What Happens to Your Face on GLP-1s?

00:28 Trina Reneá: Hi. Welcome to Facially Conscious. We're a podcast that provides insider knowledge on the world of skincare. I am Trina Reneá, the esthetician.

00:37 Dr. Vicki Rapaport: And I'm Dr. Vicki Rapaport, a board‑certified dermatologist.

00:40 Julie Falls: And I'm Julie Falls. I am the educated consumer. We're going to talk about something that I don't think we've talked about before, and that is GLP‑1s and the effect of GLP‑1s on your skin.

00:55 Dr. Vicki Rapaport: Yes. 

00:56 Trina Reneá: So let's get started with what happens with rapid weight loss and your skin.

01:03 Dr. Vicki Rapaport: I am incredibly thrilled to talk to you guys about this today because I have so many patients on GLPs. I put them on GLPs. I've been prescribing them to patients for over a year. They cry to me about the rapid weight loss ill effects, meaning, of course, you hear all the good things. You hear about the weight loss and how wonderful everything is, the anti‑inflammatory properties. But what about the fat loss and the skin laxity that it causes, and the sagging and the aging, which is, obviously, just cosmetic. People are very distraught about it. 

So we're going to talk about why this happens, of course, and what to do about it. 

01:43 Julie Falls: Is this what they call Ozempic face? 

01:45 Trina Reneá: Yes, that is what they call Ozempic face.

01:48 Dr. Vicki Rapaport: Ozempic was the first one, right? Ozempic was the first one and there are so many others now, but now we just call them GLPs. Rapid weight loss and sagging, sinking faces. 

02:02 Trina Reneá: But that happens anytime you have a rapid weight loss situation, right? You get that. Whether it's the GLP‑1. It's not caused by GLP‑1. It's caused by rapid weight loss. 

02:14 Julie Falls: I mean, what people were getting their stomachs-- what's it called? 

02:18 Trina Reneá: Stapled. 

02:19 Dr. Vicki Rapaport: The bypass. 

02:20 Julie Falls: All that skin, that's much more severe. This is like a lesser severe version of that with all the hanging. 

02:28 Dr. Vicki Rapaport: So the gastric bypass surgery, you’re right, it's like you don't even hear about that much anymore. But yes, the gastric bypass, when they were losing weight so rapidly. Plus, the people who would get gastric bypass were hundreds of pounds overweight. Typically, those are the ones that are approved for that procedure. It's not for people that want to lose 20 to even 50 pounds, which seems like a lot, but these are people that need to lose hundreds of pounds. 

And when you lose hundreds of pounds, remember you lose fat everywhere. You're just not going to, unfortunately, lose it in your stomach and your buttock and your thighs. You're going to lose it in your face, in your neck, under your eyes, on your jawline. So when we lose fat everywhere, the skin can naturally rebound, but it takes your body time, six to 12 months, especially if the weight is lost slowly, which it's not lost slowly, unfortunately, with these GLPs and, of course, with the gastric bypass, which was more dramatic. 

So my recommendation to my patients, even though they love this rapid weight loss, is you have to slow it down. They think a pound to two pounds a week is slow. It is not. That is fast. One to two pounds a week is traumatic to your body and definitely traumatic to your skin. 

I recommend a quarter to a half‑a‑pound of weight loss a week, which means 25 pounds in a year which, to some people, is way too slow. But the point is they're going to suffer with skin sagging and increased laxity if they go any faster. 

03:55 Trina Reneá: I started on Ozempic when it first came out because I have diabetes, so it was part of my plan. So she started me out on a quarter of a dose for two months. Then I went to half a dose and never went up from there. But that was to manage diabetes, and weight loss was included in it. But I went really slow so I didn't get that saggy face rapid weight loss. It was just slowly coming off over time.

I think that people go too fast with it, like you're saying. If they slow it down and do like a quarter dose for a while or however you guys dose it. For me, for Ozempic, it was that way. 

04:38 Dr. Vicki Rapaport: Trina, did you have any body fat to lose? And did you lose weight? 

04:44 Trina Reneá: Yeah, like maybe 12 pounds. 

04:45 Dr. Vicki Rapaport: You seem quite thin to me. I can't even believe that you lost 12 pounds, because you look the same. And I think you're right because you were doing it for a different reason. 

04:52 Trina Reneá: But I did lose it, and I was getting scared that I was losing too much because clients would come in and say to me like, “Oh, my God, you're so skinny.” And I'm like, “Ooh, I don't want to be too skinny where it's that look.” I actually capped out at a half a dose, which I still take and will take forever. But I didn't try to lose fast. 

