Ozempic body: MANAGING THE AESTHETIC CHALLENGES OF RAPID WEIGHT LOSS

With weight loss drugs on the rise, patients are increasingly seeking aesthetic support for the skin laxity and volume loss that follow rapid fat reduction. Ellen Cummings explores some of the options

The rise of GLP-1 receptor agonists has reshaped the weight management landscape. Originally developed for type 2 diabetes, these drugs are now widely prescribed for weight loss, often delivering results that would once have required bariatric surgery.

But with this new era of rapid weight loss comes a growing clinical challenge: how to help patients manage the aesthetic consequences of shrinking quickly. For many, the result is not just a slimmer body, but skin that can feel looser and look deflated.

THE SKIN UNDER STRAIN

Skin is a highly adaptable organ, but its ability to remodel is limited when weight loss is fast. As London-based aesthetic doctor Dr David Jack explains, “Rapid weight loss, whether through GLP-1 agonists like semaglutide or even as a result of dietary restriction, can have a striking impact on skin integrity. When fat is lost quickly, the dermis and subcutaneous tissues have little time to remodel in tandem, which can leave the skin appearing lax, thin and deflated. Collagen and elastin networks are already under pressure with age and UV damage for most, and when subcutaneous fat is suddenly withdrawn, the scaffolding effect diminishes, leading to crepiness and sagging.”

This mismatch between how patients feel and how they look is a recurring theme in clinics. Dr Jack explains, “I often see patients presenting with a ‘deflated balloon’ quality to their skin. This shows not only in the face but also in the body areas such as the abdomen, arms and thighs. The texture often feels looser, sometimes with striae or worsening cellulite visibility and in the face, there can be disproportionate hollowing that ages a patient quite abruptly. For many, it is the mismatch between how well they feel and how tired their skin looks, driving them to seek aesthetic help.”

For consultant plastic surgeon Dr Mark Solomos, the pattern is clear. He says, “Rapid weight loss, especially from drugs like Ozempic, often leads to significant skin laxity, loss of dermal elasticity, and in some cases, a more pronounced appearance of redundant tissue folds. Essentially, the skin doesn’t have adequate time to adjust to the reduction in underlying fat volume. Alongside this, we often see changes in skin quality, such as thinning or a ‘crepey’ texture, particularly in older patients or those with previous sun damage or lifestyle-related collagen degradation.”

By contrast, gradual weight loss allows some natural skin retraction. “Patients who lose weight gradually tend to experience less severe skin laxity, as the body has more time to adapt, both hormonally and metabolically,” Dr Solomos explains. “Collagen and elastin remodelling may occur in tandem with slower fat loss, allowing for better skin retraction. While genetics and age still play a role, the overall tissue quality and tone are usually better preserved.”

DEVICES AT THE FOREFRONT

For patients who wish to avoid or delay surgery, energy-based devices are often the first port of call.

“Energy-based devices are a cornerstone here,” says Dr Jack. “Radiofrequency microneedling, such as Morpheus8, has been particularly effective in my practice because it stimulates neocollagenesis and neoelastogenesis at various depths, with the added benefit of tightening fibroseptal networks in the subcutaneous tissue on body areas. Fractional lasers, especially CO2, Erbium:YAG and newer systems like Ultraclear, also play a significant role in remodelling dermal architecture. For body treatments, bulk-heating radiofrequency can provide more widespread tightening for patients wishing for less ablative treatments, and lasers such as Endolift can be useful in tightening at a deeper level.”

Timing is critical, as Dr Jack explains, “I generally advise patients to be at a stable weight for at least three to six months before embarking on more intensive device-based treatments. This avoids chasing a moving target and ensures collagen stimulation is happening in tissue that is not still undergoing rapid change and nutritional support has likely stabilised. That said, more superficial or ‘conditioning’ treatments such as light-based rejuvenation or microneedling can be started earlier, largely for psychological benefit and to support skin health while the body adapts.”

Patients who lose weight gradually tend to experience less severe skin laxity, as the body has more time to adapt, both hormonally and metabolically.

THE ROLE OF INJECTABLES

Injectables can complement devices by stimulating collagen and restoring lost volume.

“Biostimulatory injectables are central in supporting post-weight loss patients as they can encourage fibroblasts to rebuild collagen and extracellular matrix, thereby improving density and elasticity,” says Dr Jack. “Calcium hydroxyapatite and PLLA have traditionally been used in this space and do have evidence for stimulating collagen; however, in my own practice, I tend to favour alternatives such as polynucleotides and Profhilo, which I find more adaptable and with fewer concerns around nodule formation. These products work to enhance skin quality in a way that complements more structural restoration.”

When hollowing is evident, structural fillers can be added. Dr Jack comments, “When significant volume loss accompanies laxity, hyaluronic acid fillers are often combined with biostimulatory treatments. Here, the approach differs from standard facial rejuvenation: rather than simply softening lines, the priority is to re-establish contour and projection lost with subcutaneous fat. My strategy is often to begin with deeper structural support and then layer biostimulation with energy-based treatments to improve skin thickness and elasticity over time. In some cases of very extreme weight loss, of course, surgical lifting remains the only realistic route to achieve major tightening, and this should be part of an honest conversation with patients.”

