Restoring Facial Balance and Other Aesthetic Concerns After Weight Loss

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As a plastic surgeon who has been treating post bariatric and massive weight loss patients for the past decade, the changes seen in the face and body after rapid weight loss are not surprising to me. With the rise of weight loss medication aides such as Ozempic, Wegovy, Mounjaro, Zepound, and compounded semiglutide and tirzepetide, we are seeing more women and men than ever with facial atrophy and laxity, which has been coined with the term Ozempic face.¹

As physicians, we recognize the health benefits of these medications are undeniable. Sustained weight loss is difficult for most and with the help of these medications and lifestyle changes, people are able to improve both their physical and mental health, curb cravings, and improve overall quality of life. However, the secondary physical changes, especially those of the face, can negatively impact these individuals due to facial volume loss, skin laxity and in some cases skin excess. These changes can give an aged appearance making some patients report“looking worn and fatigued.”²

Not all of the individuals using these medications would fall into the same category as those who undergo bariatric weight loss.³ They often are looking to lose less weight and may overall be younger and healthier than their bariatric counterparts. I point this out as expectations may differ. A young woman who rapidly loses her goal of 20 lbs.may be less prepared about the facial changes than an individual who has gone through the pre-bariatric surgery education and counseling.
Many individuals I treat using weight loss medications are seeking out minimally invasive treatment options with minimal downtime in order to improve their facial balance. I believe the key here is not just treatment but prevention. Setting expectations that certain facial changes are commonly seen with rapid weight loss, and offering treatment along with weight loss as well as after weight stabilization to prevent the full appearance of an aging face. These are some of the best options currently available for aesthetic professionals to keep in mind.

Skin Laxity

This can be addressed both during and after weight loss to reduce the appearance of the weight loss facial changes. Devices used to treat this can comfortably be performed awake with local anesthesia and nitrous oxide, if desired.

Radio Frequency (RF) microneedling

By creating tiny microchannels within the dermis, these devices stimulate regenerative growth, coupled with the radiofrequency heat energy trigger collagen contraction and skin tightening. This can be done during weight loss and after goal weight has been achieved. RF microneedling also has the benefit of being able to be performed multiple times generally spaced out at least 6 weeks.Several devices are currently on the market including Morpheus 8, Vivace, VybeRF, Secret RF and Profound RF.⁴

Renuvion

Renuvion is FDA-approved for use after liposuction and for contracting subcutaneous tissue. This device also utilizes radiofrequency energy along with helium plasma to provide skin tightening via contraction of collagen bundles beneath the dermal layer. This works particularly well on the submental and neck areas after liposuction is performed and can provide significant tightening. This is generally aone-time treatment.⁵

Volume loss

Both dermal fillers and structural fat grafting can provide excellent options for volume restoration. For smaller volume placement or during active weight loss, fillers may be the best option. While after weight loss has stabilized, and if larger volume transferred is needed my preference is for structural fat grafting.

Dermal fillers

In my practice hyaluronic acid (HA) fillers most commonly used from the 3 major lines: Restylane, Juvéderm and RHA. Due to their hydrophilic nature, they work well to not only plump but also hydrate the treatment areas. Patients have a comfort level with HA fillers which may be partly due to more widespread education on them and the fact that they can be reversed. Biostimulatory fillers such as Scultpra or Radiesse may also be utilized and work well but are unable to be reversed and require more patience but work well coupled with RF micro needling for more preventative treatment. In general, results may last up to 2 years.⁶

Structural fat grafting

Once weight loss is stabilized, structural fat grafting is my treatment of choice. You are replacing like with like. The procedure can be performed comfortably awake and it can also be a more economical option if patient requires larger volumes, greater than 5 to 7 ccs. There is no concern for allergic reactions and results can be maintained for 7 to 10 years. The healing course for the face is similar to dermal fillers while donor sites, usually the lower abdomen or thighs may require a couple weeks. Processing the fat with a LipoCube, the adipocytes can be cut into microfat and nanofat for precise and smooth volume restoration. Donor site discomfort is minimal and does not add significantly to downtime. I do not recommend performing this during active weight loss as more than the expected fat transfer loss may occur.⁷

Rukmini Rednam, MD, FACS

While none of these procedures will prevent long term continued natural aging, they can help restore facial balance after rapid weight loss and improve confidence.

Rukmini Rednam, MD, FACS, is a board-certified plastic and reconstructive surgeon based in Houston, Texas.

References

1. Carboni A, Woessner S, Martini O, Marroquin NA, Waller J. Natural weight loss or "Ozempic Face": demystifying a social media phenomenon. J Drugs Dermatol. 2024;23(1):1367-1368. doi:10.36849/JDD.7613
2. Couto RA, Charafeddine AH, Zins JE. Facelift in patients with massive weight loss. Clin Plast Surg. 2019;46(4):559-571. doi:10.1016/j.cps.2019.05.003
3. Klair N, Patel U, Saxena A, et al. What is best for weight loss? a comparative review of the safety and efficacy of bariatric surgery versus glucagon-like peptide-1 analogue. Cureus. 2023;15(9):e46197. Published 2023 Sep 29. doi:10.7759/cureus.46197
4. Alexiades M. Radiofrequency Microneedling. Facial Plast Surg Clin North Am. 2023;31(4):495-502. doi:10.1016/j.fsc.2023.06.010
5. Gentile RD. Renuvion/J-Plasma for subdermal skin tightening facial contouring and skin rejuvenation of the face and neck. Facial Plast Surg Clin North Am. 2019;27(3):273-290. doi:10.1016/j.fsc.2019.03.001
6. Guo J, Fang W, Wang F. Injectable fillers: current status, physicochemical properties, function mechanism, and perspectives. RSC Adv. 2023;13(34):23841-23858. Published 2023 Aug 10. doi:10.1039/d3ra04321e
7. Vasavada A, Raggio BS. Autologous Fat Grafting for Facial Rejuvenation. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557860/