Episode 25- Ozempic Face

In this first part of a two-part series, Dr. Saluja and Kane unpack how GLP-1 and GIP medications, including Ozempic, Wegovy, and Mounjaro, are reshaping not just metabolism, but also facial structure, leading to what’s now known as "Ozempic Face." In this episode, they explore what GLP-1 receptor agonists and GIP agonists are, how rapid fat loss affects skin, collagen, and volume, and introduce key strategies that can be done at home from a nutritional perspective to support collagen health and overall facial balance. Join them as they break down the science and lay the foundation for more advanced treatment approaches discussed in Part Two. 

Thank you for your listenership!

Transcript

MIC1 0:13

Hi everyone. I hope you're well. Welcome to another episode of just Laser It and all things cosmetic. I'm here with Kane and only one dog up here today. How are you doing Kane?

MIC2 0:24

I'm doing really well. It's a beautiful day.

MIC1 0:26

It is a

MIC2 0:27

It's been a while since we've done one of these.

MIC1 0:28

We always say

MIC2 0:29

Well, I can't even remember what we did the last time.

MIC1 0:32

We did the last one about two months ago.

MIC2 0:34

It's been a while.

MIC1 0:35

been a little while. Okay, we need to get back at it. Today we're gonna do something a little different. We're not gonna talk about lasers. We're gonna talk about something that may require lasers down the road, but we're gonna talk about Ozempic face. Do you know what that is? Kane?

MIC2 0:53

Uh, why you put me on the spot like

MIC1 0:55

Because I like to,

MIC2 0:56

well, I look, uh, yes, I do know what that is. It's, uh, provided a lot of great benefits for people to lose weight. But that weight loss does come with potential downside.

MIC1 1:07

It does, and we see a lot of patients with this in the past couple of years in particular, and when we say ozempic face, that's kind of lumping it into one category. This actually is both glide and tirzepatide can cause this ozempic face, Dr. Paul Frank in New York was the one that coined that. And actually there's another Dr. Dr. Heel who's done a lot of work on it. And she's a, um, physician in France and she's actually just written a really good paper on it as well. But it basically means that when we're taking these GLP-1 agonist and GIP agonists, if, if we're doing tirzepatide, that this can give some substantial. Loss of fat and collagen in our face.

MIC2 1:53

I wanna stop you for a second. Let's just rewind for like 30 seconds. Talk about what it actually is, the actual ozempic or tirzepatide is. Sure,

MIC1 2:02

sure. So there are hormones, there's incretin hormones that are GLP one, which is glucagon-like peptide, and there's also GIP, which is gastric inhibitory polypeptides. So semi glut tide, which is the wegovy. You've heard the ozempic. Certainly that is only GLP one. That's one receptor that

MIC2 2:24

one, which I think a lot of people have probably heard of that. The GLP

MIC1 2:28

Yeah. That's like, puffs or Kleenex. Um, people really know that word. And, there's also Tirzepatide, which has got, um, you're laughing at me looking

MIC2 2:38

I'm laughing at puffs and Kleenex. It's just Kleenex.

MIC1 2:41

Okay. Um, so you, you also know about the GLP one and GIP, which is the tirzepatide. That is manjaro zep bound, if you've heard about that. Because it works on two receptors, it actually has greater weight loss and, and greater fat reduction as well that the studies

MIC2 3:00

Okay, so they're just simple injections that people give themselves at home.

MIC1 3:05

Correct. They're once a week injections that people give themselves, and they might be on it for a short period of time. They might be on a for a long period of time. But we'll talk about some of the challenges with that too. You know what's interesting is it's not just for weight loss. Off-label. It's also being utilized at low doses. Uh, there's some studies where it's used to minimize inflammation and also for, neuroprotective effects as well. There's been some recent data on Alzheimer's disease and all of

MIC2 3:33

and it was originally developed for diabetes,

MIC1 3:35

correct? Correct. There are, there are some things too that you always have to watch you know, if there's any family history of thyroid, cancer. I mean, there's, it is important to know all the, the benefits of this, but also to be aware of some contraindications as well with this. This is

MIC2 3:51

is not necessarily for everybody,

MIC1 3:53

Correct. But I have seen a lot of patients on it, and I have seen them take off the, unwanted weight.

