Facial Fat

[Nathanologist]

“I’d

Are you sure about that?

People have rapidly lost weight via gastric bypass (and its variations), extended water fasts, GLP1-RAs, as well as the newer multi-agonist injections. My suspicion is that there's something specific to single-agonist GLP1 drugs that biases people towards losing a higher protein:fat ratio on very-low calorie diets and being a major driver of "Ozempic face."

For example, if someone goes on a water fast their body will up the release of growth hormone, as a means of preserving lean mass. I'm not sure if this has been studied, but I wouldn't be surprised if a perpetual 24/7 "I just ate" signal being faked from the gut to the brain along the afferent pathway of the vagus nerve could interfere with growth hormone release and cause the body to catabolize more lean mass than is ideal (vs breaking down fat). You could try to counter that effect by upping your protein (which is consistent with your advice). Or it's conceivable that moving to a multi-agonist treatment might mitigate that effect too.

Nothing in life or scientific practice is sure… But the science so far contradicts your suspicions. Let me show you my receipts

Frank, P. J., & Rueda, A. E. (2024). Natural Weight Loss or "Ozempic Face": Demystifying A Social Media Phenomenon. Journal of Drugs in Dermatology, 23(1), 1367-1372.

Dedhia, R. et al. (2025). Are the Next GLP-1 Drugs Finally Going to Outrun “Ozempic Face”? Los Angeles Times.

Rueda, A. E., & Frank, P. J. (2025). GLP-1RA and the possible skin aging. International Journal of Dermatology

Wade, C. (2025). “Ozempic Face”: An Emerging Drug-Related Aesthetic Concern and Its Treatment with Endotissutal Bipolar Radiofrequency (RF)—Our Experience. Journal of Clinical Medicine, 14(15), 5269

Patel, P., & Ali, M. (2024). Ozempic Face: What Is It and Why Does It Happen? HealthCentral

Papoian V et al. (2015). Effects of Bariatric Surgery on Facial Features. Aesthetic Surgery Journal, 35(8), 918–924

De Luca, B., et al. (2024). Soft Tissue Facial Changes Following Massive Weight Loss Secondary to Medical and Surgical Bariatric Interventions: A Systematic Review. Aesthetic Plastic Surgery

While I do use Gemini restricted peer reviewed and scholarly sources to find the articles I cite and read, I do read them all to understand the specifics to the best of my ability. Muscle loss and facial changes have been two areas I’ve been concerned about and intensely researched before embarking on my encretin mimetic fueled body recomp journey.

 

[tubby]

“I’d


Nothing in life or scientific practice is sure… But the science so far contradicts your suspicions. Let me show you my receipts

Frank, P. J., & Rueda, A. E. (2024). Natural Weight Loss or "Ozempic Face": Demystifying A Social Media Phenomenon. Journal of Drugs in Dermatology, 23(1), 1367-1372.

Dedhia, R. et al. (2025). Are the Next GLP-1 Drugs Finally Going to Outrun “Ozempic Face”? Los Angeles Times.

Rueda, A. E., & Frank, P. J. (2025). GLP-1RA and the possible skin aging. International Journal of Dermatology

Wade, C. (2025). “Ozempic Face”: An Emerging Drug-Related Aesthetic Concern and Its Treatment with Endotissutal Bipolar Radiofrequency (RF)—Our Experience. Journal of Clinical Medicine, 14(15), 5269

Patel, P., & Ali, M. (2024). Ozempic Face: What Is It and Why Does It Happen? HealthCentral

Papoian V et al. (2015). Effects of Bariatric Surgery on Facial Features. Aesthetic Surgery Journal, 35(8), 918–924

De Luca, B., et al. (2024). Soft Tissue Facial Changes Following Massive Weight Loss Secondary to Medical and Surgical Bariatric Interventions: A Systematic Review. Aesthetic Plastic Surgery

While I do use Gemini restricted peer reviewed and scholarly sources to find the articles I cite and read, I do read them all to understand the specifics to the best of my ability. Muscle loss and facial changes have been two areas I’ve been concerned about and intensely researched before embarking on my encretin mimetic fueled body recomp journey.

Are you just copy/pasting an LLM output for an answer?

I ask because I went to the very first reference you listed (I assumed you'd lead with the best evidence), which I was able to find a full text copy of here:

https://jddonline.com/articles/natural-weight-loss-or-ozempic-face-demystifying-a-social-media-phenomenon-S1545961624P1367X

It discusses Ozempic and weight loss, but seems to be focused on telling physicians how they should counsel patients about facial appearance changes. There is one sentence in the conclusion that reads:

Currently, there is no evidence to suggest GLP-1 agonists directly catabolize adipocytes within the face. As the usage of semaglutide increases, it is critical that a dermatologist obtains an accurate history from a patient and counsels them on the compounded effect of facial filler and GLP-1 agonist cessation.