05:14 Julie Falls: Are you primarily prescribing it for weight loss? You don't have weight loss patients coming to you per se. You're a dermatologist. How did you start prescribing and what are the main reasons you're prescribing it for? 

05:26 Dr. Vicki Rapaport: That's a great question. Sometimes people think it's confusing that the derms prescribe it, but we were marketed to prescribe it for our psoriasis patients. One of the GLP medications is owned by the same pharmaceutical company that we have a really wonderful anti‑psoriasis medication for. 

I think it was a combo marketing. It was marketed to us as, “These patients who have psoriasis, if they are obese, their psoriasis does much better, so put them on a GLP. We own both medications.” 

I was really suspicious at first. I was like, “God, really? They want us to put these patients on GLPs? But I'm treating their psoriasis.” We also do know as dermatologists that heavier psoriasis patients do worse. I remember thinking, “God, I'm not going to prescribe this. That's just getting more money in their pocket.” 

And then I read the studies. And study after study after study showed this decrease in inflammation was quite impressive over all categories, for cardiovascular, for brain health, definitely for psoriasis patients. So we felt very confident prescribing it. 

And then, of course, we see these glowing results. Then we start to prescribe it for weight loss as well, because then I had the confidence. I knew about the drugs. I'm not obesity medicine board certified but I'm on my way there. It's actually not a difficult certification to get. There are a lot of dermatologists that are getting it now, again, because of this crossover with psoriasis, and we have such an interest in just the weight loss patients as well. 

I mean, there's a whole list of positives that GLPs give us. The benefits, the long list of benefits, so long that it's important to hear because there are a lot of naysayers and a lot of negative connotations that go with the GLPs. But the truth is, people who are prescribed them, like Trina for diabetes, nobody would question you because, of course, it's FDA approved for diabetes, sleep apnea, now obesity. Why are you doing it if you don't have obesity? 

Listen to the list of benefits the GLP medications have. Weight loss, blood sugar control, protection of your cardiovascular disease, which means lowering heart attack rates and lowering the risk of stroke. It lowers inflammatory markers, which drive chronic inflammation and blood clotting. With less fat, there's less inflammatory signaling. It improves your lipid profile. The cholesterol improves, those profiles. Potentially it's protective of your kidney. On and on and on. It helps with patients with polycystic ovarian disease. It helps them with their insulin resistance, because they get insulin resistance. Again, on and on, even a potential addiction to alcohol, drugs and compulsive disorders. It's being studied in those situations. 

There's now this brand new talk about longevity with microdosing GLPs. I know that's not what we're talking about specifically today, but I want to tell you why we feel so confident in prescribing these medications. Yes, you have to be evaluated. Yes, you can't just go on them without getting a full medical exam and getting the history, to be sure that you're not at risk of developing certain strange cancers that have been discussed. But, in general, I think it's kind of a miracle medication. 

08:33 Julie Falls: So what do we do for Ozempic face? 

08:36 Dr. Vicki Rapaport: Often, there is a natural improvement after the weight is stabilized. Once people get to their goal weight, the skin can bounce back in some people, in some ages. Obviously, the younger, the better. The older patients, not so much.

08:50 Julie Falls: Have you seen patients coming to you with it already? 

08:52 Dr. Vicki Rapaport: Have I seen patients with Ozempic face? Oh, my God, Julie, shocking. This is not somebody I prescribed it to but, actually, two patients in the last month. As she walked out, her legs were like toothpicks. And there is no way.

Okay, I don't know if she's on it for sure, but I'm going to ask her next time I see her. I didn't notice until she was walking out. Then this one one I hadn't seen in a whole year, she looked anorexic to me. 

09:19 Julie Falls: I think people are taking it too far. That's the other thing I've noticed. They're like, “Oh, this is so great. I don't want to stop. I'm going to keep going.” There's a store I shop at near me, and she said, “We can't keep size zeros in here anymore. There's no zeros left.” 

09:34 Dr. Vicki Rapaport: I think that it is something that people don't see in themselves. And then their partners sometimes don't see it in them. Every day they're looking at themselves so they don't see that drastic difference. But when you haven't seen somebody in a year, the difference was shocking. I just told her, “You got to go much slower.”

Again, I'm not prescribing it to this one woman, but I know she's on it. And I explained to her, like, “I'm your doctor. The difference between now and you look like a completely different person. You don't look healthy.”

