Ozempic’s side effects revealed: Sagging faces, wrinkles

Last fall, Alla started using Ozempic to lose weight. After six months of taking the drug, the 55-year-old woman is 5-foot-4 and has lost 55 pounds. The body looks 10 years younger, but the face is 10 years older.

“My face was really starting to sag,” she told The Post, as she was trialling the diabetes drug, which Americans across the country have been using to lose weight quickly.

“I've noticed more wrinkles, especially on my cheeks and the sides of my face,” continued Ala, who lives in New Jersey and declined to give her last name for privacy reasons. “If I look in the mirror from the side, my face looks flat — like there's no actual structure or features of my own.”

After Alla's initial weight gain led to her developing type 2 diabetes, her doctor prescribed Ozempic. While the semaglutide drug retails for around $900 for a 1.5ml pen that lasts a month, Alla's prescription is covered by insurance. But she still spent $4,500 on three rounds of the injectable filler Sculptra and two rounds of Restylane Lyft (another type of filler) to lift her cheeks a bit, and filler Radiesse to smooth out her wrinkled laugh lines.

Rachel Clewell, 43, lost 64 pounds after taking diabetes drug Mounjaro.
Rachel Clewell, 43, lost 64 pounds after taking diabetes drug Mounjaro.
Provided by Claywell

A person who injects diabetes medication into the abdomen.
There is such demand for Ozempic and the similarly formulated Wegovy, both of which are now listed on the FDA's Drug Shortages website.
Getty Images/iStockphoto

Diabetes drug Ozempic and a similar formulation of Wegovy are so popular among those looking to lose weight fast that everyone from Elon Musk to Chelsea Handler has admitted to trying semaglutide injections. Demand is so high that both drugs are now listed as in short supply on the Federal Drug Administration's Drug Shortages website. Now, users are dealing with a dreaded side effect – an “ozone face”, in which facial skin looks gaunt and aged due to the rapid loss of facial fat. People flock to dermatologists and cosmetic surgeons for expensive fixes.

“This just takes the needs of our practice to the next level. Many people are losing weight in the midface – the tissue in this area helps create youthful structure, and when it’s lost, it can make the face look sagging and gaunt ,” said Tara Adashev, an advanced practice RN at Neinstein Plastic Surgery in Manhattan, who worked with Ala.

The most commonly affected feature is saggy cheeks, which can also lead to minor dimples and wrinkles at the temples, as well as dimples in the under-eye area, she says. The skin under the chin will also begin to sag.

Ilana Mechoullam, 33, who also runs a medical spa, lost 50 pounds when she started Ozempic nearly a year ago after gaining weight early in the pandemic.
Ilana Mechoullam, 33, who also runs a medical spa, lost 50 pounds when she started Ozempic nearly a year ago after gaining weight early in the pandemic.
Supplied by Mechoullam

To counteract the ozone face, Adashev's approach is to use hyaluronic acid fillers, such as Restylane or Juvéderm, to improve immediate volume loss. Then, they add a secondary filler like Sculptra, an injectable poly-L-lactic acid that helps stimulate collagen production and provide additional structure over the next six to eight weeks of treatment.

Dr. Robert Schwarcz, an Upper East Side plastic surgeon, asks patients to bring in old photos of themselves before they lost weight and when they were younger so he can see where the fat on their faces naturally goes.

“The last time we saw something this extreme was with the rise of knee girdle surgery in the early 2000s,” Schwartz told the Post.

Some people who use Ozempic for weight loss are developing “Ozempic face”, which causes facial skin to look gaunt and prematurely age.
Getty Images/iStockphoto

Fat loss in the central cheek area and neck can lead to “significant aging,” he notes. With long-term use, the temples can also be affected, creating a “bone-eye appearance that makes people look older than they really are,” he says.

For women 50 and older, Schwarcz typically recommends a facelift, which can cost between $35,000 and $40,000. In more severe cases, he'll use fat grafting, also known as fat transfer or fat injection, to surgically transfer fat from one area to another, which can cost between $4,500 and $6,000. For younger patients, he favors fillers ($1,000 to $1,500 a vial).

Rachel Clewell, a 43-year-old medical assistant in central Florida, lost 64 pounds after six months of taking Mounjaro, a tirzepatide injection for type 2 diabetes that, like Ozempic, is prescribed with for weight loss.

The 201-pound mom-of-three said she is now seeking counseling to address wrinkles caused by excess skin on her neck. Since starting Botox last August, she has also continued to get Botox injections every few months to help fight the effects of aging.

“I noticed sagging skin under my chin and neck. Beyond that, my cheeks were thinner,” she says. “But before, I felt like you couldn't even see my eyes because you could only see my cheeks. It definitely took a lot to get used to my new body, but I enjoyed it.”

Likewise, Boca Raton RN Ilana Mechoullam, 33, thinks her face looks older after losing weight so quickly. Mechoullam, who runs the medical spa Peace Love Med Aesthetic Rejuvenation, told the Post that since starting Ozempic nearly a year ago, she gained weight early in the pandemic and lost 50 pounds. Now, she weighs 110 pounds.

Chelsea Handler said she used to take Ozempic.
Stars like Chelsea Handler, pictured here, have used Ozempic.

“A lot of millennials are using Ozempic. We see young people coming in looking old,” she says.

To treat her sagging skin, Mechoullam started using fillers ($1,000) on her chin and cheeks ($849) and under her eyes. She also had four sessions of microneedling (totalling about $2,796), a cosmetic procedure in which thin needles are used to repeatedly puncture the skin to help stimulate collagen production and make skin look younger.

“It's a double-edged sword,” she says of losing weight and looking older. “You can't have your cake and have your cake and eat it.”

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