S05E74 Ozempic Face: A Deep Dive into the Cosmetic and Medical Consequences of Weight Loss Medications

Have you considered the unexpected cosmetic side effects of weight loss medications? Dr. Sam Jejurikar @samjejurikar from Dallas, Dr. Sam Rhee @bergencosmetic and guest host Dr. Lawrence Tong @yorkvilleplasticsurgery from Toronto, (subbing in place for Dr. Salvatore Pacella @sandiegoplasticsurgeon) peel back the layers on a topic that's reshaping more than just waistlines.

As the use of medications like Ozempic and Mounjaro for weight loss surges, we're seeing a new wave of cosmetic concerns – enter 'Ozempic face'. We discuss the effects on facial structure, stirring up a conversation on the intersection of medication, rapid weight loss, and the aging process.

Navigating the after-effects of shedding pounds doesn't stop at skin-deep; the battle between surgical and non-surgical treatments takes center stage. Non-invasive methods such as radiofrequency skin tightening and injectables are pitted against the knife, with patient recovery and skin elasticity as deciding factors.

We share stories and strategies for managing facial changes post-weight loss, emphasizing the critical role of medication management prior to any surgery. The nuanced dialogue uncovers how weight loss drugs can alter the landscape of anesthesia risks and gastric emptying – because nobody wants a side of aspiration with their facelift.

But there's more to these medications than meets the eye, as Dr. Rhee, Dr. Tong, and I touch on their broader ripple effects. From addiction management to potential improvements in cholesterol, we unpack the layers of impact beyond the scale, even as we navigate the pitfalls of side effects like stomach paralysis.

Humor isn't lost on us either, as we chat about peculiar Amazon finds and dimple makers. Strap in for a journey that bridges the gap between medicine and cosmetic surgery, leaving you primed for the next wave of advancements in this transformative medical saga.

@3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic 3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S05E74 Ozempic Face: A Deep Dive into the Cosmetic and Medical Consequences of Weight Loss Medications

TRANSCRIPT

[00:00:00] Dr. Sam Jejurikar: Welcome, everyone, to another episode of Three Plastic Surgeons and a Microphone. As always, I am Sam Jejurikar in Dallas, Texas, and I am joined by Dr. Sam Rhee at Bergen Cosmetic, who is in Paramus, New Jersey. And, uh, as it's been a recurring pattern lately, we are joined instead of Dr. Pacella by Dr. Larry Tang.

Larry Tong, I'm sorry. Oh my god. I swear I've known

[00:00:30] Dr. Lawrence Tong: Beloved

25 years. Uh, but Larry Tong at Yorkville Plastic Surgery, uh, in Toronto. Boy, that's embarrassing. Um, actually, anyways, I swear I know Larry. Uh, no, no, let's capture how bad this intro was on my part. But, um We're going to talk about an interesting topic today, something that I think every plastic surgeon in America, uh, is, uh, is facing, which is how to deal with some of the newer weight loss medications and what we're seeing in our, in our patients.

Um, before we get into the meat of it, we have a disclaimer. One of you gentlemen want to read that for us?

[00:01:09] Dr. Sam Rhee: This show is not a substitute for professional medical advice, diagnosis, or treatment. The 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 advice of your qualified health provider with any questions you may have regarding medical care, and never disregard professional medical advice or delay seeking advice because of something in this show.

[00:01:30] Dr. Sam Jejurikar: All right, so, uh, before we get into the meat of it, just, uh, just a little background for our viewers, um, you know, I'm sure if you are paying attention to what's going on in the news, you hear about medications like Ozempic, or Wagovi, or Semaglutide, and then a newer one, Monjaro, which goes by the name Perzepatide, um, and then it's got a new name, too, for a new indication.

And basically, these medications, uh, were first kind of brought into the spotlight about a year or two ago. Um, They were initially marketed for the treatment of type 2 diabetes, but they realized during the clinical trials that weight loss, um, was actually a really common thing that occurred with this as well.