The skin laxity part, if the skin isn't rebounding on its own, number one, before the procedures and all that stuff, they have to exercise. They have to exercise and they have to weight train, period. And if they're going on a GLP and they're not advised to do that, then I feel like maybe that practitioner isn't the right practitioner for them because, number one, we tell them must weight train. Number two, must eat protein. Protein helps build muscle. What is muscle doing? It's supporting the skin. And, of course, it's challenging to weight train, but you have to do it, period. 

It's also just good for longevity and brain health and cardiovascular health. We know all this, right? So I feel like there are some lifestyle changes that can be done that will mitigate all this skin laxity. So, again, exercise with weights three times a week, really ideally. Eating protein, 1.3 to 1.5 grams per kilogram. And then hydrate. Sagging is accentuated by dehydrated skin. So you must drink water, you must hydrate, all that stuff. 

And then, of course, in menopausal women, who I feel like is a lot of our followers, our crowd, the people who listen to us, either pre‑, post‑ or in‑menopause women with lack of estrogen, there's increased amount of skin sagging. Those women who are of a certain age going through menopause and being on the GLPs, they have to be extra careful. Again, the slow weight loss is the key. 

11:21 Julie Falls: Plastic surgeons are saying that facelift business is like never before because of this. So, I've heard that. The other thing I hear about is a lot of people think that now they have carte blanche to just eat anything they want, and they're eating a lot of sugar and they're eating a lot of junk. 

11:41 Trina Reneá: You know what I found going on it, is that because I get full so fast and I can't put another bite of food into my mouth, I want those five bites to be delicious and healthy. I'm like I have to get my protein in, I have to eat something really good for me. So I won't eat bad food. It stops me from wanting to do it.

But I'm also health conscious. I'm sure people take advantage of, “Oh, I can eat whatever I want and stay skinny.” But they're going to get sick too. You physically cannot take another bite. It's the weirdest thing, what it does to you mentally. 

12:20 Dr. Vicki Rapaport: When we put people on GLPs, we only have a couple of minutes with them. And if they're not coming in every week for an injection, they're injecting themselves. I really do try and stress everything that you guys just talked about. Julie, you're saying people just eat whatever they want. But I think that they don't necessarily crave all the bad things. I think people are more doing what Trina was explaining. Like you just don't have those cravings. You want to eat healthfully, especially if we are advising them, you have to get protein. Protein should be the first thing that goes in your mouth. And then the healthy fats and then some carbs, if you want. 

Helping these GLP patients, reminding them every week is the key. I love sending them to a nutritionist. And nutritionists, sometimes insurance will cover that, which is great. They're the best at counseling these patients. I love it. But it's hard because, you're right, it's happening so fast. They love it. They don't understand. It's like ruining their bodies. They're becoming emaciated and malnourished, which is not okay. 

And then you were talking about the facelift business, Julie. It's true, but there are two things they can do before they have to do surgery. They can do the cosmetics and the skincare, the body tightening things. Like retinols can tighten the skin a little bit. And, of course, sunscreen so that you're not adding to the insult with more sun damage. All the things that we sort of already know for anti‑aging for the skin are even more important on the whole body skin when you're on a GLP. 

So I love the retinol body tightening creams and I love body sunscreen. Anywhere, all over your body. Only if you're exposing. If you're wearing clothes then you don't have to worry about sunscreen. 

13:49 Julie Falls: Well, let's say you have a patient who's already lost a lot very rapidly and is showing these signs of this aging. If they back off and maybe they're not taking as much or they stop or whatever, is this at all reversible? 

14:04 Dr. Vicki Rapaport: I mean, you don't want them to do like yo‑yoing, yo‑yo diet. It's even worse. The skin gets stretched and then pulled and then stretched and then pulled. That's like a recipe for disaster. If they're losing too fast, you got to lower the dose, and that's so easy. 

The problem is that they don't like it because they love not being hungry. They love not having those cravings. They love not having that food noise. So if you go too low on the dose and that comes back, they don't like that. So you have to keep working with them and managing them. 

Managing the dose is great. You can lower the dose. You can go back up to slow down the weight loss and/or they can stop it completely for a little bit, or they can just stretch out their shots. The shots are typically weekly. If they're on the pill, the oral pill, which doesn't quite work as well. Studies have shown that the pill doesn't work as well. Unfortunately, it has to be taken on an empty stomach for 30 minutes, no food, which is really hard with compliance. Patients just have a hard time doing that. So if they're on this weekly shot, they can stretch out the shot to two weeks or 10 days, that kind of thing. 