But otherwise, the paper doesn't seem to be trying to get to the bottom of whether or not GLP1s are more or less likely to give "Ozempic face" vs other rapid weight loss methods.

Not trying to be a jerk here. Just genuinely interested in the topic and curious if you had a specific reference or rationale that you found compelling in reaching your conclusion.

 

[desinr-gal]

After some research I've came to a possible solution:

After reaching my lean goal, if my face is still rather cherubic I will use HCTZ diuretic to try and debloat. Also, I'm currently eating like twice a day and dry scoop 3 times (75 g protien), and if that doesn't work my buddy I'm going to Agartha!

You could try lymph drainage massage, gua sha, and face yoga. If the fullness is due to blocked fluids, those will help. I am tempted by those face brushes I keep seeing. The massage and yoga can probably be found for free on you tube.

 

[Retazempic]

I know that I'm going to look a little older in the face when I get my weight all the way down (Started at BMI 30, currently 24, aiming for 20), and I'm at peace with that. I'd rather look 45, a little weathered, and gloriously happy with a gorgeous, lean body than looking a little less weathered but doughy and round and also deeply worried about my cholesterol. I'll moisturize and call it good; I'm never going to win any beauty contests, but I'm also never gonna ENTER any.

Exactly the same here

 

[Nathanologist]

Are you just copy/pasting an LLM output for an answer?

I ask because I went to the very first reference you listed (I assumed you'd lead with the best evidence), which I was able to find a full text copy of here:

https://jddonline.com/articles/natural-weight-loss-or-ozempic-face-demystifying-a-social-media-phenomenon-S1545961624P1367X

It discusses Ozempic and weight loss, but seems to be focused on telling physicians how they should counsel patients about facial appearance changes. There is one sentence in the conclusion that reads:

But otherwise, the paper doesn't seem to be trying to get to the bottom of whether or not GLP1s are more or less likely to give "Ozempic face" vs other rapid weight loss methods.

Not trying to be a jerk here. Just genuinely interested in the topic and curious if you had a specific reference or rationale that you found compelling in reaching your conclusion.

No, I am not simply copy/pasting from AI- I am maintaining a library of articles as I research- this is a sampling of the more recent articles I was reviewing in no particular order. I also am not trying to be a jerk, but… Here are the statements throughout the article that present the current scientific position regarding causation of facial changes while on GLP-1, backed by citations. It is good to not just skim, but to read and understand as well as find the citations (if possible) and confirm the position.

“Although known to cause weight loss, the relationship between the GLP-1 agonist mechanism of action and facial weight loss is not characterized and may be unrelated.”

“Evidence of GLP-1 agonists favoring adipose catabolism of the face, as opposed to other body regions, is lacking.”

“There is no evidence that subcutaneous adipose tissue is more likely to be catabolized compared to other adipose stores.”

“Despite this phenomenon, this adverse effect is explained by any variation of rapid weight loss in combination with slow elastin turnover and is not solely medication derived.”

“Currently, there is no evidence to suggest GLP-1 agonists directly catabolize adipocytes within the face.” (the one sentence in the article you picked up)

That is exactly the point of the paper you read- the facial changes are not the result of the medication, rather the weight loss. It draws on other scholarly sources to back up that foundation. This makes it necessary of dermatologists to take accurate history and use appropriate tools and counsel patients about THE MISINFORMATION surrounding “Ozempic face”

You may be better served reviewing the citations. I find that sharing them can be difficult because often they are behind paywalls, but some of these specialty field articles are not, but are scholarly sources we may trust the statements are accurate to current standards and conclusions.

 

[tubby]

No, I am not simply copy/pasting from AI- I am maintaining a library of articles as I research- this is a sampling of the more recent articles I was reviewing in no particular order. I also am not trying to be a jerk, but… Here are the statements throughout the article that present the current scientific position regarding causation of facial changes while on GLP-1, backed by citations. It is good to not just skim, but to read and understand as well as find the citations (if possible) and confirm the position.

“Although known to cause weight loss, the relationship between the GLP-1 agonist mechanism of action and facial weight loss is not characterized and may be unrelated.”

“Evidence of GLP-1 agonists favoring adipose catabolism of the face, as opposed to other body regions, is lacking.”

“There is no evidence that subcutaneous adipose tissue is more likely to be catabolized compared to other adipose stores.”

“Despite this phenomenon, this adverse effect is explained by any variation of rapid weight loss in combination with slow elastin turnover and is not solely medication derived.”

