The Dark Side of Weight Loss: How GLP-1 Medications Impact Your Skin and Aging (Ep. 96)

We’ve all heard about the dramatic weight-loss results from drugs like Ozempic®, Wegovy®, semaglutide, and tirzepatide, but what aren’t you hearing about? In this episode of The Trillium Show, board-certified plastic surgeon Dr. Jason Hall explains the under-the-radar effects these GLP-1 medications can have on your face and skin, including accelerated volume loss, thinning, and changes to your skin’s ability to rejuvenate itself.

Dr. Hall breaks down:

• Why these drugs can dramatically change your skin quality
• What treatments (fat transfer, fillers, lasers, etc.) may help combat this and their limitations
• How to protect your muscle mass and skin health if you’re taking or considering GLP-1s

If you’re curious about the real impact of GLP-1 medications on aging skin, this episode is a must-listen.

Transcript

Dr. Jason Hall: 0:36

Are you tired of wasting money on skincare products and treatments that don't work? Or are you afraid of looking unnatural after having some non surgical treatments done? If you are then my new book, The Art Of Aging, is for you. In The Art Of Aging, I break down the aging process and talk about treatments that target specific parts of the aging process, what works and what doesn't. Also, I lay out a biology based skin care and non surgical treatment plan that will keep you looking great without looking fake. Check out your copy of The Art Of Aging on Amazon or in any of your local booksellers. You've all heard the names Ozempic, Wegovy, semaglutide, trizipatide, whatever the things they don't want you to say on YouTube, or that I can say on my podcast, because it's my podcast, these things are everywhere. They really work for weight loss, but they can have really significant detrimental side effects to your skin, and on this episode of The Trillium show, what we're going to do is we're going to talk about what happens to your skin and your face when you take these drugs, and what we can do to treat it, which might not be a whole lot. Welcome to The Trillium show, where each week, we discuss ways to help you improve your mind, your body and your life. I'm your host, board certified plastic surgeon and author of the new book, Art Of Aging. Dr. Jason Hall. If you're interested in what works in the cosmetic field, what doesn't and what is a bunch of hype, I would encourage you to go to grab a copy of my book on Amazon. You can click the link in the show notes and go right there. So GLP-1s are everywhere on a day to day basis. Conservatively put the number of new patients that I see in my office that come in either on a GLP-1 agonist or having taken a GLP-1 agonist at about 75 to 80% in 2024 these things were a $53 billion a year business, and that business is growing at a pretty good clip, almost 20% per year. So you can do the math on that one. Today we're going to talk about, really what these things do to your face. Everybody knows what GLP-1s do. When you take them over a long period of time to your body, you lose a lot of weight, that creates a lot of skin excess that we are seeing a lot of now, I would say I'd probably see more patients for skin removal who have been on GLP-1s than I do who have had bariatric surgery that that is brand new, and is really something that is I think most plastic surgeons out there are seeing now with facial aging. If you've listened to my podcast on facial aging, heard me talk about it before read the book, you know that volume loss plays a significant role in how our faces age without GLP-1s, we get a stable weight, we lose volume in our face, happens in our temples, happens under our eyes, around our mouth, the base of our nose. And volume loss is a big component of what people perceive as looking old with GLP-1s, though, there are things that happen to our fat and things that happen to our skin that go beyond what normally happens with aging. And we'll talk a little bit about what those are. Just a warning for everybody, this is going to get a little bit nerdy. It's going to get a little bit sciencey. So if you don't like this, fast forward to the end, where I talk about what we can do to it, do about it. So one of the big things that GLP-1s do to our skin that is really detrimental is that we lose something called the the subcutaneous or dermal white adipose tissue. And this is the fat that is kind of directly below the skin and is attached to the under surface of the skin. This is this fat. Is fat that you really want. You don't want to get rid of this stuff. This is not the fat that makes you look fat. It's not the fat that makes you look puffy. This is the fat that gives your skin a nice sheen. It gives your skin some a little bit of elasticity and thickness to it. And you don't want that fat to go away. We're naturally going to lose that, that dermal white adipose tissue a little bit as we age. And is one of the things that makes our skin papery thin. You know, if you've seen somebody who's who has really advanced aging arms and hands and things like that, their skin gets papery, almost transparent. That's from losing, among other things, that dermal white adipose tissue. The other thing that GLP-1s do is. Is that it changes the what we call adipose derived stem cells. And you know, stem cells are big in medicine and big in regenerative medicine, big in esthetics. Now it seems to be the big buzz word out there, but the adipose derived stem cells are kind of shut down, and that is going to really hamper your skin's ability to rejuvenate itself. It actually causes some of these cells to die, and they don't then regenerate. And so that is a very difficult problem for us to address, because we don't really know how to turn them back on. The third thing that that GLP-1 agonist, can do is really affect your metabolic function by decreasing the estrogen. Amount of estrogen that's produced in your skin and everybody's skin makes estrogen, guys and women. And it is really estrogen is really essential for collagen production, which is a big, you know, huge component of facial rejuvenation procedures, mainly non surgical procedures, and also for skin elasticity. So you turn that estrogen down, you turn that estrogen off, and your the aging process in your face gets accelerated. It reduces the hydration that's in your skin, and really, just overall, worsens your skin quality. Now, estrogen replacement is not something I do. I'm not We're not into the the bioidentical hormones, but there are a number of places, both locally and that work nationally, that I've worked with to help my patients improve their overall metabolic health by getting back on what's called bioidentical hormone therapy. I've done podcasts about that with a with a local practice here. I also work with a practice out of Austin that does