And so they now both, uh, Monjaro and Ozempic have been rebranded and also have FDA indications for weight loss. So the first thing I'll ask you guys is how many patients or what percentage of your patients do you actually think You see are taking these medications

[00:02:26] Dr. Sam Rhee: I would say a huge proportion, uh, and it's growing, I think, every month. Um, I have also seen patients who I originally saw maybe a year or two ago, and, um, you know, they really weren't body contouring candidates, and they've come back after having been on these medications, and it's, it's a life changer for a lot of patients.

Not only that, I know colleagues and friends and, and other people that just, um, you Who are not patients who, who have been on this medication and I've seen some really, really dramatic changes in them. So it's, it's everywhere. I mean, it's, it's grown tremendously in the past year.

[00:03:07] Dr. Lawrence Tong: Yeah, I agree with you. There's a very significant amount of, uh, patients and people in general who are, um, on these drugs, uh, and I'm sure everybody out there knows someone who's on these drugs. Um, the funny thing is that a lot of, uh, patients, uh, do take this even though, uh, these drugs, even though they're not, uh, diabetic, they're, a lot of patients are really just taking these drugs for weight loss.

So what I mean is, uh, Ozempic, for example, is not. Uh, specifically for, for weight loss as Sam had alluded to, but a lot of patients are getting prescribed this and we are starting to see a lot of patients, um, that, um, have benefited from this and it has also, you know, started to, um, generate, uh, plastic surgery demand for various procedures.

[00:03:58] Dr. Sam Jejurikar: when you say that it's generated demand. Like, what kind of things are you seeing in your practice? Larry,

[00:04:04] Dr. Lawrence Tong: So, one of the things, uh, that People might have heard of is something called the ozempic face, um, and that's really just what, that's just what happens when, uh, you have significant weight loss in a short amount of time. Um, and that results in sagging of the skin. I think that what's happening is maybe because the weight loss is so rapid, the skin doesn't have as much time to sort of catch up and you're going to see.

Um, either sagging and, uh, loss of volume because the fat is going away. So one of the things that we're starting to see is, um, you know, fillers or fat grafting or other types of volumization, uh, to compensate for some of these changes.

[00:04:52] Dr. Sam Jejurikar: do you guys? Um, yeah. So I was pointing at myself when you said that, because I've been on Menjaro for more than a year. Um, and I started it because I'm pre diabetic. My A1C normalized with it. But now, um. My doctor tells me I can never get off of it. And I 100 percent agree with you. I, um, there's definitely volume loss, but I, you know, I think it's more than just traditional weight loss.

I think that certain fat pads that we lose weight in different ways, like I have lost malar fat, um, you know, for patients that are out there, buccal fat pad removal is a, is a common procedure we will do for our patients. And literally, With, uh, Manjaro, I feel like I've had the effect of a buckle fat powder removal, like I have defined cheekbones.

In some ways, there's been some good cosmetic benefits that go along with it, but then lower facial sagging. hollowing of the lower eyelids, hollowing of the temples. It's really interesting that I think the weight loss, at least in my observation, personally, and in many patients that I'm seeing, the weight loss isn't just good weight.

It's like, it's very prematurely aging weight loss.

[00:06:00] Dr. Sam Rhee: Yeah, I think for patients over the age of 35, when I see them, they lose it in the temples and you can see it. You can literally see this sort of flatten or hollow. And then I think the other area is the malar, the cheek pads, because they start getting this deeper Nasolabial fold look. And you're right.

Those are both areas that sort of prematurely age you. And the question I always have with patients when I see them for these types of, uh, indications is how long are you, like you said, how long are you going to be on this medication? What happens when you get off of it? Are you planning on getting off of it?

