Weight Loss & Facial Volume Loss: Understanding “Ozempic Face”

Vitality Unfiltered Podcast

Host: David J. Bauder, PA-C
Guest: Alicia Sanderson, MD

In this episode of Vitality Unfiltered, we explore an increasingly discussed topic in modern weight loss medicine: facial volume loss that can occur during rapid weight reduction.

As medical weight loss treatments — including GLP-1 medications such as semaglutide and tirzepatide — become more widely used for treating obesity and metabolic disease, many patients are experiencing dramatic improvements in metabolic health. At the same time, rapid fat loss can sometimes lead to visible changes in facial structure, often informally referred to as “Ozempic face.”

Host David J. Bauder, PA-C, founder of Weight Loss & Vitality, sits down with Dr. Alicia Sanderson, otolaryngologist and facial plastic surgeon, to discuss the medical science behind facial aging during weight loss and how clinicians safely approach these structural changes.

The conversation explores an important concept many patients don’t realize:

Facial aging is structural, not simply cosmetic.

Changes in facial fat pads, collagen support, ligament strength, bone structure, and skin elasticity all contribute to how the face adapts during weight loss. When weight loss occurs rapidly — particularly when muscle mass, hormones, hydration, and collagen production decline simultaneously — the face may show visible signs of structural aging.

Understanding this biology helps physicians guide patients through weight loss while also protecting facial balance, skin health, and long-term aesthetic outcomes.

In this episode we discuss

• Why rapid weight loss can lead to facial volume loss
 • The difference between fat loss and skin laxity
• What people mean when they refer to “Ozempic face”
• How GLP-1 medications influence body fat and facial fat pads
• Why facial aging is a structural process involving bone, fat pads, ligaments, and collagen
• How muscle mass supports metabolic health and healthy aging
• The influence of estrogen and testosterone on collagen and skin structure
• Why nutrition, hydration, and protein intake affect skin adaptation during weight loss
• When aesthetic interventions such as dermal fillers or CO₂ resurfacing may be appropriate
• Why avoiding premature filler treatments can produce better long-term results

If today’s episode raises questions about your own health and you’d like a personalized evaluation, our team at Weight Loss & Vitality is here to help.

📞 Call: 571-550-9000
🌐 Visit: weightlossandvitality.com

⚠️ Disclaimer

This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult a qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

⚠️ Disclaimer
This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult your qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

Transcript

SPEAKER_01 0:00

Vitality.

SPEAKER_02 0:02

Vitality Unfiltered.

SPEAKER_01 0:04

Unfiltered. With David Bowder.

SPEAKER_02 0:10

Welcome back to another episode of Vitality Unfiltered. Today's topic is weight loss and the prevention of ozimbic phase. Very common component that's going on right now in America. Currently, approximately one in eight Americans have literally tried a GLP one medication for weight loss. That represents about 12% of the population has actively used GLP medications for weight loss or the control of diabetes, because GLP1s are used extensively also for diabetes. But recently, and most people that are aware, we have noticed an uptick in social media presence about the common word Ozymbic face. And today I'm joined by Dr. Alicia Sanderson, and we're going to be talking about what Ozymbic face is, the main reasons behind it, means to prevent it, and kind of like looking at the whole patient and how we can treat a patient properly so we can try to prevent this disease from ever happening or this condition from ever happening. So, Dr. Sanderson, thank you for joining us today. So, what is your take on Ozimbic face?