this, and I'll link, put their links in the show notes as well. Both my wife and I are big believers in bioidentical hormone replacement. If it's something that you're interested in, let me know. Shoot me an email, and we can give you more information about that. The last thing, and this comes out of a paper that was in our journals a couple of months ago, is loss of muscle mass, and I think in the face, the one gripe that I would have about this paper is that facial muscle mass and facial muscle loss really does almost nothing for the your appearance. You know, there are all sorts of non surgical treatments, and again, I talked about this a year or two ago to help stimulate facial muscle growth that do it does nothing for your overall rejuvenation. So that really, while it may happen, it is really not a big component to facial aging. The one thing that I will say about muscle loss, though, is that a significant amount of weight that people lose on these GLP-1 agonists is muscle mass, up to 40% of the weight that you lose is muscle mass, and if there is one independent predictor of longevity. So how long you're going to live? It is muscle mass. As you get older, it predisposes you to serious injuries. One of the leading causes of death once you're over 65 is falls. The lower your muscle mass, the more prone you are to falls, the more prone you are to serious injury when that happens. So if you are on a GLP-1, if you're thinking about being on a GLP-1, I can't encourage people enough make sure that you're getting enough protein in your diet, and make sure that you are 100% starting a resistance training routine to preserve and even build lean muscle mass so that you're losing fat predominantly instead of sacrificing muscle mass, which is really not good for you over time. So we kind of talked about the things, major things, three major things, actually, that damage your face, that kind of accelerate facial aging, so the loss of that dermal white adipose tissue, the loss or injury to the adipose derived stem cells, and then the kind of down regulation of the dermal or skin estrogen production. Now the question is, what can we do about that? So really, there are four things that we can do to treat those, and we'll talk about those here. The four things are fat transfer. So taking fat kind of robbing Peter to pay Paul, taking fat from somewhere you don't want it, putting it someplace you do. There's soft tissue fillers. So the hyaluronic gel fillers. Is, there is what we call composite fat grafting, where we take fat and then combine it with things like PRP to help kind of improve that fats performance. And lastly, things like lasers and things to help improve collagen. And we'll talk about each one of those. So fat transfers are now a common part of pretty much every facial rejuvenation surgery I do, because volume loss is such a big component that any time that we are lifting and kind of repositioning things that have fallen over time, we need to add volume back around those areas. The problem is, is that what we're seeing with more and more people on GLP-1s, is that fat graft acceptance. How much of that fat stays, we call it the take. How much of that stays, where we put it and goes on to live and be healthy is variable in people who are on these GLP-1 agonists, especially if you're still taking them around the time that we're doing a procedure. And so while fat transfers can work and do work, you have to understand that it is going to be variable and the chances of you needing a second or even third fat transfer to get that result that we're looking for goes way up. So keep that in mind. Fat transfers are are an option, but they're not 100% second thing is the hyaluronic gel fillers, and these are really useful in very small amounts, in very well defined places. You're not going to get a full face rejuvenation with filler, no matter what anybody tells you, first of all, it's going to be insanely expensive. And second of all, a lot of filler. Filler is not fat. It's not your own body's tissue, and it's not going to behave. It's not going to look like your own body's tissue. So I typically recommend fillers in very small amounts, in very select places to replace very small amounts of volume loss, typically in younger patients, because they don't need a whole lot of volume replacement. So, but if you're looking for big changes, big volume corrections, soft tissue fillers really aren't the way to go. Composite fat grafting, I would say there's not a lot of research that's been done on this. There's a lot of social media buzz on it, but with these composite graphs, so adding either stem cells or PRP to fat, we think helps that fat to live longer, but there's not a whole lot of good research done that proves that that is actually the case. So tread lightly with that one, use caution if somebody recommends that. And then lastly is laser resurfacing, specific, fractional laser resurfacing, or energy based micro needling, where we're trying to stimulate your body to grow its own collagen. It works, but because we're relying on you to grow your own tissue. If the cells that are responsible for helping to stimulate that, specifically those adipose derived stem cells that and other cells in your skin that are responsible for estrogen production, if they're not working real well, then the amount of collagen that you're going to replace may be not quite as good as it would be if you weren't on these GLP-1 agonists. I think the big take home in terms of therapies is that there are things that we can do to improve appearance after in patients who are taking GLP-1 agonist for weight loss, and see your skin start to thin out, get crepey, papery, and kind of dull looking. But the jury's out as to how well these therapies are actually going to work long term. So you know, in conclusion, what I would say, if you're thinking about losing weight, kind of tried and true diet and exercise, getting rid of processed food, that's going to be your best bet. Understand that's not possible. A lot of people have tried and failed at that a number of times, myself included, in that. But understand that if you do choose to take one of these GLP-1 agonist, you know, the Ozempics and tirzepatides and all of these things that these things probably will happen and that they can be hard to treat if you're interested in this, consult with a, with a board certified plastic surgeon. Talk to, you know, call my office any number of my colleagues that specialize in facial rejuvenation can talk you through options, kind of assess where you are, and then make a good plan for how to correct some of these things. Thanks for tuning in to this episode. I hope you enjoyed it. If you've got any questions, as always, shoot me an email info@drjasonhall.com. Shoot me at DM @drjasonhall, and we'll see you next time you.