Um, cause those are also things, especially not just for facial procedures, but for body procedures, like body contouring procedures. Um, you don't want to get caught in a situation where you do something and then they get off of these medications and then they gain a significant amount of weight back, which is what I think, uh, studies have shown so far that if you stop these medications, the weight, uh, The weight gain returns pretty quickly.

[00:07:04] Dr. Sam Jejurikar: Yeah. The clinical trials show that if you follow these patients out about a year, um, even with lifestyle modification, you know, assuming that's happened, that they gain about two thirds of the weight back over the span of a year. Now there are, there's a lot of weight loss doctors that are coming up with their own protocols to try to paper people off of this, which they insist. Less weight gain, but at least the study so far haven't actually borne that out. Do you guys, do you guys? Yeah, go. No, no, you go ahead.

[00:07:34] Dr. Sam Rhee: I was just going to ask, where do you guys see patients and decide this is something is that's more non surgical, you know, say, uh, treatment wise for skin versus something that maybe requires more of. And invasive like surgical type procedure. Like where, where do you see that with these types of patients?

[00:07:57] Dr. Lawrence Tong: Well, I, I would say generally if you're, um, talking about cosmetic surgery and, you know, surgery versus non surgery. Patients have to understand that there's a limitation to what can be achieved with non surgical procedures. So, filling with volume, uh, like fillers, um, is perfectly acceptable when you've had a little bit of deflation in the face.

Um, but if you have a lot of sagging, uh, patients should not expect fillers to be able to lift things. And that's, that's something that I stress, uh, to patients, that lifting is not really a realistic expectation, uh, for fillers. And then when it gets to the body In general, you're not going to be doing any sort of non surgical procedures.

Um, you know, the skin tightening machines and things like that only provide a very modest or even negligible degree of improvement in those areas. So, a lot of patients with sagging skin in the bodies will generally need some sort of surgical procedure. So, I think that's important for patients to understand that in the face of where you have a choice.

Often between surgical and non surgical, that, you know, surgery is much better suited to lift things and remove excess skin. Um, and if you choose to go with a non surgical route, you just can't have the same expectation as having surgery.

[00:09:24] Dr. Sam Jejurikar: Yeah, I have 100 percent agree with everything Larry just said, you know, just to kind of build on that a little bit more. It comes down to the amount of time people have to recover, you know, surgical procedures, whether it's the face or the body, you're looking at several weeks of recovery. Whereas, you know, injectable treatments are.

You know, the relatively rapid overnight recovery comes down to expectations. Like Larry said, if you want big expectations, you need a big recovery and you need surgery. But if you're willing to do sort of incremental treatments to get incremental benefit, non surgical stuff might be useful. I personally find that when it comes to, um, know, technologies for skin tightening, what, you know, most commonly radio frequency or ultrasound, that weight loss patients, if it's been large amounts of weight loss or skin elasticity, just isn't very good, even the best technology tends not to have huge benefits, but if it's a moderate weight loss and a younger patient whose elasticity is better, maybe we can achieve some better things with, with radio frequency.

So there's not sort of a, a straightforward answer to that question as well, but. You know, uh, you know, I feel like patients kind of drive the conversation, though, Sam, to answer your question. They kind of come in knowing people are really educated and they generally know what it is they think they need.

[00:10:40] Dr. Sam Rhee: Would you say, and because you've gone through this process, Sam, and you, your face looks pretty good actually, is would

[00:10:47] Dr. Lawrence Tong: Oh, damn good.

[00:10:48] Dr. Sam Rhee: yeah, damn good is actually, uh, what I would say. Uh, so, uh, thanks.

[00:10:53] Dr. Sam Jejurikar: You guys are going to make me blush. Why?

[00:10:56] Dr. Sam Rhee: Um, would it be worthwhile to tell patients who start these medications as they're starting to lose weight to get a jump on some of these non invasives and say, listen, don't wait until you lose 30 pounds before you get treatment. Like. Maybe start some of these non invasives early and often, if you, listen, if you have the money, because this stuff isn't cheap, but if you have the ability to do so, maybe that might help mitigate some of these issues.

