Ozempic is changing people's skin, say plastic surgeons

https://www.allure.com/story/ozempics-effects-on-skin

by bookofjoe • 2 years ago

75 121 2 years ago

cbanek3• 2 years ago

I wonder if using something like Retinol, which is proven to improve skin and make it look tighter, younger, and get rid of blemishes, marks, and sun damage, could be paired with Ozempic to keep skin more healthy along with a good skin routine?

Loughla• 2 years ago

What are the side effects from that medicine?

goodJobWalrus2• 2 years ago

For me it’s uncomfortably dry skin on my cheeks.

sctb• 2 years ago

They're minimal; retinol is usually mixed with a carrier oil or cream in various concentrations and applied topically. I would be surprised if it has an impact on the superficial musculoaponeurotic system (SMAS) referred to in the article, however.

cbanek3• 2 years ago

There's a few, but they are all pretty minor. It doesn't mix well with water (rash), so make sure to put it on right before you go to sleep. It can increase sun sensitivity of your skin, making it easier to have sun burn or additional sun damage, so again, put it on before bed. It can sometimes cause breakouts especially when you start using it, including a red bumpy rash. But after a few weeks, your skin typically adapts to it and the rash goes away.

The tricky part is there's all sorts of people that sell Retinol products but the amount of retinol is OTC. This isn't typically good enough, but you can go to your dermatologist to get a prescription strength that really works, and it's cheap.

jordanb• 2 years ago

I'm sometimes reminded of a parable of an old lady who swallowed a fly...

cbanek3• 2 years ago

I don't know why she'd swallow a fly? Perhaps she'll die?

jonplackett• 2 years ago

Kinda already on that train with the boat load of sugar to get overweight in the first place.

arcticbull6• 2 years ago

The problem is she swallowed everything else too. The obesity is a massive problem that needs to be remedied and yes there may be side effects along the way but literally nothing else works for obesity except roux-en-Y gastric bypass. Palid skin is nothing compared to losing your foot to diabetes.

__MatrixMan__• 2 years ago

I don't know much about skin care, but given that Ozempic has side effects that affect the retina, it wouldn't be crazy to get plenty of vitamin A if you're taking it.

thefz8• 2 years ago

Then if Retinol has side effects, take another pill to counter these; and if such pill has side effects too, why not resort to another, and so on.

brians• 2 years ago

The consensus is clear from the article but doesn’t support the headline: rapid weight loss changes the skin, which recovers over more time.

r00fus• 2 years ago

Not unlike the "massive muscle tone reduction" scare about GLP1 meds - you lose that muscle because you're also losing the fat you needed the extra muscle for...

nordsieck• 2 years ago

you lose that muscle because you're also losing the fat you needed the extra muscle for

That may be part of the cause, but it's also true that whenever you lose weight, you always lose some muscle. Even bodybuilders who are following the most aggressive protocol to minimize muscle loss (extremely high protein intake compared to other macros, along with intense strength training) will experience some amount of muscle loss along with fat loss when slimming down for competition.

mjamesaustin• 2 years ago

The relevant quote I saw was this:

"These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage."

Are you suggesting sections elsewhere in the article suggest otherwise?

remram• 2 years ago

It's not that clear. The article is specifically about this, is it just the speed or something else.

"We’re still waiting to find out," says Dr. Few. "I don't think anybody can tell you definitively that there's not an inherent change to the skin."

bamboozled3• 2 years ago

It's strange how there is almost never a shortcut to anything. Like a universal law.

So now you might get free weight loss without making any effort at all, but you'll also look older in the process?

