The rise of ‘Ozempic face’: the Wegovy side effect that’s here to stay

At a certain age, you have to choose between your face and your ass.” This pithy saying tends to be attributed to the actor Catherine Deneuve (perhaps it sounded less blunt in French?), but it has also been placed in the mouths of a whole constellation of stars: socialite Zsa Zsa Gabor, quippy old Hollywood star Mae West, actor and activist Jane Fonda, to name a few. Each time the wording is a little different, but the sentiment remains the same  – that as a woman (it’s only ever a woman) gets older, she must decide whether to focus her time and efforts on looking young or being slim.

Deneuve and co were speaking long before semaglutide – better known under the brand names Ozempic and Wegovy – started being touted as an aid for rapid weight loss. But now, with demand for these drugs rising fast, their devotees are finding out the hard way that there’s more than a kernel of truth to the old face/body trade-off. As the pounds drop off at speed, some users have noticed an unwelcome side effect to the so-called “skinny jab”, as they’re left looking like they’ve just pressed fast-forward on the facial ageing process.

To sum up the predicament, the New York dermatologist Dr Paul Jarrod Frank coined the term “Ozempic face” earlier this year; #ozempicface has been viewed more than 30 million times on TikTok to date, where you will find doctors and civilians alike speculating over before and after photos. According to Dr Leah Totton, non-surgical cosmetic treatment specialist and past The Apprentice winner, the tell-tale signs of “Ozempic face” are “hollowing and increased facial laxity” – that’s a loss of firmness to the skin, in layperson’s terms – along with “a gaunt and sagging” look in the face, “often accompanied with increased lines and wrinkles”.

Ozempic use has become known as “Hollywood’s worst-kept secret”. The guessing games began when A-listers started turning up on the red carpet with strikingly skinnier figures. While many have kept quiet about their rumoured Ozempic habit, celebrities as disparate as Elon Musk, Amy Schumer and Jeremy Clarkson have spoken out about their experiences of the drug, good and bad. Sharon Osbourne recently claimed that she can still go “three days without eating” after quitting Ozempic in December. Her extreme weight loss – and dramatically slimmed-down face – was on show during an appearance on Piers Morgan Uncensored last week, when she revealed that she “didn’t actually want to go this thin, but it just happened”.

That significant weight loss can leave you looking haggard or dealing with excess skin is not a new discovery: after getting a gastric band fitted, for example, it’s not unusual for some patients to opt for a skin tightening procedure afterwards. What is new is the sheer speed at which semaglutide users are shrinking, and the marked effect it seems to have on the lower face and jawline. “Compared to weight loss surgery, the effect on the face of Ozempic is two to three times greater,” consultant plastic surgeon Rajiv Grover told The Times earlier this year.

When we lose weight through exercise or dieting, it tends to be a gradual process. “The fat loss happens slowly, and with it, the skin gradually shrinks back into place,” explains Dr Sebastian Bejma, advanced aesthetic doctor at the Dr Bejma Medical Clinic in Leeds. But when it happens quickly, as it does with the help of Ozempic or Wegovy, the skin can struggle to spring back, “and in some cases, if the weight loss has been too dramatic, it won’t”, Bejma explains. Think of the skin like a deflating balloon, suggests Mr Naveen Cavale, consultant plastic surgeon at Real Clinic. “If you let the air out gradually, it probably has time to shrink back down almost to the size that it was when it first came out of the packet. And if people lose weight gradually, your skin [and] its elasticity has time to recover. Your skin can regenerate.” But if not, you can end up with “excess hanging skin”.

Rapid weight loss can also negatively impact levels of collagen (which “provides rigidity and strength to the skin”, Bejma says) and elastin (which “allows it to be flexible and retract back to shape”). And with less fat to provide padding, wrinkles can appear more prominent. Dr Totton suggests that “women over the age of 50 are particularly at risk … as they don’t have the same collagen or elastin reserves for their skin to ‘bounce back’ after sudden or significant weight loss” (it’s thought that around 30 per cent of collagen is lost in the five years following the menopause).