[00:11:27] Dr. Sam Jejurikar: Because I think everybody loses weight a little bit differently with these medications, you know, and if I go back and critically look at my face before I started these medications, my face was to add a bunch of filler to my face to kind of preempt that would have not necessarily been a great thing.

There are things, though, that I think are really beneficial that I recommend to all patients. Like, I think radiofrequency treatment is I use a home radio frequency device, um, and, and I have for a couple of years and I, and I, and I think that's a helpful thing. And I try to get people to do that. I think, you know, skincare with, with retinols is really important.

You know, I think a lot of the things that are important now are true, regardless of whether or not you're about to lose weight for body contouring stuff. I just don't know how you would like, you know, pre treat, um, Um,

[00:12:19] Dr. Sam Rhee: is the, uh, can you say what the RF frequency device is that you use?

[00:12:26] Dr. Sam Jejurikar: I forgot, I literally can't remember the name of it. I will remember before the next one, I'll pull it out.

[00:12:32] Dr. Sam Rhee: Okay.

[00:12:35] Dr. Lawrence Tong: I, I agree with Sam with that. Um, I, I don't, uh, believe it and I wouldn't. I think that it would be easy to predict how you're going to preemptively treat someone. Maybe you counsel the patient that, you know, once you start seeing things come on in quickly and we can sort of mitigate any of the extreme changes that you would see.

The other thing is though, um, is, you know, is there a role for, um, changing how you're taking these drugs? Because there is a sort of a ramp up. Yes,

[00:13:17] Dr. Sam Rhee: on the medication when they have their surgical procedures? I have seen some, um, considerations since they delay gastric emptying that there might be some side effects to the anesthesia as a result of being on these medications when they're getting surgery.

[00:13:36] Dr. Lawrence Tong: I think that's a definite must whenever somebody is going under anesthesia. For the viewers out there, when you go under anesthesia, general anesthesia specifically, You're going to be intubated and when that occurs, intubation is putting a tube down so that you can breathe when you're under anesthesia.

When that's done, there is a risk of something called aspiration and that occurs if you have food in your stomach and because your reflexes are altered by the process of general anesthesia, you may cough and have food inadvertently go into your lungs and that's a very serious complication that can occur.

So what happens with Uh, these, uh, these types of drugs is one of the effects is that gastric emptying slows down, meaning the rate at which the food leaves your stomach is much slower. So this traditional, um, advice we've been giving patients, uh, you know, stopping food, um, maybe at least eight hours, uh, before surgery might not apply.

And actually, um, there has been many reports of increased risk of, uh, aspiration. So we have to. Uh, make modifications to when patients should stop eating or drinking. And right now, um, I think the standard, uh, recommendation is if you're taking Ozempic, which is a once a week injection, you should, um, stop, um, for at least one week, um, prior to surgery.

So you should miss or purposely skip that dose. If you're on an oral medication like Wigovi, which is something, sorry, not Wigovi, uh, Rebelsis.

[00:15:14] Dr. Sam Jejurikar: Yeah,

[00:15:15] Dr. Lawrence Tong: every day, um, at least one day, uh, beforehand. Uh, but I think the, the information on that is still evolving because there's still, um, some concern that gastric emptying, um, is actually affected even beyond that stopping of, of one week.

And, uh, there was a recent, uh, editorial, um, in the Canadian Journal of Anesthesia which had recommended Uh, considering even stopping three weeks before. Now, if a patient is a diabetic and needs these medications, then I would say, you know, that should be done in consultation, uh, with their, uh, endocrinologist.

But, to Sam's point, there is, um, a special consideration, uh, with patients on these types of medications, uh, when they go under anesthesia.