I have to say, my father has been taking it, and I noticed that he does look older all of a sudden...and his weight loss also plateaued. I thought it was just my imagination, but maybe not.

mym19902• 2 years ago

I have heard that people who lose weight quickly will typically look older due to the development of wrinkles and the development of harder features. Skin simply doesn't have time to keep up with the weight loss. I don't know if this is true but the theory could have some merit as far as our perception of people. The real question is: does something like ozempic change the biological age of someone?

swozey• 2 years ago

You're going to need to include a weight percentage drop or something. I've wrestled/jiujitsued my entire life and we go up and down weight constantly, 2-30lb swings. We'll water + electrolyte fast for a week or two if we have to and drop 10-20lbs.

We all look 10-15 years younger than we are (35-45s).

But we're also not dropping 150-200lbs or whatever number you're potentially referring to to where skin would stretch. But prolonged, constant rapid dropping hasn't bothered our skin. I'm complimented all the time on mine.

https://old.reddit.com/r/wrestling/comments/2r9nwy/whats_the...

JumpCrisscross• 2 years ago

strange how there is almost never a shortcut to anything. Like a universal law

There are win-win tradeoffs. Vitamins, for instance. If you're running a vitamin deficiency, there isn't a downside to increasing your intake of that vitamin. (Curing acute dehydration via IV is another shortcut that just works.)

The Ozempic story, for me, has been more about how we almost seem to be reflexively against the idea of a win-win. A lot of people want there to be a tragic downside to the drug for reasons that aren't entirely clear to me.

xlbuttplug2• 2 years ago

But gluttony is a sin!

ethbr1• 2 years ago

Fat soluable vitamin toxicity? https://www.ncbi.nlm.nih.gov/books/NBK234920/

Because apparently a surprising number of people can't calculate bodyweight doses.

silverquiet2• 2 years ago

My perception is that we judge fat people as weak and contemptible and therefore a drug is allowing them to cheat their way out of their sin instead of paying the proper penance (diet and exercise).

It's well known that people treat fat people worse; I constantly wonder how aware people are of their own biases?

For what it's worth I've been fat before and I've been in shape before. I have my own biases that are beyond the scope of this comment. Never taken one of these drugs but only because of cost/access; I'm actually curious to experience them. If they work for people, I say they should take them.

PhasmaFelis3• 2 years ago

I think it's pretty simple, unfortunately. A lot of folks have this visceral, instinctive horror of fat people, and instead of examining that, they convince themselves that what they actually despise is laziness and gluttony: inner vices expressed outwardly, like a medieval morality play.

But if there's a way to lose weight without major lifestyle change, it threatens that tidy moral barometer. Someone might look virtuous without actually being so. Cognitive dissonance ensues. So they hope and wish for anything to catch out and punish these "cheaters."

thefz8• 2 years ago

The Ozempic story, for me, has been more about how we almost seem to be reflexively against the idea of a win-win. A lot of people want there to be a tragic downside to the drug for reasons that aren't entirely clear to me.

It's easy, substitute the obese with the smokers demographic. Imagine them whining that they smoke because it's an environmental issue, that they just can't do otherwise, that it's a metabolic issue and not a willpower one, a genetic thing, lack of access to alternatives... anything besides their own will.

I wonder how taking a medicine for the rest of your life is a win-win when there are places in the world where obesity is almost non existent and it's been proven to be largely lifestyle related. Besides, semaglutide just makes the subjects crave less, reinforcing the willpower role in weight loss.

I have read people in this forum state that if they eat less, they gain more weight for some unknown genetical issue, like thermodynamics do not apply to them.

salawat• 2 years ago

Ever heard of Fen/phen? Was a big thing back in the 90's. Weight loss drug combo that was ultimately found to do major harm.