SPEAKER_00 1:08

Yeah, all right. Again, thank you very much for having me here. So, um, as a facial plastic surgeon, you know, I followed the the research, the data, our academy, and all those things going in there. So we've definitely had an uptick in Ozembic face, concern of Ozembic face. There's, you know, social media out there and you know, research and tools. So going back to the aging face, which is my specialty and what I love, um, you know, when the natural aging process is as time goes on, we will lose volume in our face. And we lose volume both of bony volume of the support structures, the orbits around the eyes tend to open up and get wider. So the eyes become more sunken in. The supporting bone of, you know, the cheeks and the jaw tends to erode and get smaller. So that you know causes uh descent of the face and a lot lack of volume. So there's we lose fat in the face as we age, the ligaments tend to tether. So the natural aging process causes, you know, aging of the face, loss of volume. Um, you lose your collagen and elastin as you get older, so the skin becomes um a little bit more crepey, you know, wrinkly, more lines in there. So that's the natural aging process of the face. Then you get into weight loss. So when people lose weight, they lose fat in their face. When you lose fat in your face, you lose volume, but loss of volume causes you to look older. And if I, you know, I look back at pictures of myself when I'm younger, I have a much rounder face. Um, everybody thinks that my 19-year-old daughter is an exact replica of me. If I post a picture of myself from, you know, 19, 20 years old in there, we're identical and we look the same. Why? Because she's got more volume and um in her face. So as you start to if with people with weight loss, and you'll see people who have, you know, significant weight losses, they actually look older, right? So they look skinny and they look good, but they've, you know, they actually look older in their face. So there's a natural when you just lose weight in general, that you lose the fat in your face. And now we have this new phenomenon of the ozembic face, which tends to be a little bit more dramatic than the natural weight loss. And I think that what that comes what the component to it and what goes down probably has to do with the rapid the rapidity or how fast people lose the weight. And I think if you lose the weight very fast, it's very dramatic. And you're not only losing the fat in the face, but if you are not smart about how you're losing the weight and how fast you're losing the weight, you're gonna have nutrition issues. And if you have nutrition issues, you're gonna lose a faster rate of collagen, elastin, and those supportive structures of the face.

SPEAKER_02 4:00

Aaron Powell Yeah, I think there is like there's like 20 fat pads in the face, right? Something like that's a lot. Yeah. And when when an individual is losing weight, I'm I'm guessing that the fat in each of those fat pads, it's not it's not lost equally, right? There's a per disproportionate loss in the face that goes on.

SPEAKER_00 4:16

Aaron Powell Yeah. I mean, I think that in general, you know, we all have the fat, and you know, we have a finite number of fat cells in there, and they go from being really, really full, right? To decreasing in size. So it really probably depends on the concentration within that fat pad and you know, how it's actually, you know, how fast it's actually um going down. Because we're not necessarily losing those fat cells. They're just not as plump and full as they were before.

SPEAKER_02 4:41

You know, I noticed that like with our patients that are that do the weight loss, and we've had some amazing, we have patients that went from just under 400 pounds, like a 398-pound man that went just over, you know, ended up at ended up at 212 pounds.

SPEAKER_00 4:53

Yeah.

SPEAKER_02 4:54

He didn't end up with Ozimbic face. Right. And you know, he was very systematically, he went through the program, he continued to eat really well, uh, he didn't starve himself, he didn't, you know, he continued to eat. Like when you think about GLPs, right? Most people take weight loss medications with the idea that I need to take this medication so I stop eating. This is the logic, right?

SPEAKER_00 5:16

It's kind of like we've been told our whole life that you know it's calories in, calories out there.

SPEAKER_02 5:20

That's right. And even even the marketing goes. I, you know, I saw a commercial on TV marketing one of the GLPs, and they are, you know, they they talked about the appetite control piece of this, right? And really, it's not really about how much you restrict yourself, it's just really about how you eat. Are you eating correctly? And if you eat correctly, like my take on this is like all of the skin changes and the fat pad changes and all of that is I think there's actually I don't know if it has been studied or looked at, but I do strongly feel that there has to be a collagen component to this when it comes to weight loss.

SPEAKER_00 5:52

Oh, absolutely. Right. So and again, like you you think about it, like we're naturally losing our collagen and elastin. And there's a whole bunch of, you know, research and data and you know, marketing out there about like supplements, supplements to kind of stimulate that collagen. Well, if you are malnourished, you are not giving your body the building blocks to actually, you know, keep producing the natural, the natural substances that we need in life. And again, it kind of comes into like, you know, uh one of the things I love about weight loss and vitality, and I've wor I worked for you for years, and now we were part we partner together with a clinic going in there, is that you look at the whole patient. And part of the weight loss program is you actually have to come in and talk to somebody and go over what's a good strategy. These are tools. Weight loss medications are tools, they're not uh, you know, an end-all be-all um that goes in there, but it's about smart nutrition, eating the right foods, right? I mean, part of it is that we eat whatever we want and we put the you know processed foods in or empty calories, as I'd like to say it. So we lose weight because we're not eating. Well, if you're not eating the right medications, you're losing muscle mass other places. You're, you know, again, you're you're not feeding your body and the ability to actually produce the basic substances that we need to survive, both in our whole body, but also in the skin of our face and going through there. And nutrition does matter for skincare. And I like to, I talk to all my patients about when we come to the, you know, the face and the aging face or the weight loss in face. Prevention is so much better than reconstruction on the other end, right? Like it, you know, preventing, you know, preventing aging signs of the skin, like wearing sunscreen, um, not smoking, um, you know, making sure you're, you know, having hat and keeping your sun out of the face, the um using retinase on a regular basis. So by preventing those signs of aging, they're important. So I think prevention of the ozembic face by you know uh a slower, you know, weight loss, you know, plan and actually eating correct, you know, you know, making sure that you're eating the right nutrients that that allow your body to maintain muscle mass and you know, collagen production and all of those things is very important.