[00:16:09] Dr. Sam Jejurikar: there's at least one case report that shows a patient with a full stomach who was on the medication three weeks, even after having delayed it for three weeks. So, I tell my patients two weeks for, for Ozempic to not take it. Um, that's what my anesthesia group wants. For all of our, for all of our patients.

[00:16:28] Dr. Sam Rhee: Let me ask you this. If you have a patient who comes in for body contouring and their BMI is pretty high, I have heard of some plastic surgeons who actually are prescribing, managing weight loss pre body contouring surgery. And, you know, taking them through that whole process with ozempic and then operating on them.

Uh, how do you guys feel about that? Do you guys do that? Like, you know, do you recommend patients go on ozempic if their body, their BMI is high and they're looking for some sort of body contouring procedure?

[00:17:04] Dr. Sam Jejurikar: I do do it, yeah, but, but I make a point of letting people know, look, I'm not a weight loss doctor, so I'm not in the ozempic prescribing business for people that are not surgical candidates. Once they're sort of enrolled and they're going to be our surgical patients, we will get them ready. And we've had patients lose a hundred pounds on these medications before surgery to get them, to get them ready.

Um, we check labs every Every three months on them, we check, you know, labs beforehand, we counsel them on, you know, on contraindications like multiple endocrine neoplasia syndrome and certain types of thyroid cancer. And so we do all of that. Um, and then we actually will work with a compounding pharmacy that will help them get at prices that are a little bit more affordable too.

So, yeah, we, we do do it, but again, you know, there's a danger because I don't want to be a weight loss. But I think I can get better surgical results if people lose weight before surgery.

[00:17:59] Dr. Lawrence Tong: Yeah, I, I don't, uh, go that route, um, it's a little bit, um, you know, uh, more difficult for patients, um, in Canada, however, to, um, ask their family doctor or whoever's managing their weight, uh, to just put them on Ozempic, um, for the purposes, uh, of weight loss. So, um, you know, it's a little bit different situation, um, in Canada.

To Sam's point, I think definitely, uh, Ozempec and these types of drugs can make a significant difference if a patient has high BMI to bring their weight down. Um, you know, you're getting results that are similar to bariatric procedures. This is quite a change in the management of obesity, so I think these drugs are here to stay.

They're very important. Uh, they do have, you know, side effects and need, need to be monitored, uh, properly.

[00:19:06] Dr. Sam Jejurikar: Um, well, I thought of the name of that radio frequency device, if you still want to know it, Sam. It's a tripolar. It's tripolar with two L's.

[00:19:16] Dr. Sam Rhee: Oh, okay.

[00:19:17] Dr. Sam Jejurikar: I stumble, I stumbled upon it. Um, in the Dubai airport a few years ago, and they do sell it in the U. S. too, and it's reasonable.

[00:19:27] Dr. Sam Rhee: And you use it every day?

[00:19:29] Dr. Sam Jejurikar: No, no. I, I use it like once, once every week or two.

[00:19:34] Dr. Sam Rhee: Oh, wow. And you've seen a real difference, you think?

[00:19:38] Dr. Sam Jejurikar: Not sure, but

[00:19:39] Dr. Sam Rhee: Oh, yeah.

[00:19:40] Dr. Sam Jejurikar: hasn't, my, my face

[00:19:41] Dr. Lawrence Tong: Not sure yet.

[00:19:42] Dr. Sam Jejurikar: as much as, as, uh, my face hasn't sagged as much as I would have thought of given the weight loss that I've had. I mean, I'm not, I'm a moving target, so it's hard to know, right? My, I definitely have some loose skin here, but it's not as bad as it could have been with the weight loss that I've had.

[00:19:58] Dr. Sam Rhee: Speaking of, uh, devices, uh, I know that we had a previous episode where we talked about the Dimple Maker, uh, and I know that you, uh, have actually purchased the Dimple Maker, as we discussed on that last podcast episode. And if you're, uh, listening, I mean, if you're watching us on YouTube, you can see it.