You have to keep a clear head as an early adopter in some things, and be aware of incentives. Remember, the pharma company pushing the drug/treatment to market is out to make money first. Having a knock-on problem down the line to fix also serves that purpose, and in fact, has been a tactic employed by other notorious pharma manufacturers. Lest we forget the lessons of the opioid crisis do quickly.

armchairhacker• 2 years ago

What about people who are naturally thin?

wiseowise• 2 years ago

Harder to gain weight. Getting called skinny, etc.

goodJobWalrus2• 2 years ago

I see older very skinny women who look old and frail due to being very skinny. You need some fat under that skin to plump it up to look youthful. Catherine Deneuve I believe was the one that said that after the age of 40 you have to chose between your face and your ass. I say all of this as a 40 something woman.

digbybk• 2 years ago

Coffee being the only exception.

lagichikool2• 2 years ago

Even coffee is without its downsides and risks. There are cardiovascular risks, acid reflux, sleep issues, and probably more.

maximus-decimus• 2 years ago

coffee definitely ruins my sleep no matter what time I drink it, so there's that.

My father also had headache his whole working life on Sundays, not realizing that drinking coffee all week days but not on the weekend, that was probably coffee withdrawal that was giving him a headache by day 2.

rexer• 2 years ago

I don’t know, I think that might be a bias of some kind. The free shortcuts are obvious and so the alternative sounds ridiculous. No one claims to be a genius when they save time by driving instead of walking. But at the margin, of course everything has a trade off.

bananapub• 2 years ago

seems pretty unsurprising to me that when you shift the equilibrium of some extremely complicated system that evolved over an extremely long time to improve some metric, that the side effects are mostly moving down some other metric you liked.

or even more boringly: almost only bad things get called side effects rather than being redefined into the benefits

cm21878• 2 years ago

What kind of effort are you talking about? Weight loss has very little to do with exercise and mostly to do with how much you eat. Those drugs allow you to combat the carving when you restrict food. Is fighting the carving the "effort" you think people ought to make?

anakaine• 2 years ago

This, and there's seems to be a number of people with a misconception that getting medical assistance is either cheating, or you're not trying hard enough.

As someone who is quite strong and fit, but has a family history of obesity, and who has been packing on the kilos into their 40s - I've recently started with ozempic and it's a breakthrough drug. The incessant never ending demand to eat, that voice which never goes away and pervades every part of the day and task, the call which is almost impossible to ignore ore even after months of dieting and managing macros - it got moderated down from a 10/10 volume to about a 2/10 volume. I've started dropping the gut fat, and 6 weeks in my energy is coming back up to levels it was at 10 years ago.

I'm hoping that this isnt a permanent solution, but that it permits me to reset my bodies relationship with food, insulin, fat accumulation and hunger signals in the long term as the signalling cells senesce, the fat is reduced and demands less maintenance, etc.

Aperocky• 2 years ago

Weight loss has very little to do with exercise and mostly to do with how much you eat.

That's not an accurate statement. Over the past year I have averaged 2 hours of aerobics per day (~1500 active CAL). And I've simply buffeted my way eating multiple portions per day and haven't gained any weight.

It have a lot to do with a lot of exercises - it has little to do if you just had little exercise. It's all about the caloric balance, and it takes a lot of exercise to skew that balance while it's a lot easier to eat more.

throwup2384• 2 years ago

IMO GLP-1 agonists are obviously not free, from first principles. They might be for diabetics who carefully manage their diet, but many (most?) people using them for weight loss usually already have shitty diets with poor macronutrient balance and micronutrient deficiencies. Eating less of the crappy food they were eating before just makes the true situation worse.

This is just the latest [1][2] evidence for the obvious muscle wasting that will happen to a human body that is starved of protein and micronutrients. The muscles under the skin are being cannibalized for protein that’s missing in the diet and other biochemical processes that restore them are starved of the nutrients they need to function.

[1] https://news.ycombinator.com/item?id=37558780

[2] https://news.ycombinator.com/item?id=39326333

cameronh90• 2 years ago

Why do you think they just eat less of the same crappy food?

