The Type 2 diabetes medication Ozempic and the obesity medication Wegovy have skyrocketed in popularity in recent months, leading to shortages of both. While the side effects of the medications — which can induce significant weight loss — typically are gastrointestinal, a New York Times report is shining a light on another way they can alter one's body.
The phenomenon has been coined "Ozempic face," by New York City-based dermatologist Dr. Paul Jarrod Frank, who told TODAY in a Jan. 26 segment that he sees Ozempic face "every day in patients" since the drugs have become more popular.
How Ozempic works for weight loss
Semaglutide, the active ingredient in Ozempic and Wegovy, can help manage insulin levels and induce weight loss. Ozempic is approved by the U.S. Food and Drug Administration to treat Type 2 diabetes, and Wegovy is approved to treat obesity.
According to the manufacturer of both medications, Novo Nordisk, the average weight loss with Ozempic is 8 to 14 pounds; with Wegovy, it’s 15% of the patient’s weight.
The manufacturer of Ozempic and Wegovy, Novo Nordisk, previously told TODAY.com in a statement, “We do not promote, suggest or encourage off-label use of our medicines,” which includes using Ozempic for weight loss.
To understand how semaglutide works for weight loss, you first need to understand what obesity is, Dr. Ania Jastreboff, associate professor in medicine and pediatrics at Yale School of Medicine and an obesity medicine physician-scientist, tells TODAY.com. Jastreboff is on the scientific advisory board for Novo Nordisk and in charge of a semaglutide clinical trial at Yale funded by Novo Nordisk.
It all starts with what she calls the "defended fat mass set point."
"Our body wants to carry energy, and it carries that energy in the form of fat," Jastreboff explains. "It doesn't want us to carry not enough energy because then we would starve, and it doesn't want us to carry too much energy because then we wouldn't be able to do everything that we do every day. There's a sweet spot, and we call it the defended fat mass set point."
Because the factors that can contribute to obesity, such as highly processed foods and nonactive lifestyles, are more common than ever in today's environment, on a population level, the U.S.'s defended fat mass set point has increased, she says. For example, if you have a BMI of 31 in 2022, 100 years ago, it might've been a 22.
About 42% of the population has obesity, meaning they have a chronic disease "where the body wants to carry extra fat,” Jastreboff adds.
Semaglutide works by mimicking the body's hormones that signal to the brain about how much weight you're carrying and reregulating the patient's defended fat mass set point to a healthier place.
"We are decreasing their defended fat mass set point, and the consequence of that is that they lose weight," Jastreboff says.
What is Ozempic face?
Ozempic face refers to the facial changes that patients who've lost a significant amount of weight sometimes experience: primarily a loss of facial fat that can leave the face sagging and looking older. It's especially common in middle-aged and older patients, Frank said.
"One of the most common things I notice with any form of weight loss in middle-aged and older patients is we don’t all lose it in the areas we want," Frank said. "When we get older, definitely the facial volume changes and shifts around. But when you lose weight so acutely and quickly, you see more of a global facial wasting."
"There are certain diseases that cause this, but this is happening in a much milder sense with the use of these medications," he explained. "It’s not just a wrinkle we’re seeing in one area or a heaviness around the eyes. We’re seeing it in the temples, the jaw line, around the mouth, under the eyes."
"For most of my middle-aged patients ... we're seeing these types of changes in their face where it’s actually making them look older," he added.
Natasa Valocchi, who experienced a degree of Ozempic face after losing 68 pounds since she started the medication in November 2021, described her facial changes in a Jan. 26 segment on TODAY: "As the weight goes, your face does go, and you do get a gauntness."
"As we age, we get gaunt anyway, so I think it was just a little bit more excessive. People have definitely noticed in my face, 'Oh, Wow you are looking very thin these days.' So it's maybe a bit much for me, and I think I could use a little bit extra volume," she said, adding that she notices it "primarily ... in the lower jaw."
"Your jowls start to sag because there isn't really the (plumpness) to hold it in anymore," she added.
Is Ozempic face actually caused by Ozempic?
Asked whether Ozempic face is actually caused the medication itself, Frank said it’s “too early to tell,” but noted that weight loss in general can have this effect, regardless of what causes it.
Dr. Rocio Salas-Whalen, Valocchi's endocrinologist, tells TODAY.com that losing weight quickly "is definitely going to affect how the skin adapts to the new weight. And that's why we always recommend slow weight loss, especially at the beginning."
Salas-Whalen worked for Novo Nordisk in the past but on projects unrelated to Ozempic.
The recommended weight loss rate, she noted, is 1 to 2 pounds per week. Valocchi did lose weight at this pace, but other factors can also contribute to Ozempic face, Salas-Whalen explained. These include the natural aging process, genetics and being menopausal, as the lack of estrogen can contribute to wrinkles and sagging skin.
You're also more likely to see Ozempic face traits the more weight you lose, Salas-Whalen said. Patients who take Ozempic to lose 15 to 20 pounds — and there are legitimate medical reasons for doing so, she stressed — won't see as many facial changes as those who lose 100 pounds, Salas-Whalen said.
Jastreboff agrees that the phenomenon “is related to the weight reduction rather than specifically to the way that weight reduction is attained.”
She adds that one of the reasons Ozempic face may be catching people off-guard is that semaglutide is "highly effective" at treating obesity.
"Patients are losing weight at a faster rate than what we've seen with other types of obesity treatments," Jastreboff explains. "With bariatric surgery, patients also have potentially changes in their in their facial appearance, and I think potentially why it's coming up is because we're not used to seeing that degree of a change in the amount of fat that is carried in someone's face with a medication."
In fact, she says she finds it "interesting" that Ozempic face is even being called a side effect.
"If a patient had a question about this, (I'd say) the health benefits of treating obesity ... are incredibly important, and as you lose weight, there will be changes in appearance," she said. "It's really important to speak to our patients about this so that they know what to expect and ... to guide them through that process as they reach a weight where the amount of fat they're carrying is healthier for them."
Does Ozempic affect the skin?
Jastreboff say she's not aware of any skin side effects that Ozempic may cause, except for a mild injection site reaction. Ozempic and Wegovy are both administered as a shot, so "when you take a little shot, sometimes you can have a very little bruise or something, but usually that does not occur," Jastreboff says.
How can you treat Ozempic face?
Frank said fillers can be used to treat Ozempic face, but it's costly.
"When you have global facial volume loss, it can take a significant amount of filler. Whereas someone in middle age may normally spend $1,000 or $2,000, they could spend $5,000 and up to reflate the face from the volume loss," he added. "(For) patients in their late 50s and 60s, often replacement of volume is not enough, and it will require facial plastic surgery."
For those concerned about developing Ozempic face, Frank stressed the importance of staying in contact with your endocrinologist, dermatologist and other relevant specialists "to help you along the (weight loss) journey slowly."