Semaglutide was initially developed to manage type 2 diabetes. Used to help control blood sugar levels, it mimics the hormone GLP-1, which is released from the gut after we eat, reducing cravings and preventing overeating. It wasn’t until last year that it made the headlines, amid speculation that a cohort of suddenly (even) skinnier Hollywood stars had been prescribed Ozempic “off label” (ie for a different purpose to the one for which it has been medically approved) to slim down at speed. In a clinical trial, it was found to prompt an average body weight loss of 15 per cent over a period of six to nine months.

The clamour for this “wonder drug” has prompted worldwide shortages, which are deeply concerning for diabetic people; in July, the Department of Health and Social Care said that supplies of semaglutide drugs probably won’t return to normal until the middle of 2024.

The National Institute for Health and Care Excellence (NICE) approved Wegovy as a weight loss treatment earlier this year, recommending its use for a maximum of two years; then in June, Rishi Sunak earmarked £40m for a pilot scheme designed to increase access to the drug through GP prescribing. Users tend to fall into two groups, Mr Cavale says. “One is those who take it and probably could benefit from it, those people who are a bit overweight, who could do with a better lifestyle, to eat less and exercise more,” he explains. “And [semaglutide] is something that, if it’s used properly, is helping them to do so.”

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But the second group consists of “people who are not necessarily overweight, and are using [the drug] as a bit of a lifestyle thing”, Mr Cavale says. They might be accessing weight loss drugs for less legitimate reasons, through unscrupulous suppliers. “They then lose a whole lot of weight really quickly,” he adds. “If you’re a young person, you’ve got more fat [in your face], and so if you’re taking Ozempic you probably end up emptying out your face [of fat] very quickly … so you’re kind of speeding up that part of the ageing process.”

Not all Ozempic users are fixating on the facial side effects. “We’ve had so many patients on Ozempic, but usually they’re more happy that they’ve lost weight,” says Dr Grace Hula, an aesthetic doctor. “Maybe one or two have mentioned that their face has grown thin, but it’s not been a big issue for them.” Mr Cavale has found that it’s the younger people, “who are using it, too early when they don’t need it who tend to be concerned that they’re “looking haggard for no good reason”. “They come in complaining saying, ‘yes, I’ve lost the weight, but now I’m just getting people telling me I look tired,” he says.

Totton believes that “Ozempic face” is best treated non-surgically: her Dr Leah clinics have seen a 64 per cent increased demand in thread lift procedures in 2023 versus the same six-month period the previous year (a thread lift is a non-invasive treatment, in which temporary sutures are used to sculpt the skin). “A significant proportion” of the clients opting for them “are experiencing facial sagging as a result of sudden or significant weight loss”, she says. She’d also recommend a dermal filler “liquid facelift” to “replace volume in the face”.

Her clients tend to be in their fifties, but Mr Cavale has had potential patients enquiring about getting surgical facelifts in their late twenties and early thirties. “It’s not a small procedure at all, and the trouble is, you don’t want to be starting it too early,” he says. He hopes that people will “get wise” to the fact that “there are no shortcuts” to being and looking healthy (and that “every drug, every operation, has consequences and risks and complications”). If they don’t, however, and semaglutide mania continues, he wonders “whether we will start seeing people having major surgery earlier and earlier”.

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Cosmetic surgery has already been booming since the pandemic (blame those hours staring at our crumpled faces on unforgiving Zoom calls), with face and neck lifts increasing by 97 per cent between 2021 and 2022 according to the British Association of Aesthetic Plastic Surgeons (BAAPS) – and Mr Cavale questions whether weight loss drugs are “perhaps pushing [this] to the next level”. Plastic surgeons like him, he says, “will start seeing the consequences of that as people get older”, as patients might need repeat procedures further down the line. For this reason, he has “real ethical dilemmas” about doctors prescribing Ozempic or Wegovy to patients who don’t really need it. “I’ve got the same issues with people who are doing Botox on [clients] who don’t need it yet, and are potentially creating more problems – great problems that are making [doctors] lots of money”.

“These drugs have consequences,” he adds. “If you got your ears pierced and didn’t like it, you probably just take the piercing out, let it close over and go back to how it used to be. If you have a tattoo, you can get it removed now … But premature ageing changes are permanent. It’s difficult to reverse –  it’s not like in a few years you stop taking Ozempic and your face goes back. Those changes are to a large degree irreversible. Because you have pushed your face along the ageing pathway, which is a one-way pathway, when you didn’t necessarily need to do so.”