The Post-Ozempic Body: Surgical Options for Skin and Facial Rejuvenation
Dr. Traci Temmen M.D.

The Rise of GLP-1 Medications for Medical Weight Loss

Within the last few years, medical weight loss options have expanded beyond “eat healthier and exercise more”. Unfortunately, for many patients’ weight loss is just not that simple. Medical conditions, hormone imbalances, chronic stress and more can all play into weight struggles. The rise of clinically proven weight-loss drugs, known as “GLP-1’s”, have taken over the medical community. GLP-1’s (Glucagon-like peptide-1) are a class of drugs that mimic a hormone the gut releases after eating, reducing hunger cues, regulating blood sugar, keeping you fuller for longer, and drastically dropping body weight (~15-20%). Popular GLP-1 drugs include Ozempic®, Wegovy®, and Zepbound®.

At Temmen Plastic Surgery in Tampa, FL, we now proudly offer FDA-approved GLP-1 medications, both oral and injectable. However, with any medication there are side effects that may follow. Common side effects can include nausea, constipation, diarrhea, vomiting, and abdominal discomfort, however, most of these are temporary and reside over the course of treatment. Additionally, with any kind of major weight loss the body experiences many physical changes.

Dramatic weight loss can leave patients unhappy with newly sagging skin, loss of facial volume, or deflated breasts/buttocks. However, we are prepared to offer patients customized solutions to any aesthetic concerns they may have post-weight loss! With the increase of GLP-1 popularity, there is a significantly greater demand for body contouring and facial rejuvenation procedures in my practice. In this blog I will discuss GLP-1 effects, surgical options post-weight loss, “Ozempic Face”, and SMAS vs Deep plane facelifts.

Why Loose Skin Happens After Significant Weight Loss

After a patient gains weight, there are several physiological changes that occur which may lead them to consider GLP-1 treatment. The most common (and disliked) change includes stretching of the skin. As more fat accumulates on the body, the skin stretches due to its elastic nature. Skin elasticity is a powerful tool in maintaining a youthful appearance and “snapping back”, however, following major weight loss, the skin oftentimes cannot fully retract back.

Skin elasticity is driven by elastin and collagen, two important proteins that the body naturally produces. There are several factors that affect elasticity including, natural aging, genetics, sun exposure, hormone changes, lifestyle, and of course, weight loss. Losing a couple pounds in your 20s may have left no visible mark, but once collagen starts declining, losing a great deal of weight at a later age becomes more apparent in the skin.

Common Areas of Loose Skin After GLP-1 Weight Loss

I find many of my patients expressing the same areas of concern following GLP-1 weight loss. These areas include the abdomen, thighs, arms, breast, and back. Patients come to me frustrated, after working hard for months to achieve their goal weight and still feeling unhappy with their results. Once a patient’s weight has stabilized for a few months, surgery becomes the most effective way to correct unwanted, loose skin. This ensures that patients have long lasting, natural results that will help them feel proud of their new body!

Body Contouring Surgery After Weight Loss

As a female board-certified plastic surgeon, I am proud to offer different surgical options for patients, specifically body contouring surgeries for weight loss patients. As I previously addressed the most common areas of concern, I will now explain each procedure I recommend for specific concerns.

Tummy Tuck After Weight Loss (Abdominoplasty)

• Loose abdomen: Tummy Tuck. A tummy tuck, or abdominoplasty, is a procedure where excess abdominal skin or stretched tissue is removed, giving the appearance of a flat stomach. To give my patients the best results, I prefer to use a technique known as Lipoabdominoplasty. Essentially, it combines a standard tummy tuck surgery with advanced liposuction techniques, so I can better contour the body and create a feminine shape. Tummy tucks are popular in my practice, as they leave patients with a smooth waistline, better contouring around their midsection/core, and no more stretch marks or “muffin tops”!

Thigh Lift Surgery After Weight Loss

• Thighs: Thigh Lift. A thigh lift is a procedure done to remove excess skin and fat that surrounds the upper thighs, creating smoother and slimmer legs. Based on patient anatomy, this may be done through liposuction, a combination of liposuction and skin excision, or a two-staged procedure with both liposuction and skin excision. Thigh lifts help the legs to look more toned, which can be an issue after weight loss.

Arm Lift Surgery (Brachioplasty)

• Sagging Arms: Arm Lift. An arm lift, known as a brachioplasty, is a surgery that removes excess, sagging, or loose skin on the upper arm area. Very similar to the procedure for a thigh lift, it can be done by liposuction alone, or with a combination of liposuction and skin excision. Brachioplasty can be done under local anesthesia or general, both of which I have experience with. An arm lift is a great choice for any patient who has lost a lot of weight and wants to get rid of their “bat wings” for slim, toned, upper arms.