SPEAKER_02 8:11

Yeah, I mean, there's some of these people that they they have uh looked at that have gone through the program and they strictly use these medications as appetite suppression, they starve themselves to the program, you know, starve themselves. You know, Ozimbic face is like one of their least of their problems. The loss of muscle mass on top of that. And and you know what's coming out right now, when they look at overall longevity and health, it is directly tied to grip strength, muscle composition. Right. We know that once you get to 75 years of age, it's like falling off a cliff. Right. Right. And to get there, you want to go into those years with the most muscle on your body. If you're in your 40s, 50s, and 60s, if you're dissolving 30 percent of your muscle, and I would absolutely go on the record and say if you're getting ozimbic face, that is absolutely a physical appearance of what's happening under your skin and the rest of your body.

SPEAKER_00 9:03

Right.

SPEAKER_02 9:03

It's not just your face.

SPEAKER_00 9:04

Right. And and when we're talking about ozembic face, which I'm not sure, you know, like how you know to coin the term or not doing it, I'm not necessarily talking about like the natural volume loss when we lose weight, right? You know, if you people are heavy, they tend to look younger and not doing that. That, I mean, that's just, you know, you know, filler, natural aging, we can do that. But the ozembic face is like is losing everything, you know, both that collagen in there. And again, if you're young, now I'm doing the treatments that I would be recommending on like 60, 70-year-olds on 30-year-olds, right? Like you've lost that baseline collagen. As you said, it's how you go into it. And if you think about like the elderly, one of the most important things that people can do is have muscle mass and strength. You want to prevent, you know, falling and breaking your hip. You need to be strong and have muscle and go through there. You want a better metabolism so you are not dependent on, you know, medications for the rest of your life and diet. You need muscle mass because muscle mass actually gives you a higher metabolic rate and going through there. So being smart about it from you know, the weight loss standpoint, the whole body standpoint is important, but it also makes it easier if you do have volume loss in your face because of weight loss, for the treatment options to make that better.

SPEAKER_02 10:22

And then with patients that are losing weight, do you recommend holding off until they hit their ideal weight before you do any type of they do lose volume, right? Do you do is it better to wait until the weight loss is complete? Or is it can you do it as the on the way down?

SPEAKER_00 10:36

Yeah, so no, I I don't think you necessarily have to wait. And what I say to all my patients when we start talking about um options of treatment and reconstruction, like you know, whether it's like a facelift and people come in in their 50s and want a facelift or they come in in their 70s, it's about how you want to feel at the moment, right? So could you wait till you're all done and put, you know, and do reconstructive procedures? Absolutely. But if we're talking about things like putting in filler, um, laser resurfacing the face, you know, Botox, those non-surgical options, definitely you can do them anywhere along the pathway. So if you're not at your ideal weight, but you do feel like, you know, geez, I look older, you definitely can start putting in the filler in then. You don't have to wait till the end to put filler to replace the volume. You definitely don't have to wait till the end to do a laser resurfacing procedure that actually stimulates the collagen and the elastin to produce more collagen and elastin, as long as you're nutritionally supporting yourself properly, right? So if I'm gonna laser your skin and stimulate your fibroblast to produce more collagen and elastin, you want to make sure that you have the building blocks that your body can do that. So if you're doing it smartly, you know, and you're losing weight on the standard and you want to do these procedures to help with it, it definitely can be done in conjunction so you feel good about yourself the whole entire process going through there. As far as if you need surgical procedures, again, that's gonna go back to the aspect of you probably wanna wait to you're about at your goal weight because when we start doing surgical procedures and removing skin and laxity, we want to have at least a stable, you know, a stable model of how much we're gonna, you know, lose and do that thing. And I think that the plastic, the body plastic surgeons are gonna tell you that same thing. They happens, you know.