In my experience, it turned down the reward feedback for calorie dense food, and I would usually now prefer something like a lentil daal over a Dominos.

taneq• 2 years ago

This is basically the ‘no free lunch’ principle, and the thing to keep in mind is that there’s no universal free lunch, but that doesn’t mean no individual lunch is ever free. (The classic example is insulin for diabetics, which most certainly is a win.)

thefz8• 2 years ago

It's worth noting that people, in this forum especially, would defend weight loss drugs at any cost. Because for them they mean being not-obese without any trace of effort. Controlling caloric input, maybe even leaving the house and moving... puff. Gone. Just take a pill daily for the rest of your life.

exabrial• 2 years ago

here’s my casual armchair analysis about some thing I know nothing about: Is this correlation instead of causation? I mean, if you’re dumping pounds rapidly and then your skin is all been stretched out…

throwup2384• 2 years ago

From TFA:

These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.

hypercube33• 2 years ago

They aren't seeing it with other rapid weight loss so seems like no however this isn't a scientific study so it's just an observation.

dark-star3• 2 years ago

A quick explanation about what Ozempic is would be helpful in this case. Not every country uses the same name for their drugs and the brand names are often very different

istultus• 2 years ago

That's an interesting remark, considering this is most famous drug on the face of the Earth, and only has one brand name worldwide (in a different dosage it's called Wegovy, and when it's released as a pill it will be called Rybelsus). Its generic name is Semaglutide.

vintagedave• 2 years ago

Wouldn’t the most famous drug be: aspirin, heroin, cocaine, paracetamol, or maybe viagra?

I don’t know from your comment what it is, and it was unhelpful. Not really in the HN spirit. For future readers, it seems to be an anti-diabetic drug or artificial hormone originating in the 70s. More educated comments than mine are very welcome.

bgnn• 2 years ago

This is the first time I'm hearing about it. It seems here it's only prescribed to type 2 diabetes partients and doctors are strictly prohibited from prescribing it for weight loss.

Arubis• 2 years ago

I had never heard of this drug before today.

thefz8• 2 years ago

this is most famous drug on the face of the Earth

I swear in Europe if you stop 10 people on the street, 9 will ask you what the hell you are talking about

dark-star3• 2 years ago

lol what? Have you heard of Aspirin, Ibuprofen, Paracetamol? I bet you that by far more people know those three than "Ozempic".

azinman2• 2 years ago

It literally says this in the article.

dark-star3• 2 years ago

It says that a lot of people are on Ozempic. And that it changes the skin somehow. And that these people get plastic surgery.

If you search for "diabetes" in the article, then yeah, you'll find it about half way down, but by then I already stopped reading because I had no idea what the whole article was about.

So yeah, it might technically be in the article, but it wouldn't have hurt to put it in the post title now, would it?

metadat2• 2 years ago

Was this article written by an LLM? I had to scroll so far to get to the core content it kept promising, it's like it wasn't written for human consumption.

Ultimately this article is kind of a FUD nothing-burger. People's skin behaves the same anytime there is rapid weight loss.

throwup2384• 2 years ago

These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.

metadat2• 2 years ago

TFA contains mixed messaging. The part you quoted is discussing face skin, then later, also talking about face skin:

(“We see a similar pattern in other causes of rapid weight loss, including gastric bypass surgery, he says.) In some cases, the loss of subcutaneous fat is significant enough that it impacts a patients’ ability to get injectables ..

So which is it?

My takeaway was that losing weight fast == problematic.

The article dials up the FUD factor to the max, which makes me question the quality of reporting and any intent to accurately inform vs. just get clicks.

PhasmaFelis3• 2 years ago

I've got no dog in this fight, but the article explicitly says this is different from the normal effects of rapid weight loss on skin.

cm21878• 2 years ago

And if that's true, what is the conclusion? Stay obese to have a beautiful skin (and deal with the associated health effects)?

ikurei• 2 years ago

There are more options. Many medications are usually prescribed together with other meds, to help with the side effects. We may adjust the formulations, or learn what to compliment it with.

readthenotes1• 2 years ago

You remind me of a quote from a book whose name I can't remember:

She had the unwrinkled face of a woman who had never been calorically challenged.