Breast Lift Surgery After Weight Loss (Mastopexy)

• Deflated or Sagging Breasts: Breast Lift. Breast lift, or Mastopexy, is a surgical procedure where breasts that are deflated or sagging are raised, repositioned, and tightened. Dr. Temmen is trained in all the most advanced breast techniques and is highly regarded for her work with breast lifts. Patients who go through weight loss/gain experience some kind of deflation or sagging of the breast, and I recommend a breast lift for a perky, full, youthful option. Breast lifts are one of the most common procedures done in my practice, and women of all ages, backgrounds, and bodies love their results.

What Is “Ozempic Face”? Facial Changes After Rapid Weight Loss

The term “Ozempic Face” is the media’s favorite buzzword right now, but what does it really mean? When the body loses a great amount of fat in a short time period, certain side effects can occur. One of them is a decrease in the proteins mentioned earlier, elastin and collagen. Meaning, rapid weight loss decreases skin elasticity as well as reduces, facial fat volume.

When this occurs, GLP-1 patients may experience an “aging face” where they see more wrinkles, sagging skin or jowls, sunken eyes, hollowed cheeks, or thinner lips. Weight loss patients appear more tired overall, which further contributes to the “Ozempic face”. It is important to note that this is not directly caused by GLP-1 medication but is a product of losing too much weight too quickly.

Facial Rejuvenation Options After GLP-1 Weight Loss

In addition to different body contouring options, I have had an influx of GLP-1 patients seeking facial rejuvenation procedures. This is not only a way to surgically combat the effects of “Ozempic face” but restore youth, and give patients a refreshed, natural glow. Facial rejuvenation can be completed using various techniques, all which depend on a patient’s goals, anatomy, and recovery time. Effective facial rejuvenation can be done with something as simple as dermal fillers or as drastic as a deep plane face lift.

What Is an SMAS Facelift?

Most patients that seek a “natural, refreshed and youthful look” that don’t want to deal with the maintenance of fillers gravitate towards what is known as an SMAS facelift. SMAS (Superficial Musculoaponeurotic System) is the layer of tissue below the ligaments of the face, and a facelift lifts this structural layer instead of just repositioning the skin. This layer is vital in supporting facial tissue and volume. As we age, the SMAS membrane loses elasticity, which can cause sagging of the jowls, cheeks, double chin, marionette lines, and “parentheses lines”.

An SMAS facelift procedure can usually be completed under local anesthesia in my Tampa office, taking only a couple hours. During surgery, I carefully reposition the SMAS layer in addition to removing excess skin around the face. Oftentimes, to deliver the best results for patients, I will remove excess skin from the neck and do what is known as a “neck lift”. The two surgeries complement each other very well, and frequently patients need both to get the results they desire. SMAS facelifts deliver natural-looking results, have fantastic longevity (lasting around 10-12 years), and require less downtime.

Deep Plane Facelift vs SMAS Facelift: Key Differences

Another popular surgical method is Deep Plane Facelift. Deep plane facelifts go below the skin, fat, and fascia (where the SMAS is located) to free up and reposition tissue. To reposition all the layers, the ligaments in the face must be released and then a surgeon can proceed with the facelift. A deep plane face lift is a more dramatic face lift compared to SMAS, providing patients with a more “tightened” look, and can last for longer since it goes deeper. This is typically wanted by patients who have extreme facial sagging and need extreme rejuvenation. Deep plane facelifts are much more invasive- requiring a longer recovery period and surgical time. There are more risks associated with them, including a higher risk of nerve damage and complications post-operatively.

Why I Prefer the SMAS Facelift for Natural Results

As a female board-certified plastic surgeon in Tampa, FL, I strongly prefer SMAS facelifts over deep plane. SMAS facelifts are more natural and long-lasting, as well as being less invasive. Patients feel more comfortable when a surgery can be done under local anesthesia, in the same surgery suite they have visited many times before. Additionally, SMAS facelifts are much more predictable in their healing process, and there is less risk involved with the surgery. SMAS facelifts produce better facial rejuvenation with less complexity, something that any kind patient will appreciate. This surgical technique emphasizes facial harmony and movement, leaving patients with a refreshed and younger look- but not the obvious “stretched back” skin that deep plane facelifts can deliver. SMAS is especially what I guide my GLP-1 patients towards, so they can enjoy their new body and still recognize their natural beauty!