Episode 62: IS OZEMPIC FACE REAL AND IF SO WHAT CAN BE DONE ABOUT IT
The latest phenomenon known as "Ozempic face," #OzempicFace is all over social media. This new weight loss medication and similar medications, Wegovy and Mounjaro, has been sweeping the United States, resulting in the fear that losing weight with these medications would result in a hollow, saggy, droopy facial appearance.
Well, the Three Plastic Surgeons have the actual scoop on #OzempicFace, with one of our surgeons who describes what one of these new weigh-loss medications did for him, analyzing his own face and discussing possible solutions for combating "Ozempic face." If you want the real deal, this episode is a can't miss!
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S04E62 IS OZEMPIC FACE REAL AND IF SO WHAT CAN BE DONE ABOUT IT
[00:00:03] Dr. Salvatore Pacella: Good morning everyone. It's Dr. Sal Pacella from San Diego, California. Hope everyone's well, I'm joined today, of course. My colleagues, Dr. Sam Ree from Paramus, New Jersey. He's at Bergen Cosmetic, and Dr. Sam Jejurikar from Dallas, Texas. He's at Sam Jejurikar. I am at San Diego Plastic Surgeon. How are you guys?
Doing great
[00:00:25] Dr. Sam Jejurikar: guys. Doing amazing.
[00:00:27] Dr. Salvatore Pacella: We have had a hiatus from our usual podcast, three plastic surgeons and a microphone, and we're happy to pick things back up here and talk about an awesome new topic. All right, so today's topic we're gonna talk about what's hot in the media, Ozempic face
Okay. So these are new class of weight drugs that lot of doctors have been prescribing recently. and they've had some, some interesting side effects. So we're gonna talk about those today. But first, before we do that, we're gonna give a little disclaimer or usual disclaimer. This show is not a substitute for professional medical advice, diagnosis, or treatment.
This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment. After appropriate discussion, always seek the. Of your surgeon or qualified health provider with any questions you may have regarding medical care. Never disregard professional medical advice or delay seeking advice because of something in the
[00:01:20] Dr. Sam Jejurikar: show.
Alright, Jens,
[00:01:23] Dr. Salvatore Pacella: well, so I'm gonna hand it over to Dr. Jejurikar. He's gonna take the lead here and Tell us a bit about Ozempic
[00:01:30] Dr. Sam Jejurikar: face. Perfect. Yeah, so much like you guys over the last two weeks, my social media feed has been sort of dominated by this hashtag ozempic face. I have saw sort of articles in the New York Times.
I've seen other plastic surgeons talking about it on their social media feeds. And so I thought this would be a timely topic for us to talk about. So, First of all, what are these medications? Ozempic and Wgo were the first few medications that that were sort of released. They're both actually the same medication.
Semiglutide and Ozempic was actually released for the treatment of type two diabetes Wgo v. Was which, which is a higher dose of Semiglutide, was approved for the treatment of obesity. A few months later like June of 2022, Manjaro was FDA approved for the treatment of type two diabetes. But interestingly enough as the clinical trials were done, even though Manjaro is technically for type two diabetes, the clinical trials actually show that weight loss of this medication.
Could be twice as much as you might see with these other meds. And so, in a lot of cities, Dallas being one of them, I know New York City, I'm sure you guys as well, you're, you're seeing it a lot. A lot of patients started getting this prescribed for their doctors for the treatment of weight loss. And there's just tons of chatter.
It's almost like it's magic that's out there. And there you know, again, Ozempic was sort of the first one that was, that was talked about a lot. Najaro seems to be the most effective. Before before we get any further, I want our patients to know we're not necessarily promoting the use of these medications.
There are side effects, like there could be with any other medications. The, the reported ones that they've, they've seen thyroid, cancer and rodents with, with all of these medications. Pancreatitis could be a side effect with these medications. So we are not trying to. To to push these medications.
But in the New York Times article that I read earlier this week they actually said that on Twitter, the hashtag ozempic face had actually already been referenced 2.3 million times. So a lot of people are actually talking about this. So how do these medications work? Manjaro, I'm gonna talk about that as well as ozempic.