And you can actually see

[00:20:19] Dr. Sam Jejurikar: really,

[00:20:23] Dr. Sam Rhee: Dr.

[00:20:23] Dr. Sam Jejurikar: not easy to get in here.

[00:20:26] Dr. Sam Rhee: is actually inserting it into his mouth. It looks like a clip with little balls on each end. And he actually put it on his right side of his cheek. How does that feel?

[00:20:36] Dr. Sam Jejurikar: something Dr. Tong has a lot of familiarity with.

[00:20:39] Dr. Sam Rhee: Oh

[00:20:41] Dr. Lawrence Tong: is that?

[00:20:43] Dr. Sam Jejurikar: Putting, putting little balls in your mouth. Um, so my, my initial thoughts is that, um, It would be very difficult to get anything done while wearing this because, um, it's, uh, it gets your attention. It's, uh, it's a little painful. Um, I could see where if I left this on for several hours, I might get, uh, full thickness necrosis of my skin because it would definitely cut off the blood supply.

I don't know how long to leave. There were no directions that came with this. It was 7 on Amazon, but it came with no direction. So not clear how long I'm supposed to wear it for or not, but, uh, Maybe I'll just try it through at the end of this podcast and leave it on,

[00:21:35] Dr. Lawrence Tong: It looks like some weird

[00:21:36] Dr. Sam Jejurikar: we do the next one.

[00:21:38] Dr. Lawrence Tong: So what, what would you say the, uh, the pain level is on a one to ten scale when you're wearing it?

[00:21:46] Dr. Sam Jejurikar: Like a, like a three, but like enough where it, it's hard to focus. Like I couldn't like sit down and do work while I was doing this. I can't like work on my computer. And I would have a hard time sleeping with it in, so I don't really see this as a sustainable thing.

[00:22:01] Dr. Sam Rhee: And I think just looking at you hold, like putting that in and seeing how tight it is, I don't think any of us would ever recommend anyone actually trying this. It sounds like you could actually hurt yourself pretty badly with it. If you left it on like for any amount of time.

[00:22:16] Dr. Sam Jejurikar: the potential for badness exceeds, I think, the efficacy of this.

[00:22:22] Dr. Lawrence Tong: Thank you for being a guinea pig.

[00:22:24] Dr. Sam Jejurikar: Yeah, that's, that's what we do. what we do. Right.

[00:22:29] Dr. Sam Rhee: for, for our, uh, for our listener? Okay.

[00:22:32] Dr. Sam Jejurikar: Ooh, I got a little dimple there, you see that?

[00:22:34] Dr. Sam Rhee: Oh yeah. Oh, there you

[00:22:35] Dr. Lawrence Tong: it works. Oh, there you go. Let's see how long it lasts.

[00:22:40] Dr. Sam Jejurikar: yeah.

[00:22:40] Dr. Sam Rhee: You look so much cuter with that too, Sam. Let me tell you.

[00:22:43] Dr. Sam Jejurikar: Nothing like an aging face with a dimple in it. Like, so,

[00:22:53] Dr. Sam Rhee: All right, well, uh, is there anything else you guys want to talk about with ozempic, uh, and, uh, weight, uh, weight loss and plastic surgery?

[00:23:01] Dr. Lawrence Tong: I was, I was just curious, uh, Dr. Jejurikar, you had said that your, your doctor who's prescribing this said you can't ever go off of it, and it's just because for the reasons that they're concerned that you're going to gain weight. Is that, is that correct?

[00:23:17] Dr. Sam Jejurikar: no, I went on it because my hemoglobin A1c was high. And my, uh, I have a strong family history of diabetes. Um, my dad was a type 2 diabetic for about 50 years before he passed. And was on insulin forever. And so, um, before I started, I was Um, really it changed my lifestyle a lot. I had lost weight, diet, and exercise, but my hemoglobin A1c had actually climbed like, um, almost around six.