MIC2 3:58

you see it advertised everywhere too.

MIC1 4:00

advertised everywhere

MIC2 4:00

seems like everybody's wanting to do it.

MIC1 4:02

Sure. And it used to be compounding pharmacies were doing this, but now that stopped as of March 18th, and so now it's just because there's no longer a shortage. And so now it's just through, um, the brand names that you would get it. Right, but so those are what they are. They work on these receptors and they work by enhancing insulin secretion. They suppress something called glucagon, which allows us to know that, okay, we are hungry, let's eat. So they suppress that. they delay gastric. Emptying time. And so that's why when you, whenever patients first start on this, they start at low levels because you can get a lot of nausea, and issues if you, if you go too high too quickly. So you start at low levels and certainly they reduce appetite, not just by the gastric emptying, although that's one of the key components is you got food in your belly, you're no longer gonna be hungry. But they also work directly to the hypothalamus, which. Also minimizes hunger as well.

MIC2 4:59

there's multiple mechanisms of action going on, but I think the, the primary one that at least I am aware of, and probably most people have, it just kind of slows your di digestive process,

MIC1 5:08

Correct. Slows that

MIC2 5:09

So you, you, you don't feel like you have to eat,

MIC1 5:12

right? And so then when you don't eat, of course, then you lose weight when you, when your appetite is suppressed. But what it also does with this ozempic face that we're talking about is you begin to lose, the volume in your face. So we see a lot of hollowing that occurs in the midface. We see a lot of hollowing in the temple area as well. So when patients come in. They feel better in the sense that they've lost their weight, but their main concern is I've aged overnight. You know, look at my face. I've aged overnight. My neck's now a little bit lax, my midface is, is sagging. So it's really concerning to them.

MIC2 5:50

So that weight loss brings benefits, obviously, when you lose weight for many different reasons. But it does also bring hollowing out potentially and like sagging, right?

MIC1 6:01

it brings sagging. And so that's usually what brings them in. And so why does this occur? You know, why do we see such profound, loss in the face and. Certainly part of this is how quickly we lose the weight. If, folks are losing it quite quickly, we're gonna see that type of presentation, with these patients more so if they're losing it slower, there's time for the face to catch up, so to speak. But one of the main reasons is that in our face we have white adipose tissue. Whereas in other areas like our shoulders, our neck, we have brown adipose tissue, and with these GLP ones and these gis, the white adipose tissue, which is primarily in our face. Or I should say there's, there's no brown adipose tissue in our face. It's very susceptible to this. So we really see that loss there. There's no brown fat there to help protect and cushion that. So when we see that the fat is being disrupted, we're really seeing it in our face.

MIC2 7:01

So that's what the GLP ones are really, attack probably isn't the right word, but have an impact on the white adipose

MIC1 7:09

So, but typically it is the, the, the white adipose tissue in the face that we're seeing. And so we see that profound loss. Now, the problem is this. White adipose tissue. I mean, the fat in our face has other effects. It's not just, cushioning for our face or aesthetically pleasing, but it also secretes its own subset of signaling hormones, such as leptin. And leptin is one of the hormones that also stimulates fibroblasts. Now, certainly leptin is one of the satiety hormones, so. If you are minimizing leptin secretion, the thought is you get hungry. Right? Right. But this GLP one works directly on the hypothalamus, so it supersedes that. But when we don't have as much leptin, we're not stimulating the fibroblasts in our skin to produce collagen. So not only are we losing fat, we're also losing collagen and elastin from our face, or

MIC2 8:04

ability to produce it.

MIC1 8:05

Correct.

MIC2 8:06

It's not like it's not just disappearing, but the impact is you're losing the ability to actually produce it.

MIC1 8:11

Well, there's always a degradation component that occur that occurs on a daily basis. So you're not having that same ability to, bring it back, uh, into place. So that's really important. And there's also something called, adiponectin. That's another thing that fat, releases. And so this is suppressed as well. And adiponectin also promotes dermal remodeling. So that's another kind of a double punch to the skins where we lose that collagen. So there's a couple of things going on that really affects the aging perspective of our face.