Saline95152• 2 years ago

The article explains that this happens also with patients who aren't obese but are using ozempic to lose 20 pounds.

It's an important side effect that ought to be researched.

rtsil• 2 years ago

I'd say a more important side effect that ought to be researched is possible thyroid tumors, including cancer.

In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.

https://www.ozempic.com/how-to-take/side-effects.html

irusensei• 2 years ago

Hit the gym eat healthy and get fit while retaining your beautiful skin?

cm21878• 2 years ago

Let them eat cake

mistercheph• 2 years ago

There's no shot that the cure everything pill will have any negative health consequences, it's been working so well for me that I just spoke to my pharmacist and we're doubling my dose.

brigadier132• 2 years ago

Two guesses:

- it's just stretched skin

- people get on ozempic but are not eating nutritious diets, so now they are malnourished

ceejayoz• 2 years ago

This is a challenge for the first hypothesis:

These are changes he hasn’t noticed in patients who have lost significant weight in other ways—like through diet or gastric bypass surgery—which makes him think it’s unique to GLP-1 usage.

pwthornton2• 2 years ago

I've seen other data that says that 50% of weight lost on these drugs is muscle mass, which is high for weight loss. You should expect to lose both muscle and fat when losing weight, but that's a very high ratio. With weight lifting, you can attenuate that a bit, perhaps completely.

It would be interesting to see a study that compares people who take GLP-1 drugs and make no other modifications and others who lift heavy weights under supervision.

The other issue that should be studied is diet. If you eat a poor diet lacking in protein and then you take drugs to make you less hungry and now you just eat the same diet but less, you may not be getting nearly enough protein.

It would also be good to study the impacts of protein consumption while taking these drugs.

I also wonder about the velocity of weight loss. Losing weight too fast could also be part of the issue.

comice• 2 years ago

Worth keeping in mind that many plastic surgeons are in competition with drugs like Ozempic.

fyrepuffs• 2 years ago

People are coming to them with sagging skin from Ozempic. Since 6% of Americans are on it now (according to that article), how is that competition for the plastic surgeons?

frosting1337• 2 years ago

Liposuction is incredibly profitable for plastic surgeons worldwide.

cosmicvarion• 2 years ago

Don't these plastic surgeons have a conflict of interest if they perform liposuction? Liposuction is probably wildly more profitable than prescribing a GLP-1 inhibitor.

Saline95152• 2 years ago

As the article says, they have patients come anyway to reduce the side effects of GLP-1.

Plastic surgeons are like the bank in casino: they always win in the end.

cm21878• 2 years ago

Not the least because aging only goes one way!

gosub100• 2 years ago

"...but gravity always...wins"

arcticbull6• 2 years ago

“Fifteen years ago, I would never have done a lower body lift on a patient unless they had gastric bypass, a lap band, or a gastric sleeve,” he says.

Right, because 15 years ago nobody else lost any weight. GLP-1s and roux-en-Y are literally the only two treatments shown in clinical studies that cause people to lose weight and keep it off indefinitely.

Maybe the skin is saggy because there’s nothing under it, maybe not? But at least they won’t have a stroke, heart attack, cancer or type 2.

Chemo is going to make you look much worse.

The new category of patient is “person who successfully lost weight and kept it off without gastric bypass.”

[edit] if you think I’m exaggerating there’s a great study from 2023 that tracked how many people lost more than 5% body weight in a given year.

Answer: 1 in 10, skewing mostly to people who had more to lose.

If you were morbidly obese your probability of achieving a healthy weight is 1 in 1667 in a year.

And if you manage to thread that needle your average weight regain over 5 years is 80%.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

orwin• 2 years ago

Wow. 10% success rate for diet is really lower than I thought. I'd have guessed 25% based on my experience (34 BMI to 25 over 6 years). Not that surprising though, loosing weight is the hardest, most painful thing I ever done.

arcticbull6• 2 years ago

I’m glad you better appreciate just how much you beat the odds! Congrats.