In most cases, a combination approach is required. “Combination protocols are usually necessary and almost always done in my clinical practice as part of a holistic treatment plan,” says Dr Jack.

“For example, a patient may undergo three sessions of radiofrequency microneedling spaced a month apart, combined with biostimulatory injectables at strategic intervals, and then small amounts of filler for contour. The plan is highly individualised, but rarely does one treatment modality suffice.”

WHEN ONLY SURGERY WILL DO

While non-surgical modalities can deliver improvements, they have limits.

“It depends case by case and what the patient’s goals are, but typically when the skin laxity isn’t responding to non-surgical intervention meaningfully, surgery becomes the only realistic and effective option,” says Dr Solomos. “This could be in situations where excess skin causes functional issues or where the aesthetic burden is affecting the patient’s quality of life and confidence.”

Suitability for surgery requires careful judgment, Dr Solomos explains: “When assessing a patient’s suitability, I think it is best to take a holistic approach and consider the stability of the patient’s weight. It’s also key to look at their general health and nutritional adequacy, their skin quality and elasticity and if they smoke. It also comes down to a patient’s mental readiness and ensuring they have realistic expectations. Plus, it’s important to understand a patient’s motivation; they have to want it for themselves and not due to any kind of external pressure.”

Timing also matters here. “I generally recommend that patients wait at least six to 12 months after reaching their target weight, with stable weight maintenance for at least six months,” comments Dr Solomos. “This ensures that the body has stabilised hormonally and metabolically, and the skin changes have plateaued. If further weight loss occurs post-surgery, this can lead to suboptimal results or the need for revision surgery.”

MANAGING EXPECTATIONS AND AFTERCARE

Both doctors emphasise the importance of clear communication.

“Patient education is absolutely central,” says Dr Jack. “Even with aggressive non-surgical intervention, results can be modest compared to what a lower face lift or abdominoplasty could achieve. I generally emphasise staged improvement, the importance of ongoing maintenance and the possibility of surgical referral if expectations exceed what injectables and devices can deliver.”

For Dr Solomos, honesty is also vital. “Transparency is key. I spend time explaining that scars are inevitable but can be discreetly placed and will fade over time. I also set realistic expectations around recovery timelines, swelling and the final outcome, which may take several months to fully appreciate. Many of these patients have gone through profound physical and emotional journeys, so psychological support and reassurance are an important part of the process.”

Aftercare is another cornerstone. Dr Solomos says, “Aftercare includes wearing compression garments, avoiding strenuous activity during the healing phase, scar management protocols, including silicone gels and massage. Regular follow-ups to monitor healing. In some cases, lymphatic drainage massage can be beneficial.”

SUPPORTING SKIN HEALTH HOLISTICALLY

Beyond clinic walls, patients need a strong foundation in their skincare and lifestyle habits.

“Topical skincare and systemic support should not be overlooked,” says Dr Jack. “Vitamin A derivatives, antioxidants like vitamin C and E and barrier-supporting ingredients such as niacinamide and azelaic acid are all useful in enhancing dermal resilience.

“Oral supplementation with protein, omega-3 fatty acids and antioxidant blends can help support the metabolic processes involved in collagen synthesis and repair. Nutrition is particularly important because patients losing weight rapidly are at risk of micronutrient deficiencies. Adequate protein intake is vital for collagen production.”

Prioritise stability of weight before major intervention, favour protocols that combine energy-based tightening with biostimulatory injectables and always keep the option of surgical referral in mind.

LOOKING AHEAD

As the use of weight loss drugs becomes more prevalent, so too will the demand for aesthetic intervention.

“GLP-1 medications have opened a potentially new patient demographic for aesthetic medicine, but they also require us to manage expectations carefully and to be honest about the limitations of non-surgical approaches,” says Dr Jack.

“Absolutely,” agrees Dr Solomos. “As medications like Ozempic become more widely used, we’re seeing a growing demographic of patients with moderate to severe skin laxity, many of whom are younger and wouldn’t traditionally have considered body contouring surgery. I expect a continued rise in demand over the next three to five years, particularly for procedures like abdominoplasty and arm lifts. There has certainly been a lift in enquiries and surgeries in my clinic due to the Ozempic boom.” For aesthetic practitioners, the message is clear: empathy, honesty and collaboration are essential.

“For practitioners, the key is to approach these patients with empathy and pragmatism,” says Dr Jack. “Prioritise stability of weight before major intervention, favour protocols that combine energy-based tightening with biostimulatory injectables and always keep the option of surgical referral in mind.”

“Don’t dismiss the emotional impact of skin laxity,” adds Dr Solomos. “These patients often feel deflated after achieving something significant. If skin laxity is beyond what non-surgical methods can address, it’s appropriate to refer them to a qualified plastic surgeon early in the process.”