“Currently, there is no evidence to suggest GLP-1 agonists directly catabolize adipocytes within the face.” (the one sentence in the article you picked up)

That is exactly the point of the paper you read- the facial changes are not the result of the medication, rather the weight loss. It draws on other scholarly sources to back up that foundation. This makes it necessary of dermatologists to take accurate history and use appropriate tools and counsel patients about THE MISINFORMATION surrounding “Ozempic face”

You may be better served reviewing the citations. I find that sharing them can be difficult because often they are behind paywalls, but some of these specialty field articles are not, but are scholarly sources we may trust the statements are accurate to current standards and conclusions.

Thanks for pulling out the relevant quotes. I appreciate you putting in time and trying to help me out on this. Sorry if my tone didn't reflect that. I was just a little frustrated by your approach.

The main issue I have with those quotes is that many of them have the format of "there's no evidence that GLP1s cause Ozempic face." Now that could mean single-agonists GLP1s don't cause Ozempic face (the way you're interpreting it) or it could also just mean that nobody has seriously studied the phenomena to the point where they can definitively answer the question (the way I interpret it).

If we think about this, the question we're really trying to ask is what percentage of people taking Ozempic go on to develop Ozempic face during the weight loss process. Clearly that number is non-zero. We then want to know what percentage of people who undergo gastric bypass, water fasting, or multi-agonist formulations (other rapid weight loss methods) develop Ozempic face and how the rate compares between the different methods. Or for most here, we'd want to know if the rate of Ozempic face is higher from sema vs tirz or reta, or if it's similar across all three.

I can't imagine the manufacturers are sponsoring such studies so the only way we could possibly know the answer to this would be if some weight loss clinic was monitoring client results and tabulating them (whether informally or as part of a trial).

My thinking is biased by listening to bariatric surgeons do their best to badmouth GLP1-RAs. They'll make claims that point to studies that found a greater lean mass loss on GLP1s VS bariatric surgery, which makes sense since they're in the business of selling surgery and GLP1s threaten their livelihood. I just don't have the time to invest hunting down all the different studies that might inform on the subject and determining if there's any merit to what they're saying or if they're cherry picking. So I'm not really looking for a long list of references. I'm more interested in a rationale for reaching a particular conclusion or even just a single study that digs into the subject in a serious manner (VS just quoting others).

 

[miss-sanne]

Ive noticed that when I pinch my cheek, inside of my cheek on my right cheek, there is like a slightly tender thing in there that is a little squishy, but squeezing the left side of my cheek is just slightly squishy but no tender feeling.

Cheeks are probably not always alike ??

 

[mraajr]

Thanks for pulling out the relevant quotes. I appreciate you putting in time and trying to help me out on this. Sorry if my tone didn't reflect that. I was just a little frustrated by your approach.

The main issue I have with those quotes is that many of them have the format of "there's no evidence that GLP1s cause Ozempic face." Now that could mean single-agonists GLP1s don't cause Ozempic face (the way you're interpreting it) or it could also just mean that nobody has seriously studied the phenomena to the point where they can definitively answer the question (the way I interpret it).

If we think about this, the question we're really trying to ask is what percentage of people taking Ozempic go on to develop Ozempic face during the weight loss process. Clearly that number is non-zero. We then want to know what percentage of people who undergo gastric bypass, water fasting, or multi-agonist formulations (other rapid weight loss methods) develop Ozempic face and how the rate compares between the different methods. Or for most here, we'd want to know if the rate of Ozempic face is higher from sema vs tirz or reta, or if it's similar across all three.

I can't imagine the manufacturers are sponsoring such studies so the only way we could possibly know the answer to this would be if some weight loss clinic was monitoring client results and tabulating them (whether informally or as part of a trial).

My thinking is biased by listening to bariatric surgeons do their best to badmouth GLP1-RAs. They'll make claims that point to studies that found a greater lean mass loss on GLP1s VS bariatric surgery, which makes sense since they're in the business of selling surgery and GLP1s threaten their livelihood. I just don't have the time to invest hunting down all the different studies that might inform on the subject and determining if there's any merit to what they're saying or if they're cherry picking. So I'm not really looking for a long list of references. I'm more interested in a rationale for reaching a particular conclusion or even just a single study that digs into the subject in a serious manner (VS just quoting others).

How can you possibly quantify something as subjective as "Ozempic Face?" This is not objective science. Who decides whether or not someone has it? The doctor? A panel of judges? This is such a weird argument. I know plenty of people who have lost a ton of weight and their face never changes, and others, like myself, who lose 5-10% of their body weight and it is very obvious in their face.

Like I said before, it all comes down to genetics. Where and how much subq fat you lose in certain areas of your body is a genetic thing. Not a GLP-1 thing or any other type of weight-loss thing. We have known this for a long time. Some people lose it in the face first. Some people never lose it in their face. Some people never have loose skin, and others do. Thank your parents, their parents, and their parents' parents, and so on if you cannot lose the fat where you want to the most.