Andaith• 2 years ago

GLP-1s and roux-en-Y are literally the only two treatments shown in clinical studies that cause people to lose weight and keep it off indefinitely.

Total Diet Replacement (TDP) is apparently also quite effective. This isn't the article I read, but it's talking about the same trial(Direct) so here you go: https://tdmr-europe.com/2024/01/17/experts-demonstrate-total...

freitzkriesler2• 2 years ago

If you're using ozempic or any other form of semiglutide , you'll want to keep and prioritize a high protein diet to reduce or eliminate the muscle wasting that the drug causes.

Nothing worse than losing weight but most of the weight loss was muscle mass.

Modified3019• 2 years ago

My impression from watching various people debating studies on the topic, is that even more important than protein is physical activity, when it comes to stopping muscle loss. Someone sitting in a box eating nothing for a month will come away from it with all sorts of health issues compared to someone who walks for half an hour and otherwise lives normally, despite the second person supposedly having higher energy and nutritional needs. Physical activity is a powerful signal to the body to maintain itself. This is why the health of bedridden people looks like a horrible feedback loop that destroys them.

Another issue that makes me wary is that normally when fasting, there’s an initial period of being hungry, followed by adaption and minimal/no hunger. After a few weeks (or longer if there are special circumstances), hunger should eventually return, and this is your signal to start eating again regardless of plans. What concerns me is that Ozempic may prevent the return of hunger signal. I could see this leading to malnutrition, which another post already mentioned in a different way.

cm21878• 2 years ago

In the UK those products are only available to people with a BMI > 30. If you have 20 or 30 kg to lose it is simply not true that most of the weight loss is muscle mass. The fat is visible and the fat loss is also visible. You might lose a bit of muscle mass, and doing exercise at the same time is good. But between the loss of a bit of muscle mass during the diet vs remaining obese, it is an easy trade off from a health point of view.

thefz8• 2 years ago

BMI is an empty metric anyway, you can be VERY muscular, slim but not very tall and still being in the same category of a near obese person.

prbl2• 2 years ago

A few things to consider:

1. If other weight loss methods also have significant impacts on the skin, it seems plausible that a shared mechanism could be the most parsimonious explanation. Therefore, if this effect exists, it might be due to weight loss itself rather than specifically due to Ozempic. The article cites a study supporting the fact that dramatic weight loss has negative impacts on skin health.

2. GLP-1 agonists modify appetite, which could lead people to consume less satiating foods (e.g., protein). This might negatively affect both lean muscle and skin health. There is data supporting collagen supplementation for skin health, as collagen likely raises serum amino acids. This would have the opposite effect on skin health compared to a lower intake of protein.

3. The observations made by plastic surgeons might be influenced by healthy user bias. Ozempic is an expensive medication, and insurance coverage is generally granted to those who are already quite unhealthy. To make a fair comparison, these patients should be compared to individuals with similar health characteristics.

It's also worth adopting an engineering mindset and considering the trade-offs involved. For someone who is extremely metabolically unhealthy, the benefits of weight loss might outweigh potential negative effects on the skin in terms of long-term health.

fnord77• 2 years ago

wonder if this happens with Mounjaro, too

ddmf• 2 years ago

I've been using tirzepatide since the end of february, since then I've lost 52lbs in about 25 weeks, if my fat skin was stretched and it's since relaxed at a rate of 2lbs per week then maybe right now it is like an old rubber band that's been unstretched, but in a few months time once the rate of loss reduces it will be ok. I'm almost 50 so tbh I expected it to be much worse, I've virtually no loose skin compared to the 6 inches I've lost around my waist.

czard0mn• 2 years ago

Gum Gum fruit, unlocked. Am now a Sun God.

Ozempic is changing people's skin, say plastic surgeons

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