It all started with “Ozempic face.” This was, for most, our first exposure to the underbelly of GLP-1 medications—the unforeseen cost of a suddenly slimmer figure. Alluding to the deflation and sagging that can accompany rapid weight loss, the term first penetrated the zeitgeist (or at least our Google search bars) in January 2023 when The New York Times announced: “Those Weight Loss Drugs May Do a Number on Your Face.” The next spike in curiosity about the phrase came three months later, coinciding directly with a Hollywood Reporter piece on the rise of a related phenomenon: “Ozempic body.” As the medications melted away fat, people were confronting flaccid skin that no longer fit their frames.
While GLP-1s are lauded for their myriad health benefits—metabolic, cardiovascular, neurological, psychological—the media buzz not only alerted the public to the drugs’ cosmetic side effects, but signaled a seismic event: Ozempic’s entrée into the world of plastic surgery. (I’m using “Ozempic” here as a catch-all for GLP-1s, which now fall under several brand names, including Wegovy and Mounjaro.) As people started looking for ways to get rid of the excess skin, surgical body-contouring procedures became more popular, with liposuction, butt lifts, arm lifts, and thigh lifts seeing the greatest growth, according to the American Society of Plastic Surgeons (ASPS). For a subset of plastic surgeons, the GLP-1/aesthetics crossover moment also included prescribing semaglutide (the active ingredient in Ozempic and Wegovy) to select patients in advance of body contouring procedures, like tummy tucks, in order to help them reach a safe weight for surgery (higher BMIs are associated with a greater risk of complications) and to shrink the visceral fat in their abdomens, allowing for a more dramatic cinching of waistlines.
As more powerful GLP-1s, like tirzepatide (aka Mounjaro/Zepbound), hit the market and the drugs became more accessible, people began losing more weight faster than ever before—and the demand for tissue-tailoring lifts and tucks soared. GLP-1s became a catalyst for a host of cosmetic procedures that people never wanted or anticipated needing. Even now, “the rapidness of the weight loss catches some people off-guard,” says Amaka Nwubah, MD, a board-certified plastic surgeon in Brentwood, Tennessee. “No one warned them, ‘Hey, you’re going to have all this loose, hanging skin afterwards.’” In extreme cases, she adds, “they almost feel a little bit deformed because of the skin.”
With next-generation GLP-1s, like an oral version of Wegovy and injectable retatrutide, poised to launch as early as 2026, “body contouring procedures will continue to skyrocket,” says Darren Smith, MD, a board-certified plastic surgeon in New York City. More potent than its predecessors, retatrutide activates three receptors—GLP-1, GIP, and glucagon—as opposed to only one (as is the case with semaglutide) or two (like tirzepatide). “All three receptors are responsible for controlling hunger, satiety, and metabolism, but the glucagon additionally promotes fat burning,” ramping up results, explains Caroline Messer, MD, a board-certified endocrinologist in New York City. “In the clinical trial [for retatrutide], people were losing about 25% of their body weight after 48 weeks.”
“The rapidness of the weight loss catches some people off-guard. No one warned them, ‘Hey, you’re going to have all this loose, hanging skin.’”
Based on real-world experience with this class of medications, Dr. Messer says, “the amount of weight loss we’ll see clinically with retatrutide will probably exceed what researchers saw in the trial.” Some doctors tell me they expect the drug to outperform even bariatric surgery, leading to more weight loss in less time. (Bariatric procedures, like sleeve gastrectomy and gastric bypass, alter the digestive system in various ways, restricting food intake, suppressing appetite, and/or limiting nutrient absorption. According to one study, “a successful outcome of bariatric surgery is one that achieves a loss of 50–70% of excess weight or the 20–30% loss of the patient’s initial weight.”)