MIC2 8:42

Yeah, it sounds like it. Now, I don't want to throw a curve ball at you, but one of the other phrases that I think is somewhat common is, is ozempic, but is that, is that similar?

MIC1 8:53

Correct. Yeah.

MIC2 8:54

what's going on there?

MIC1 8:56

You do, you get it kind of a pancake, kind of a butt

MIC2 8:58

I get that old man flat butt

MIC1 8:59

you get the old man or the old lady flap, but, uh, because you're losing that fat. And so there are things that can be addressed with that as well. But that is something that occurs. Okay,

MIC2 9:09

Okay,

MIC1 9:10

so what can we do about this? You know? We'll, you know, I think that what we'll do Kane is today. I'm gonna talk about things that patients can do at home and more from a nutritional perspective. And maybe what we'll do is we'll follow it up with another episode to talk about what we can do in clinic. Does that sound good?

MIC2 9:28

yeah, yeah. We try to keep these brief so people don't have to, you know, listen to it for an hour long,

MIC1 9:34

Right? Outboard them otherwise, but so. We have to think about how can we maintain that collagen? What can we do at home that can maintain that collagen? Well, when you think about collagen. You think about vitamin C, I mean, vitamin C is a co-factor for building collagen. Collagen is, think of collagen as a rope that has three strands that have to be bound together. It's a triple helix, is what the collagen protein is. And so the proline, the lysine of these triple helix have to be hydroxylated together, and this is probably too much information, but, but vitamin C is really important for that perspective, that step. So if you don't have vitamin C, you're gonna get a very weak. Collagen fiber, so vitamin C is really important. So I would say that definitely we wanna make sure that patients are eating their fruits and vegetables for sure, but maybe a little supplementation with vitamin C. It could be as little as 500 milligrams a day

MIC2 10:29

you're, you're so orally, you're talking vitamin C. What about, what about topically?

MIC1 10:34

topically is a wonderful thing too. You know, I love the SkinCeuticals, vitamin C, E, and ferulic, but topical vitamin C is important and it can help maintain that, especially if you're going down the line of creating micro wounds, controlled micro wounds with lasers, you wanna be able to have your topical vitamin C as well. So that's one thing that you can do, but. The other thing that is important is that because you're getting this delayed gastric emptying and it affects the bile and whatnot, which bile is important for, for fat solubility, you are not, I. You're not getting as much of your fat soluble vitamins and especially one that comes to mind is vitamin D. So you definitely want to supplement with Vitamin D and Kane. What's important is when you supplement with Vitamin D, you want to try to get a D three K two. Do you know why that is? I do

MIC2 11:31

not. And I'm assuming K two is vitamin K.

MIC1 11:35

Correct. and you'll see it sold as D three, K two and the D three because it's the most bioavailable. And what Vitamin D does is it allows you to absorb calcium from the gut. And calcium, of course, we want it to deposit in our bone, but. You can get calcium that deposits in vasculature as well, which we don't want that. But the K two component directs it back to the bone. So when you're getting your vitamins, you wanna look for a D three K two. So that's important. The other thing is you wanna start to look for B12, because B12 can also be affected. Again, because the gut, the slower gut, you're not getting as much of this as well. So you, you wanna get a little B12. Now, whenever you do these vitamins, it's also important to evaluate how you're doing. Like you wanna get your vitamins checked at some stage, your, your levels checked so that you're not off the charts with it as well.

MIC2 12:31

I mean, and, and I've been told, and I'm, I'm, I don't know the validity of it, but, you know, be careful on the B12. You don't want to necessarily supplement too much with B12

MIC1 12:41

with anything. I mean, you've gotta be careful with it. another you should consider as well, especially with the skin, for collagen purposes is zinc and copper. And you'll find that the amounts of zinc and copper again, are. Lower levels, like even, zinc glycinate is something that you would take, but it could be kind of at a 10 to one ratio. And so sometimes you'll see 10 to one or maybe even 12 to one, but sometimes you'll see 15 to 30 milligrams of zinc with one to two milligrams of copper, that are sold as a supplement. And that might also be something to consider.

MIC2 13:15

Now, these are all things that we're talking about just related to helping with your, with your skin, correct?