SPEAKER_02 12:27

What happens on these patients that uh they get this volume loss in their face and then there's some reconstructive efforts done or there's some fillers or what have you. Sure. And then they regain the weight.

SPEAKER_00 12:39

Um so it usually it's fine. You know, usually it's fine in there if you are doing your procedures correctly, right? So when you start to gain the fat and, you know, like your fat in your face, usually there's not enough fillers in there, and there's not enough regaining of the fat in your face that it makes you look abnormal. And unfortunately, a lot of times when they regain, you know, like, you know, the fat, it's going everywhere else before it's going in the face. And that's kind of like women will say, like they lose weight and they like their breasts will go down, but the breast doesn't always come back in there. So there isn't a any problems with necessarily putting in fillers and then gaining weight in fillers. And I don't see that in my patients that I put fillers to fix a defect and then they happen to gain a lot of weight, and there's no like contraindication to putting them both in there together.

SPEAKER_02 13:29

Aaron Powell Yeah. When when you know when we for a while there, you know, with the liposuction you know component, you know, like you you remove if you do liposuction on their stomach, and then they don't a patient doesn't take care of themselves, they're just gonna gain it somewhere else. Yeah. And uh it becomes kind of a problem.

SPEAKER_00 13:46

Aaron Powell Right. It does become a problem. And there's certain areas that are going in there. So you definitely want, you know, like you know, I'm not a you know, liposuction isn't the answer to maintaining a healthy weight. Right. It's it's helps with contouring of certain things. So if you have a little area like you've lost all the weight, it's that stubborn, you know, area that doesn't go away, then you take those fat cells off. But you know, the the goal is to maintain where you are to keep where it is. Not so much in the face. I wouldn't say like I've not really seen that in the face with people, you know, you know, gain, you know, gaining weight and then gaining it in other places in the face, because we're not going in and taking fat out of the face. And I definitely don't recommend taking fat out of the face. I will do liposuction in the neck very rarely, um, kind of focally in general, because I think taking it out kind of skeletonize you. You lose volume, you do it. Um, I again I don't, you know, under the eyes, sometimes when I'll do a blufferoplasty, I'll, you know, reposition the fat underneath or if I do take, you know, fat out for pseudo-herniation of um fat underneath the eyes, um I'm very conservative in that nature because we need volume. So I'm not proactive about taking a lot of fat out of the face. Upper eyelids in general, like when I do upper eyelid blufferoplastys, it's mainly skin. Because if you look at a youthful face, it has volume and it has fat. And they love to look at like pictures of Cindy Crawford, who I think is absolutely beautiful. And I'll look at her, and it's nice because they're on the internet. You look at her when she's youthful and you look at her now, she's still absolutely beautiful, but she's more hollow. Like if you look at her the infrabrow area when she's young, she has this beautiful full infrarow. So people come in with that lack skin and they want all this, you know, like fat and skin removed. That isn't necessarily a more youthful look to have a hollow open eye. It's it's in there. So like managing that, I'm very conservative about taking um fat out of people's faces.

SPEAKER_02 15:40

So I get one thing that isn't probably discussed a whole lot too is patients that rapidly lose weight on GLP1s. I'm guessing there has to be there there has to be a hormone component to this also. I'm sure. On starvation type, nutritional depletion starvation component, we know that estrogen is very, very helpful for the health of the skin. We know that testosterone is very healthy. That's right. And and these hormone levels drop during periods of physical stress, and starvation is physical stress. So I I think it's such a multifaceted type component here. It's not a singular answer. You know, it's the nutrients, the the hydration, the hormones, the skin care.

SPEAKER_00 16:23

Absolutely.

SPEAKER_02 16:23

The whole compete. The whole compete. It does.