So Manjaro and Ozempic both work through something called GLP one receptors, which are glucagon-like peptide receptors, and they do a few things. The first thing they do is they sort of increase the effects of. Insulin in, in your body. So as we get older or when people have diabetes, they get more resistant to insulin, meaning that their ability to just sort of break down glucose and process it gets, gets worse.
So they're more likely to start seeing diabetes. They're more likely to start gaining weight and storing that glucose. So these medications increase the sensitivity of, of. Of your body to insulin. The second thing they both do is they reduce gastric emptying, meaning you eat a little bit and you get full a lot quicker.
And then they both reduce glucan glucagon levels, which means you're less likely to mobilize glucose in your bloodstream. And so all of those medications, Ozempic, will, govi and manjaro do this . Then when Jarl actually does something else, it actually works through another receptor as well, which are called G I P receptors or glucose dependent Insulinotropic Polypeptide receptors.
So what it also does, it also works on your brain so you're not hungry and it increases the sensitivity even more so to insulin. So I, that's the, it's sort of speculated because it's got this dual mechanism of action. That's why it's more effective than ozempic. So my personal story is this. I come from a, a family that has a strong history of type two diabetes.
About a year ago when I checked my hemoglobin A1C level, which is a marker of diabetes it came back elevated at 5.6, which is the beginning of prediabetes. So with my doctor, we came up with a regimen. Changes to my diet were basically, I was having less carbs. I actually started doing intermittent fastening all in an attempt to control my, my levels of you know, of my glucose levels and to try to control my, you know, propensity for type two diabetes.
So, a year goes by I actually lose about 12 pounds doing this. I check my hemoglobin A1C again, and it's gone up to 5.9. And so now my doctor is telling me, well, you probably need to start some medication for this. He actually recommended that I start a different medication, a different pill, but because I've seen so many of my patients on Manjaro, I actually asked, can I try Manjaro for a few months?
I wouldn't mind losing. 15 or 20 pounds and then transitioning to this to which he agreed to. So I started on Manjaro about five weeks ago. And what what happens is in this past five weeks, I have actually lost 15 pounds. And it just so turns out that about a year ago I'd actually taken some photos before I was getting a laser treatment.
And so I got another set of photos to see whether I had gotten Ozempic face. So gentlemen, what do you think? Do I have Ozempic face? I think you look
[00:06:12] Dr. Salvatore Pacella: chiseled. I think you look like the rock
[00:06:18] Dr. Sam Jejurikar: Yes. Well, so yes I do. It's interesting, right? It's interesting. So when we look from these views, I mean, I definitely think I look better, but I also think that the weight loss in my face is disproportionate to a 15 pound weight loss. I think there's a lot. Yes.
[00:06:39] Dr. Salvatore Pacella: Well, so, so let me say I you know, we see a in, in cancer reconstruction that I do very frequently.
We have the benefit of kind of seeing patients over and over. Throughout several months and over a year, two years, et cetera. And we, we sometimes take pictures of their face, et cetera, and there is some yo-yoing that occurs sometimes with, with weight. And I, I would say that, you know, even five to 10 pounds of weight loss.
You can actually see it in the face. I'm gonna say, so it, it's actually not surprising to me with just 15 pounds that we're seeing, you know, some subtle changes in your face. You know, the thing thing that jumps out at me the most, I think your, you know, your jaw looks great. Go to the oblique for a second here.
I mean, your jaw definitely looks more chiseled. Look at the submental area. You know, you don't have any, any additional fat underneath the, your chin area area, so you, you look great. The, the only thing I see here that I, I would say may be a little bit treatable. Is the temporal area right here above right in between your ears and your eyebrow.
That is notoriously a place where I see patients kind of lose weight to sort of have issues related to weight loss. So, we got some treatments for that my friend.
[00:07:50] Dr. Sam Rhee: The other comment, the other comment I would make is, is I agree with Sal a hundred percent. The only other place I would see any sort of maybe more overt signs of aging is, Under, under your eyes a little bit.
There's a little bit of hollowing there that honestly though for your age and for your weight loss is pretty good. What I'm impressed with is when I see a lot of people who've lost this kind of weight Their nasal labial folds get pretty, pretty deep and I don't see that in you and I don't know if that's good genes or, you know, you just never really had that to begin with, I'm not sure.
But that honestly, for 15 pounds at your age is, your face is holding up pretty well.