 

[tubby]

How can you possibly quantify something as subjective as "Ozempic Face?" This is not objective science. Who decides whether or not someone has it? The doctor? A panel of judges? This is such a weird argument. I know plenty of people who have lost a ton of weight and their face never changes, and others, like myself, who lose 5-10% of their body weight and it is very obvious in their face.

Like I said before, it all comes down to genetics. Where and how much subq fat you lose in certain areas of your body is a genetic thing. Not a GLP-1 thing or any other type of weight-loss thing. We have known this for a long time. Some people lose it in the face first. Some people never lose it in their face. Some people never have loose skin, and others do. Thank your parents, their parents, and their parents' parents, and so on if you cannot lose the fat where you want to the most.

So we're talking about two different things here:

Genetics determine where and in what order fat deposits reduce as you lose fat. Notable examples of this principle would be someone like Kim Kardashian where as she gains weight it's going to pool more strongly in one particular part of her body. Everyday examples (the rest of us) determine at what point during weight loss the face starts to slim up or otherwise reduce. I think we both agree on that and let's consider that part settled.

I'm not an expert on "Ozempic face," but it seems to be a phenomena where the proportions of the face itself change in some other manner. It's not that the face slims out of order compared to other body parts, but just that when you look at the face, something about its proportions look "off" to the observer. Part of it is temporary loose skin from rapid weight loss, but that doesn't seem to be the full story. I can't personally spot it very well myself, but I did observe a friend who lost a ton of weight on liraglutide and ended up with an oddly proportioned body for a period of time in terms of her muscle to her fat and I would guess this is either the same or a similar phenomena.

When you lose weight, you're supposed to lose both fat and muscle (and that balance is also hormonally regulated and should vary at different stages of the weight loss process). For example, when you go from 300 lbs to 200 lbs, it's perfectly acceptable to lose some muscle in your legs, since they're now hauling around 100 lbs less of you. At the same time, if you were to lose excessive lean mass, that could be a problem.

 

[Nathanologist]

Thanks for pulling out the relevant quotes. I appreciate you putting in time and trying to help me out on this. Sorry if my tone didn't reflect that. I was just a little frustrated by your approach.

The main issue I have with those quotes is that many of them have the format of "there's no evidence that GLP1s cause Ozempic face." Now that could mean single-agonists GLP1s don't cause Ozempic face (the way you're interpreting it) or it could also just mean that nobody has seriously studied the phenomena to the point where they can definitively answer the question (the way I interpret it).

If we think about this, the question we're really trying to ask is what percentage of people taking Ozempic go on to develop Ozempic face during the weight loss process. Clearly that number is non-zero. We then want to know what percentage of people who undergo gastric bypass, water fasting, or multi-agonist formulations (other rapid weight loss methods) develop Ozempic face and how the rate compares between the different methods. Or for most here, we'd want to know if the rate of Ozempic face is higher from sema vs tirz or reta, or if it's similar across all three.

I can't imagine the manufacturers are sponsoring such studies so the only way we could possibly know the answer to this would be if some weight loss clinic was monitoring client results and tabulating them (whether informally or as part of a trial).

My thinking is biased by listening to bariatric surgeons do their best to badmouth GLP1-RAs. They'll make claims that point to studies that found a greater lean mass loss on GLP1s VS bariatric surgery, which makes sense since they're in the business of selling surgery and GLP1s threaten their livelihood. I just don't have the time to invest hunting down all the different studies that might inform on the subject and determining if there's any merit to what they're saying or if they're cherry picking. So I'm not really looking for a long list of references. I'm more interested in a rationale for reaching a particular conclusion or even just a single study that digs into the subject in a serious manner (VS just quoting others).

What studies are those surgeons citing that indicate GLP-1 weight loss causes greater lean mass loss than other weight loss interventions? Without the evidence it’s just opinion and bias. You are right to question, and reason, but don’t stop there. Dig deep- go look up the citations used to support their statements. Most scholarly articles accessible without subscription or paywall simply state the current position and support with citations. Maybe pay for access if it’s that big of a concern, and you aren’t finding what you need otherwise? In my signature is a link to UC Davis lecture series that touches on the subject among many other GLP-1 peripherals. It’s about 2hrs and I found it informative and digestible. One lecturer in particular toward the beginning addresses specifically the lean mass loss compared between several wight loss interventions. Which is simply to say- it has been studied, and the findings are clearly presented in several venues to the point of being stated as foundational fact during follow up discussions. Most of what we find now is scientists/researchers talking around that foundation. Essentially, “Since we know it’s not the action of the medication, what is the cause? What can we do to manage patient expectations and mitigate the effects of such weight loss?” They’ve moved past asking, “Is it acutely the drug?” and looking into, “What are the compounding factors? Advanced kidney disease in DT2 patient population? Loss of vascularity to the muscle tissue?” Etc etc.

If you’re not looking for citations from which to further your research, I’m not sure what else to say.