MIC1 13:21

Correct. And just in general too, I mean, vitamin D has more effects than just the skin. It, I mean, vitamin D, that's more talking about your bones and the importance of the immune function and whatnot of it as well. But, but in, in regard to skin, it's more the vitamin C and the zinc and copper are, are things,

MIC2 13:38

So zinc and copper, vitamin C, you're also looking at vitamin D three and K two as a combo, and then B12 as well. But you know, this isn't just, Hey, go out and take a big mouthful of these every day and that's gonna solve your issues. It's something you want to be smart with and

MIC1 13:55

And discuss with your, with your doctor as well and see if that's something, that, that you might want to implement. Now, other things that you can do too is, so just from a, from a collagen perspective, is a retinoic acid, you know, that is so important to be on a Tretinoin, for the skin. Remember Retin increases cell turnover. It stimulates elastin collagen. It's antioxidant turns on growth factors. And I know patients sometimes will say, oh, I've tried that and, and my skin, you know, is too sensitive. You know, it's really important to start it off slowly. With a p size amount, um, and you dab it onto your forehead, your nose, your cheeks, and your chin, and you rub it in at nighttime when you, after you wash your face, and maybe start it twice a week, Monday, Thursday. And that's a, that's a good thing to add to the list as well.

MIC2 14:40

Okay.

MIC1 14:41

Okay. So really easy. And of course, definitely, definitely sun protect. So every morning when you wake up on, goes to sunscreen. So I think that's really important

MIC2 14:51

And what about, you know, you see a lot about these red light therapies. Is that something that

MIC1 14:56

Oh, sure.

MIC2 14:57

for doing at home? I know it's probably not quite as powerful as a medical grade red light therapy, but. Would that be beneficial?

MIC1 15:05

I mean, like some of these red light therapy masks and we did a, I think we've done a podcast on it too. they're definitely important. They help with the cytochrome c oxidase component of mitochondria, and they help to stimulate your fibroblast to produce collagen. The nice thing about at home masks are that you're doing it more frequently, but when you talk about, um. In office type of, of therapy. I mean like a full body red light therapy in office has close to about 44,000 LEDs there. Whereas an at home mask might have 132. So

MIC2 15:40

Big

MIC1 15:40

big difference and, and the amount. But I still think that these are

MIC2 15:43

is some benefit of course. So there's a lot of different things I guess you can consider looking to do at home, with your vitamin supplements, LED, red light therapy, zinc and copper. But be smart about it. And, and oh, and, and what was the other one?

MIC1 15:58

one? Retinoic acid as well is important to utilize just to kind of make sure that you're doing all that you can do to, stimulate your collagen.

MIC2 16:06

All right. But these are, and if you're really seriously thinking about the supplements, I mean, do probably speak to a physician or somebody that could help give you guidance.

MIC1 16:14

Absolutely. And we'll talk about what we can do at the office and I would almost caution patients and let them know that when you're starting on these, don't wait until the 30 pound weight loss occurs to begin working on your collagen. Do it from the beginning. Right. Really, start to work on it. Because I will say there are a lot of patients that come in and they've definitely lost a lot,

MIC2 16:37

which is great.

MIC1 16:39

Which is well, so they've lost a lot in their face, which is not great sometimes. and also, you know, be careful with these, medications as well. They're certainly helpful and they've certainly been prescribed a lot. But at the same time, once you get to your goals, then it might be time to start to ease off or go to maintenance therapy with

MIC2 16:57

Right. And hopefully this, you know, podcast just, you know, I, from my perspective, when we do these, I just wanna help inform people. So hopefully this kind of head sheds a little bit of light for people to kind of think about.

MIC1 17:09

That's right. Let's call it quits.

MIC2 17:11

And then, and then we won't wait another two months, but we will come back with another one soon, probably in a couple weeks with, with some other options that you could, uh, that we could help with.

MIC1 17:22

Sure. Like, like hyper dute, radius, Sculptra fillers, and the different type of energy based devices that we can use as

MIC2 17:29

Okay. Sounds good.

MIC1 17:31

Okay. Thank you so much. Thanks. Bye. Bye-Bye.