And, yes, you can slow down the crazy sagging that's happening. 

15:05 Trina Reneá: I feel like the GLP‑1s, the key is don't lose weight so fast. And if you do, back off. Because filling your face full of filler and facelifts and all of that extremeness to be so skinny, I think, at the end of the day, you're fighting against yourself.

15:25 Dr. Vicki Rapaport: Fillers came on the market 20 years ago. We live in LA, right? LA is health‑obsessed people, skinny‑obsessed people. So there were a small handful of people who needed a lot of filler because they were just too skinny, just because they lived in LA and they had all that pressure. Now, we're seeing it in massive amounts of people.

And, you're right. Go slow, as we talked about ad nauseum. If they are happy, they're at their goal and then you need a little filler, fine. A little filler, because we're aging, right? You need a little filler anyway. But, yes, shoving filler in the face, 10 syringes, they're not going to be happy. It's going to look weird. 

So skincare first, then non‑surgical things, the tightening devices, the fillers, the Botox, and then of course the surgical treatment. And as you said, Julie, the surgeons are so busy with these patients. And it's not just face and neck, it's arms, it's buttocks, it's thighs. They're lifting everything. 

16:25 Trina Reneá: What a time to be a plastic surgeon. 

16:27 Dr. Vicki Rapaport: Yes. What a time to be a plastic surgeon, right? And then the new generation GLP coming out, retatrutide, is much more powerful. The percentage of weight loss is much larger, but it's protective of the muscle. So a lot of these people who are losing so much weight on GLPs, they're also losing muscle because they're not weight training and they're not eating their protein, but this new one is potentially a little bit more protective of the muscle. 

And, apparently, this one is going to be a trillion dollar medication, not a billion dollar medication. So you're going to see that one soon. I think it's going to be FDA approved in 2027. 

17:01 Trina Reneá: That's exciting for those people also who these weight loss drugs aren't working on. 

17:06 Dr. Vicki Rapaport: Exactly. We hear all the positives, but there are people who stop it (a) due to cost, (b) due to side effects, and (c) unfortunately, it doesn't work in everybody, even though it can be a miracle in others. It's interesting. So maybe this new one will help. 

But, again, if these people go on and they're losing too much weight, go back, listen to our podcast so they know what to do about the saggy skin.

Trina, do you have clients who are on GLPs and are complaining about rapid weight loss and saggy skin? 

17:34 Trina Reneá: I do have patients on GLPs, for sure. A lot of them. Because I've been on it since the beginning and talk about it with my clients. When I have seen clients go on it, I do talk to them about going slow and how I did it slow so that they don't get rapid weight loss. So I don't see a lot of their faces shrinking in because I've had that conversation with them.

And I also keep up on the microcurrent and the LED and the plasma technology and things that help to tighten the skin while they're doing it. I make sure they're on really good products to support their weight loss, but they're also doing it slowly because I'm guiding them. 

I don't really see people with rapid weight loss, but definitely on GLP-1s for sure. 

18:22 Dr. Vicki Rapaport: When I see my patients, I send them to the nutritionist. I should also send them to the esthetician. And if they're in LA, I'm going to send them to you, because it sounds like you have a good grasp because you're personally on it, and you have good technology and you have good technique to help prevent the sagging. 

18:38 Trina Reneá: I do. I work alongside of them on their weight loss to help their face stay tight. 

18:43 Dr. Vicki Rapaport: Okay, good. Good, good. We did talk about stopping the medication, slowing the medication. I know that, Oprah, for instance, talked about being on it. Then she wanted to try being off of it and she gained so much of her weight back. And now she talks about how it's like a lifelong medication for her. 

I think that these are lifers. These people are going to need to continue to do all the things that we recommend, the lifestyle changes and then the products and the procedures. It is a medication they most likely will be on for a very long time. 

19:14 Trina Reneá: Yes, and thank God we have this now. So people are getting less heart attacks and less medical problems and less medications because they're able to keep their body weight in a better place. I think it is a miracle drug, like you said in the beginning. 

19:31 Julie Falls: Sounds like the positives really outweigh the side effects, and they can be dealt with. I think it's very exciting.

19:42 Dr. Vicki Rapaport: That's our GLP episode. 

19:45 Trina Reneá: Well, if you guys are enjoying this show, there's a few easy ways you can help support us. 

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20:15 Julie Falls: And you can also follow us on social media at Facially Conscious from the show and updates on what's coming next. 

20:21 Trina Reneá: Thank you so much for listening, everyone. And we'll see you next week.