[00:08:34] Dr. Sam Jejurikar: Pretty well there. Yeah. Looks great. So, so, you know, this is, this is an interesting one for you guys because normally we'll look at these pictures and they're just some patient you don't know. So it's easier to sort of tear it for you to critical of it.
But because it's me and you guys are nice guys, you are being exceptionally kind. So, so I, I agree. I think I look healthier having lost weight. I think my face looks more chiseled. I will say a couple of things. My jawline area. Sam, in terms of your comment, I'm kind of a, I'm kind of a freak about radiofrequency treatments.
You know, I'm a big believer that radiofrequency and retinols treatments together at, at at home can be, can be really beneficial for keeping skin tight. So I think between Morpheus eight treatments, which I've sort of done regularly over the last year and a half to two a home form of radiofrequency treatment that I do about once a week.
And then being very good about retinol treatments. I think that probably explains what we're seeing with the jawline area a little bit, where it hasn't, I think my jawline actually looks better with weight loss, which is interesting than it did before. Cause you would expect this, this area along the lower jawline to get to get more.
To get more sagging. Mm-hmm. in terms of the nasal labial folds, which are these lines for our patients, between the nose and the lips and the marionette lines, which are the, the lines between the lips and the jawline? I mean, I think there is some deepening that has actually occurred in this spot.
These are very treatable by by by fillers. I agree that I think that I've lost a lot of fat in the, in, you know, in the, in the orbital region where if you look at my lower. It looks substantially more sunken than it did 15 pounds before. I thought the thing which which you guys, oops.
Which you guys didn't really mention. I thought I lost a lot of my buccal fat, which is another hot topic. You know, a lot of patients will sort of come to us and talk about you know, do I need my buccal fat pads taken out? They want to get more of that chiseled look. And I, and I was thinking, part of the reason why my cheekbones actually look a little bit more defined was, I think my, my buckle fat is gone.
Which I, which I don't know if that'll come back if, if the weight comes back because, you know, which we didn't mention a lot of patients on these clinical trials, once they stop manjaro and Ozempic, they, they get a, a, a portion of this weight back. So I'm, I don't know if my buccal fat will come back. I don't know if my orbital fat will come back.
I don't know if my temporal hauling that Dr. Pacella was talking about would come back as well. I don't know. It's, it's interesting because some of these, some of the fat that we lose in our face is, is just different kinds of fat. They're fat pads than, than, you know, than the typical fat that we might see in our abdomen that, that waiver.
So, I don't know
[00:11:05] Dr. Salvatore Pacella: Dr. Jay, one question for you. Do, do you smell what the rock is cooking?
[00:11:15] Dr. Sam Jejurikar: I it's unbelievable. I mean, you,
[00:11:17] Dr. Salvatore Pacella: what you need to do. You need to shave your head and get a touch your shoulder and you are a spitting image of the rock. I mean, it's amazing. So
[00:11:27] Dr. Sam Jejurikar: if only, if only, if only, if only that were true . So, alright, so let,
[00:11:31] Dr. Salvatore Pacella: let's talk for a second about y you know, you mentioned fat transfer.
I, I do a, a tremendous amount of fat transfer in and around the face in the perioral region. And, you know, the, the beautiful thing about fat transfer in and around the face is very easy to do. Very predictable and very long term. This is something you could do right in the office. So, that fat that's harvested from the abdomen though remembers that it's from the abdomen, right?
So anytime you transfer tissue around if you gained or lose weight after fat transfer, you will see it accordingly in those areas. So as to if you gained weight again, will you see it in your temple? Temporal fat pads. My, my answer to that is probably not, I, my experience has been that when people lose this in this area, it tends to be permanent.
You know, even when people put weight back on it, it's like that, that's a combination of aging and or weight loss. But it, but it's interesting, one of the only places in the body that once you lose the weight, it's gone and it doesn't come back. It's that area in my.
[00:12:36] Dr. Sam Jejurikar: Yeah, I, I agree with that. I, I feel like buccal fat, temporal fat and orbital fat, when they go away, they don't come back.
And I think you're right. There's a lot of longevity that comes with a fat transfer. And for patients that don't want to do repeated filler treatments, that is a very nice alternative. I, I, I am a big fan of doing. You know, transient filler treatment as well, because I find that to be predictable as well.
