Anyone trying to lose weight likely can’t escape mentions of Ozempic, Wegovy, and Mounjaro. Fitness and diet modification and a variety of bariatric surgery procedures have now been joined by the emerging field of medical weight loss.These medications, whose generic forms are semaglutide and tirzepatide, are increasingly in the headlines, magazines, social media, and in the spotlight everywhere. Largely unknown to the general public just a few years ago, there has recently been an exponential gain in their use, and even bigger loss of stubborn fat and extra pounds. Considering their effectiveness for weight loss, overall health improvements and safety profile, this attention is no surprise.
Semaglutide, a glucagon-like-peptide-1 (GLP-1) receptor agonist, and tirzepatide, a dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist, have similar mechanisms of action that help regulate blood sugar through a weekly injection. This regulation, in turn, provides appetite suppression, slows the function of the digestive system, and lengthens the feeling of satiety. The result for many is profound weight loss. The benefits can be abundant, including lower risk of heart disease, improved lipid levels, less hypertension, better blood sugar regulation, and improved overall health and quality of life. For some, these dramatic health and weight loss benefits can also come with trade-offs as well.
If you’ve heard of Ozempic, Wegovy, or Mounjaro, you’ve likely also heard of side effects like “Ozempic face”. Loss of regional fat stores can manifest differently from one person to another, or may affect certain areas of the face, breast or body more than others. “Ozempic face” occurs in patients who have experienced deflation of facial features, predisposing to excess sagging skin and a drawn appearance. While rapid weight loss can create this problem more often than slower loss, this is not an issue specific to Ozempic or any semaglutide or tirzepatide use. Significant weight loss, especially when it’s quick, can frequently result in loose skin, uneven contours, and sunken facial features. The good news is that there are safe and effective solutions. Surgery after weight loss encompasses a variety of reductive or restorative treatments that can address face and body laxity and deflation to improve your appearance following your successful weight loss journey.
Because subcutaneous fat is stored throughout the body, skin laxity after weight loss can occur just about anywhere, including the face, neck, breasts, torso, arms, and thighs. There are several surgical procedures that can be used to remove unwanted excess skin, restore lost volume, and for skin tightening. A skilled, board certified plastic surgeon with experience in plastic surgery after weight loss can tailor surgery to the specific aesthetic needs of each patient. This includes both men and women who desire smooth contours and tighter skin after weight loss.
An abdominoplasty, or tummy tuck, is extremely effective at removing excess skin of the abdomen, reducing localized excess residual fat, and repairing and recontouring stretched muscle. When the excess is more extensive than the anterior abdomen only (including the flanks or back), and extended abdominoplasty or lower body lift can be performed to effectively treat the circumferential midsection and upper thigh areas. The abdomen is an incredibly common area to see sagging skin in individuals who have experienced medical weight loss, and the thighs will also demonstrate similar hallmarks of skin laxity, droop and deflation. During these procedures, excess skin is removed, and residual fat pockets can be reduced by direct excision or addressed with liposuction, and when necessary, the muscles are also strengthened to address diastasis recti and effectively recontour the entire abdominal area for a more attractive, sculpted result.
Loose skin of the arms can be difficult to hide, and a source of self consciousness and shame. For many, it is extremely frustrating to have been successful in losing the desired weight, and to still feel uncomfortable in a tank top or T-shirt. With an arm lift, also known as a brachioplasty, loose, excessive skin can be removed, localized residual fat can be reduced, and the remaining skin will be tightened, leaving the arms looking more toned and attractive.
The breasts are subject to significant changes for many women related to hormonal variation and weight changes. Oral contraceptive use, pregnancy, weight gain and loss, and the aging effects on skin elasticity, fat and breast tissue, can all result in progressive skin laxity, breast droop, and breast deflation. The rapidity of breast changes after medical weight loss is a new addition to the many factors that can result in deflated appearance, and sagging, droopy breasts. With a breast lift, also known as a mastopexy, an experienced board certified plastic surgeon can effectively reshape the breasts, elevate their positions, and enhance balance, proportion and overall appearance. For some individuals, when there is breast droop but when ample breast tissue is present, a mastopexy surgery alone may be sufficient. In cases with both breast droop and breast deflation, when restoration of volume is also needed, a breast augmentation mastopexy, a breast lift combined with breast enlargement using silicone breast implants or saline breast implants, may be the best option.
Fat is distributed and carried differently by every individual, and for some, medical weight loss may impact the thighs disproportionally. This can have a profound impact on visual appearance as well as functional limitations with problematic residual fat and lax skin. Thigh lift surgery often entails fat reduction, commonly performed with liposuction techniques, in addition to removal and tailoring of the excess skin. For certain individuals, staged procedures with liposuction performed first followed by thigh lift surgery excising skin at a later date can enhance safety and effectiveness.
Facial soft tissue atrophy is commonly seen with natural aging, but can be hastened by weight gain and loss, and recently with medical weight loss in particular. “Ozempic face” may amplify an aged appearance, with facial fat loss through the cheek regions, lower lids, temples and lips. A youthful balance of fat predominance in the midface, cheeks and temples with a more defined chin and jawline is often replaced with a more aged rectangular or trapezoidal orientation with upper face fat deficiency, widening of the jowls and jawline, deeper fold facial folds, increased wrinkling and skin elasticity loss, and a sunken, hollow appearance. A facelift is an incredibly effective way to both reposition the deeper inelastic support layers of the face (the SMAS) to a more youthful shape, restore lost upper facial volume with autologous fat transfer (fat grafts harvested from the torso or extremities and transplanted to the face). and lifting facial skin, removing excess, and insetting it meticulously so that it is taut, but never tight. CO2 laser resurfacing can also be used to further improve skin quality. Facelift is the most powerful means by which to refresh and rejuvenate the aging, deflated appearance of the face after medical weight loss.
Often going hand in hand with the facial skin laxity, soft tissue deflation, and shape change at and above the jawline, the neck is also prone to similar volume loss, skin sagging, and loss of youthful shape and appearance. A neck lift is most often performed in conjunction with a facelift, but occasionally is performed by a board certified plastic surgeon as a stand alone procedure. Neck lift very effectively reshapes the neck at the deeper levels beneath the skin by reducing or recontouring residual fat, tightening the SMAS and muscular planes, and redraping and tightening the skin.
How do you know if you are a candidate for plastic surgery after weight loss? As the effects of weight loss on skin laxity and deflation of the face, breast, body and extremities can differ dramatically for everyone, it is important to consult with a plastic surgeon certified by the American Board of Plastic Surgery who is experienced in the many facets of plastic surgery after weight loss. After a thorough history and physical examination, your plastic surgeon will examine the areas that concern you most, identify your goals, and recommend a safe and effective surgical plan based on your unique desires and anatomy. New York City plastic surgeon Adam R. Kolker, M.D., a double board certified plastic surgeon in Manhattan with over two decades of experience and expertise in facial plastic surgery, breast plastic surgery and body contouring surgery for patients after weight loss, can advise you on the procedure(s) that suit you best, tailored to your unique goals and desires.
To schedule a private consultation with Dr. Kolker, please call the office or request an appointment online. We welcome your visit.
710 Park Avenue, New York, NY 10021