So, uh, yeah, so, um, I started this medication, precipitous drop in my A1c, weight loss accompanied it as well, and I didn't mind, I didn't mind that. So, um You know, now my hemoglobin A1c is like 5. 0. Like it's really low. So talking to my doctor, I was like, I don't really want to lose any more weight. Like I, I, I, I've looked gaunt.

Um, he, uh, can I get off this? He said, I mean, not really, for the reasons that you're on it, it has been effective, it has minimal, you know, minimal changes in your lifestyle. You, you've got changes, you know, in. Like minimal side effects, you really shouldn't ever get off of this. So that's why I'm not getting off of it because it controlled my hemoglobin A1c.

But my dosing, so the modifications, I'm sorry, the modifications that we made was, um, for Manjaro, it goes from two and a half to 15 milligrams. That's the typical once a week dose. I have cut my dose down to, um, two and a half milligrams and I only administer it every. 2 3 weeks. We check my hemoglobin A1c every 3 months.

I'm still, I still try to be pretty good with diet and exercise. And so that's kind of my, you know, my way of doing it. But I don't think we've figured out for every patient, like, what's the right long term dosing.

[00:25:07] Dr. Sam Rhee: is your weight stable on that regimen?

[00:25:11] Dr. Sam Jejurikar: Well, I've actually tried to put weight back on. So, I'm, I lift weights and Try the Sam Rhee, lots of protein. And I've, I've, uh, I've, I've, uh, up my testosterone dose. So I've actually gained about 10 pounds back.

[00:25:25] Dr. Sam Rhee: Oh, nice.

[00:25:28] Dr. Lawrence Tong: Very good. Well, I think that, you know, these drugs Unless there's some hidden, really bad side effects that we don't know about with long term use, I think they're here to stay. I think the drugs are going to continue to improve. Uh, you know, the newer generations of these drugs will have less side effects, will be more tolerable.

So, you know, we didn't really mention it, but some of the side effects, common side effects are like nausea, diarrhea, um, Pancreatitis, uh, there's some more serious effects like, uh, some types of cancers are at high risk. Um, so hopefully, as, you know, as time goes on, the side effect profile will decrease, the efficacy will improve, which means that, you know, we might, as plastic surgeons, be seeing a lot more patients who are in need of our services in terms of non surgical, surgical procedures.

[00:26:27] Dr. Sam Jejurikar: No. Yeah. These, these medications are not going anywhere now. Like the latest thing, the frontier for them is addiction management. I don't know if you've seen this, but there, uh, there's thought that, but the desire and alcoholics to, to, to drink, um, really goes down quite a bit. So I have, I have several patients in my practice who are on it for addiction management, obviously weight loss, obviously diabetes.

Um, a lot of internal medicine doctors are saying that they're seeing that cholesterol profiles are coming down and improving with this as well. And so they're definitely side effects to them. Um, and it's unfortunate if patients do have them like profound delayed gastric, uh, emptying and paralyzed stomachs, but I don't see them going anywhere.

I just see their use. going up and up and up.

[00:27:13] Dr. Sam Rhee: can't wait till they start putting it in our water. That's what's gonna happen next. So, everyone's gonna be on it.

[00:27:20] Dr. Sam Jejurikar: yeah, I think we should probably wrap it up, gentlemen. We're kind of approaching that time.

[00:27:24] Dr. Sam Rhee: Yes, thank you so much. Uh, I learned a lot on this one. Especially the, uh, dimple maker and, uh, the whole ball thing. Thanks very much guys for sharing that with me.

[00:27:35] Dr. Lawrence Tong: You're very welcome. A little personal, but we shared it.

[00:27:38] Dr. Sam Jejurikar: Exactly.

[00:27:41] Dr. Lawrence Tong: Alright, anyways, nice to see you guys.

[00:27:44] Dr. Sam Jejurikar: They care.