And the thing is, is if my weight yo-yos afterwards, I've definitely seen fat to the temporal region, fat to the cheeks, gain weight afterwards once a fat transfer happens. And people's fat face look abnormally fat as well. So for, for, so my personal approach to me, which I'm gonna show you guys in a second, is I'm probably gonna do some extensive filler treatment in the next few months here to try to overcome some of these change.
Any comments, Sam, before we move on to like, how would you, how if, let's say I showed up in your office and I said I, I want, I want, I want you to help me with some of these signs of aging. What would your approach to me be?
[00:13:33] Dr. Sam Rhee: Yeah. My first go-to generally, I mean, Sal is right, fat is. An amazing treatment method, and I use it a lot too for the face.
But I always, usually for a first time patient, we'll start with some sort of filler just to make sure that we know what we're doing in terms of results, whether they like it. And it helps us sort of gauge what a future fat transfer is. So I, I will usually start with filler and then bridge to fad.
If, if it's something they really like.
[00:13:58] Dr. Sam Jejurikar: So, I I use some virtual aesthetic software in my practice, which is called Crystally. The only eatery thing about Crystally is that it cuts off your hair like a weird looking mask. But I simulated, I sort. Playing around. I'm like, how can I still sort of maintain this look that I hopefully I'll maintain most of the weight loss that's occurred, but how can I reverse some of these signs of aging?
And so Chris Looks, has a partnership with Allergan and I do use a lot of Allergan filler products in my practice. So in this, I sort of simulated what I thought two syringes of velure would look like in my nasal labial folds in marionette lines, which is a hyaluronic acid filler. I simulated. Two syringes of vella would look like in my lower eyelids and kind of spread a little bit into my temple area.
That's a hyaluronic acid filler. I simulated with two syringes of VOA would look like in my in my cheeks to try to add a little bit of volume. To this lid cheek junction. I even added a little bit of luxe to my jaw line, just a little bit to, to try to, to try to make my jaw line even a little bit more, more rocklike in, in Dr.
Patella's analogy, . And and, and I thought I thought this would still maintain sort of that chisel look. Without, you know, without any substantial downtime. You know, the next thing about filler is I don't have to have surgery. That's something that can be done in the office, and I can just sort of go back on my way.
And so I, I anticipate doing, doing doing something like this in the next few months, maybe in a piecemeal manner. You guys have any comments about this?
[00:15:34] Dr. Sam Rhee: I think it looks great. Yeah, I think it's amazing how, I think, I believe this is fairly accurate in terms of simulating what that kind of filler treatment is. What is surprising and yet not surprising is how much. How much filler you, you had to use to achieve these results on the simulation? Like, how many syringes is that?
Is that like eight or 10 syringes? Like that's a lot. Like I was,
[00:15:57] Dr. Sam Jejurikar: I was estimating about seven syringes of filler altogether to make this happen. Yeah, it's a lot. You know, that's the thing, you know, I. Seven altogether was what I was thinking. Two of allure, two of voa, two of Ella and, and the Luxe. I don't really know if I need that one.
I just knew, so I wanted play around with it. i'll jawline filler.
[00:16:18] Dr. Salvatore Pacella: So, so that's a, that's a good point about, about the amount of syringes. So let's just say on average syringes of the fillers are four to $600, something like that. Would you, would you. I mean,
[00:16:32] Dr. Sam Rhee: I mean, the balloons are way more expensive than that probably.
[00:16:34] Dr. Sam Jejurikar: Yeah. But, okay. Yeah. So let, let, let's just see. Probably, I see, say I see between 700 to a thousand a syringe. Okay. So you, let's
[00:16:42] Dr. Salvatore Pacella: just do the math real quick. So you have 700 bucks of
[00:16:45] Dr. Sam Jejurikar: syringe. It's about $5,000. Let's, yeah, let's just say about $5,000. Okay. Okay. Yeah. So
[00:16:50] Dr. Salvatore Pacella: $5,000. So I fat transfer is relatively inexpensive.
Can be done in the office setting, takes about an hour. And I, I would say that it's well below the cost of that. And so just to, to keep this in perspective for patients when they, when they choose a filler, fillers are temporary, very easy to do. Fat transfer takes a little bit time, a little bit of recovery, a little bit of, a lot more swelling.