SPEAKER_00 16:25

And I think traditional medicine has done very they have not done well and they're poor at looking at the whole entire picture of it. And I think that's why a lot, you know, like weight loss and vitality and things, we there's a big role in society for it, because you have the time to kind of sit down and look at the whole entire picture and talk about all those things. And it is amazing the kind of the lack of data and research out there, especially with hormone replacement, you know, therapy and things that go through there, that we're not factoring that in and looking at it because, you know, as a woman who recently has been going through menopause, you know this, I was amazed when I was having all the symptoms and going through all the symptoms and, you know, you going to, you know, your primary care doctor or your specialist or even, you know, seeing like a weight loss doctor, they're all very kind of focused on their little area of it. Or if we look at hormones, we only, you know, look at one aspect of it, not the whole picture of it. And we don't look at like where, you know, where we are in the trend, right? Because nowadays we're not gonna just accept aging and aging comes and we fall off and we look like our grandmother did um when we go through there. We want to stay youthful, we want the fountain of youth, but we have to kind of look at like where were our hormones in these because as you lose hormones, I know personally that when I went through menopause, I went through body changes that I never knew were going to happen. I have been fit my whole life. I run, I'm a big runner, I run a lot. I had things happen to me, like I almost like aged overnight. My skin quality got bad, my hair was falling out and thinning, um, going through there. I started gaining weight around my midsection. I've never had weight around my midsection. And I ended up talking to you, and we actually had to do some hormone replacement for me, which made a huge difference. And my midsection fat went away. And it was amazing that it happened like that. And I had done the traditional medical route. Like I went to my primary care and you know, I went to these things, and they, you know, they'll check a level once. They don't check testosterone because there's no data out there for women on testosterone. And that's a whole nother topic that you could get me on to go through there. And they, you know, they give you a pill and they say, see you later, have a good day. Menopause will stop in 10 years. Like, well, I don't want to like have all this damage go through me for 10 years. And again, that's the face, the quality of the skin, the quality of my hair, my energy level, how I feel about myself. And that's vitality, right? That's the whole aspect of I want to feel and look at like I'm youthful. I'm I have energy because I still think I am. Like I'm the, you know, like what is what did they say about like 50 is a new 30 or whatever you you say those things. Like my expectation is that I am active, you know, having all those things. And there is a component to it, is how I look when I look in the mirror, like my skin, my hair, my quality up there. And it's amazing that just simple hormone replacement to levels that were smaller have helped me. And if you look at the data that gets out there on hormone replacement, a lot of hormone replacement is cardioprotective. It's helpful. Like, so these are like improving our quality of life and longevity down the road. So we we haven't even started to touch on, you know, from a research standpoint, what do hormones do to our face, to the skin, to the quality. We know that when you go through menopause, your skin's horrible. It's all crepey. I look down at my the skin of my thighs, and it had never looked like that before. That's hormones, right? Because I didn't have weight changes or anything like that. So I think it's a huge component that we haven't even kind of, you know, reached the tip of the iceberg on.

SPEAKER_02 20:13

I get it, right? Hormones are important for the skin.

SPEAKER_00 20:15

Right.

SPEAKER_02 20:16

But you you touched on it, the cardiovascular. I mean, we're off topic a little bit, right? But the point the point of this is the hormones are a reflection of what's going on on the outside. What do you think is going on on the inside? Right. The endothelial linings of your blood vessels, the the bone density of your bones. I mean, these things matter in a big way. And so I think hormones have a great they have a great point place in this. And then the management of the patients with osimbic face, it's just similar that of any patient with lost volume, right?

SPEAKER_00 20:44

I mean, this is what lost volume, then you add on the collagen elastin, which is a quality of the skin. So we're talking about, you know, volume replacement and probably some skin resurfacing, proper skin care, right? You know, you want to do retinols, vitamin C creams, you want to have, you know, supplements and you know, making sure you're taking the nutrients you need in there. And then they probably need, you know, some you know, some kind of skin resurfacing procedure that helps to stimulate that collagen and elastin.

SPEAKER_02 21:12

Very good. I really thank you for being here today. Thank you. All right. For the listeners out there, if you enjoyed the show, make sure you click on the link below to follow. And this is Vitality Unfiltered, and we will see you next time.

SPEAKER_01 21:23

Thanks for joining us on Vitality Unfiltered with David Bowder. Addressing norms, busting myths, and uncovering health realities for a more vibrant life today. For more expert insights and real talk, make sure to subscribe and join us next time.