retract well, hanging skin can cause concern.

A brachioplasty is the best way to eliminate lax skin. However, the surgery can leave a long scar on the inside of the arm, which many are opposed to. To help reduce the scar, Dr. Lee says she often treats it with BodyTite, Renuvion or a heat-based treatment to get the skin to contract a little more.

Chicago plastic surgeon Michael Horn, MD performed an armlift on this 55-year-old patient to remove excess skin.

The Knees + Legs

The knees can actually bear the brunt of weight loss—that’s because losing fat in the thighs can cause the skin on and above the knees to wrinkle. “It’s almost like there’s a tub of fat that descends towards the knees,” Dr. Lee says. “It’s a good area to treat with CoolSculpting and a skin tightener, but liposuction is the answer if that doesn’t improve it enough. Liposuction can leave behind a small scar just above the knees that many people are not tolerant of.”

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