But the, the fillers. A little bit more reversible, a little bit more subtle, et cetera. So it is, it is a financial issue many times between the with the cost of fillers for
[00:17:27] Dr. Sam Jejurikar: sure. Absolutely. But the, the couple of things I might take issue with what you said is there's a lot of downtime with fat grafting to the face.
There tends to be a prolonged amount of swelling that can happen with it. It's not a little bit reversible. I mean, it's not really reversible. That's what I
[00:17:44] Dr. Salvatore Pacella: meant. That's, that's when you
[00:17:46] Dr. Sam Jejurikar: say a little bit more reversible. It is reversible and fat is not revers.
[00:17:52] Dr. Salvatore Pacella: Right. I did, I did say that. I did say, wait, wait, wait.
I did say the fillers are more reversible, and I said that there's extended, extended
[00:18:01] Dr. Sam Jejurikar: reversible. Yeah. But, but then hold
[00:18:08] Dr. Salvatore Pacella: on, hold on. Let's give you some correct information there. There are ways to o to treat overfilling of. Injection of steroids, there's massage, et cetera. So, you know, that's, I'm just saying the degree of reversibility or change is much more difficult with fat transfer.
I agree. But it's, it's not a zero sum.
[00:18:31] Dr. Sam Jejurikar: Right? A hundred percent. But then the, the, the, the other type of cost that I would, would talk to you about is, is. Is an opportunity cost. And you, you know, you know what that is and Dr. Reid knows what it is. But for people that don't know what it is, an opportunity cost is, is that cost that From downtime, that what you're gonna lose out on.
So for me, if I can do filler injection and do it during the course of my day and continue to work and not look abnormal for a couple of weeks, or three weeks, or four weeks, or however long it takes fat to go away, or the, the swelling and bruising to go away I, I, I actually think that that's less expensive for me in, in the long term if I'm not looking.
Abnormal for a period of time, and I'm seeing patients and I'm able to continue to operate. So I, you know, and I agree, I'm not hating on fat at all. I love fat transfers to face. I don't tend to do a lot of it in the office setting for this. When I do fat to the temples, when I do fat to the lower eyelids, I do fractionated fat, you know, fract to fat, which it just EAs, you know, and so there's just lots of preparation.
So I tend to do this in the operating room when, when I'm doing it. So, There's pros and cons to either approach, but it's not uncommon for me in my practice to do four to six syringes on people at a given session. I mean, I, I probably do that on a weekly basis for people that, that have needs. So to, to me, that's not an abnormal amount of, of of filler product to use.
[00:19:52] Dr. Salvatore Pacella: I love this
[00:19:53] Dr. Sam Rhee: debate between you two because I think for certain patients, fat is, is definitely their answer, and for some people, fillers or both, sometimes. And so I feel like the fact that we can have a good debate about both shows that there's utility in both methods of approach and it's something that you, you know, discuss with your surgeon and then you sort of figure out what what probably would work best for you.
[00:20:18] Dr. Sam Jejurikar: Yeah, so I think the take home message. Least in my mind. The two questions are, is ozempic face a real thing? Yeah, I think it is. I think it, I do think you definitely see signs of facial aging with it. Is it unique to Ozempic or is it more just related to weight loss? Who knows? But is it treatable? Yes, it's treatable.
There's, there's great ways to add volume back to the face. So for me, I'm personally very happy that I've been taking Manjaro. I, I love the fact that over a few mo over a few weeks, I've lost. Kind of a ridiculous amount of weight. And then I'm motivated to keep it off afterwards. We'll see if I'm actually successful.
I think the other
[00:20:53] Dr. Sam Rhee: key, the other key to remember is that you did a lot of non-invasive skin treatments during this time, which can be very helpful. So people should sort of keep that mind as well as, as they're going through medi this medication regimen that maybe they should also be focusing on, on that as well to help themselves.
[00:21:10] Dr. Salvatore Pacella: Great. Well, well, Jen, that's the, that's a great place to, to end, I think. I mean, I think the, the key here is we're gonna be seeing much more of this in the future as surgeons, and good to know there's a lot of treatments for that. I'm gonna leave you with this. Know your role.
[00:21:30] Dr. Sam Jejurikar: Be sad everyone. 3PlasticSurgeryPodcast.com or youtube.com/@3plasticsurgeons
