, 2025-05-02 10:00:00
ORLANDO, Florida — The metabolic and cardiovascular health effects of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), a class of diabetes and weight loss drugs known as GLP-1s, have been well studied. The drugs’ effects on skin, meanwhile, are just beginning to be explored.
Studies have revealed the agents’ potential benefits for wound healing and for calming inflammatory skin conditions such as plaque psoriasis. But GLP-1 RAs are also notorious for producing “Ozempic face,” a term that has made it into the dermatology literature to describe the facial fat loss and sagging skin that can accompany their use. Researchers have begun investigating whether the drugs can trigger aging effects that are independent of weight loss.
At the American Society for Laser Medicine and Surgery 2025 Annual Meeting, presenters shared insights from their practices about how they are working with patients taking GLP-1 RAs. In a presentation on ablative therapies, Brian Biesman, MD, an oculofacial plastic surgeon at Vanderbilt University Medical Center, Nashville, Tennessee, who is in private practice in Nashville, said that he expected more patients to seek care regarding skin issues arising from GLP-1s, a phenomenon he has seen in his cosmetic practice. But that raises a host of other concerns, he acknowledged.
“The question then becomes, if we do aggressive ablative resurfacing treatments, can we expect that skin to heal the same way as skin in someone who didn’t undergo that type of weight loss?” he asked. “Right now, we don’t know. It might be that the skin has plenty of reserve. Or it might be that we need to modify our treatments or modify the technology we use.”
In another presentation at the conference, Suzanne Kilmer, MD, a dermatologist at the University of California, Davis, who is also in private practice in Sacramento, California, advocated for a “multifaceted continuous approach” to address skin laxity and muscle loss related to GLP-1 RA use. She recommended different combinations of treatments that included neuromodulators, which can relax facial and neck muscles to make energy-based treatments more effective; hyaluronic fillers; biostimulatory injectables such as poly-L-lactic acid (PLLA); laser resurfacing; ultrasound- and/or radiofrequency-based skin-tightening therapies; and facial muscle stimulation.
Elaborating further in an interview, Kilmer said that the sense of urgency in treating these patients has to do with the fact that natural remodeling of skin collagen is more efficient with some tension or stress on skin. Once skin becomes lax because of aging, weight loss, or other factors, it can be difficult to treat even with aggressive resurfacing treatments. Tension on skin can be restored using fillers, surgery, and other types of treatments, she said. But prevention is better still.
Kilmer added that she advises counseling patients to initiate collagen-stimulating treatment with PLLAs even before they begin taking weight loss drugs, noting that these have been helpful in addressing facial weight loss among people treated for HIV. “I’d like patients to be proactive and start a round of [PLLA injections] on day 1 of GLP-1 RA treatment. It’s likely to work better when you haven’t yet become calorie deficient,” she said.
The reality, however, is that patients often do not disclose their intentions to take GLP-1 RAs or that they are already taking them. Kilmer said she has also observed patients who are so satisfied with their weight loss they will want to continue losing weight even when it is no longer indicated, or they do not want to treat facial gauntness.
R. Rox Anderson, MD, professor of dermatology, Harvard University, and director of the Wellman Center for Photomedicine at Massachusetts General Hospital, both in Boston, who also presented at the conference, commented in an interview that the type of laxity seen with facial weight loss is challenging to energy-based medicine specialists. “We’ve always said we can predict who’s going to respond and who doesn’t. And it’s typically somebody who has really lax skin who does not respond well.”
Both Kilmer and Anderson said that the field needed to get a better handle on the cell biology of skin changes induced by GLP-1 drugs, and fast. “I would like to see a study using [samples taken during micro-coring procedures] to study up- and down-regulation of genes before and after treatment with GLP-1s,” Kilmer said.
“This is a mechanical problem with roots at the microscopic level,” Anderson agreed. “And there’s no theoretical model for it yet. It’s something we need to build.”
Kilmer disclosed receiving research support, stock holdings, and/or fees from Acclaro, Allergan, BellaMia, BTL, Caliway, Candescent, Cynosure/Lutronic, Cytrellis, Engage Technologies, Galderma, Lumenis, Revance, Sofwave, Solta/Valeant, L’Oréal, Merz, Acclaro, Accure, AVAVA, Candescent, Cutera, and Engage Technologies. Biesman disclosed research funding and/or fees from AbbVie, Acclaro, Alastin, Canfield, Cytrellis, Galderma, Jetema, Levation, L’Oréal, Lumenis, Luvo, Merz, Raziel, RBC, Revance, Revelle, Revision, RVL, Solta, Teoxane, xMedica, and Zimmer. Anderson disclosed financial relationships with Accure, Blossom Innovations, and Cytrellis.
