Ozempic's side effects revealed: Sagging faces, wrinkles

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Last fall, Alla started using Ozempic to lose weight. After six months on the drug, the 55-year-old had dropped 55 pounds from her 5-foot-4-inch frame. Her body looked 10 years younger, but her face had aged a decade.

“My face really started to sag,” she told The Post of experimenting with the diabetes drug that Americans across the country have been using off-label to shed pounds fast.

“I noticed more wrinkles, especially in my cheeks and sides of my face,” continued Alla, who lives in New Jersey and declined to share her last name for privacy reasons. “If I looked in the mirror from the side, my face just looked flat —like it hung with no actual structure or characteristics of myself.” 

Alla’s doctor had prescribed Ozempic after her initial weight gain had caused her to develop Type 2 diabetes. While the semaglutide drug retails for around $900 for a 1.5 milliliter pen and lasts for one month, Alla’s prescription was 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 add a little lift to her cheeks, as well as the filler Radiesse to smooth out her wrinkled smile lines.

Diabetes drug Ozempic and the similarly formulated Wegovy have been phenomenally popular for those looking to lose weight quickly, with everyone from Elon Musk to Chelsea Handler admitting to having tried semaglutide injections. Demand has been so high, both drugs are now listed in short supply on the Federal Drug Administration’s drug shortage website. Now users are dealing with one dreaded side effect — “Ozempic face,” which causes facial skin to look gaunt and aged because the face has lost fat so quickly. And people are flocking to dermatologists and cosmetic surgeons for pricey fixes.

“This is just bringing demand to our practice to the next level. Many are losing weight in their midface — tissue in this area contributes to a youthful structure and when it is lost it leaves the face looking saggy and gaunt,” said Tara Adashev, an advanced practice registered nurse at Manhattan’s Neinstein Plastic Surgery, who worked with Alla.

The most commonly impacted features, she said, are drooping cheeks, which can also lead to slight indents and wrinkles at the temples, as well as sunken under-eye areas. Skin under the chin can also start to sag for those who lose more drastic amounts.

To counteract Ozempic face, Adashev’s practice uses hyaluronic acid fillers, such Restylane or Juvéderm, to improve immediate volume loss. Then, they add in a secondary filler such as 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.

Upper East Side plastic surgeon Dr. Robert Schwarcz will ask patients to bring in old photos of themselves pre-weight loss and in their younger years so he can see where face fat is naturally distributed.

“The last time we saw something this extreme was during the rise of lap-band surgeries in the early 2000s,” Schwarcz told The Post.

He noted that loss of fat in the center cheek area and neck can result in “significant aging.” With longer term use, the temples can also be impacted, yielding a “skeleton eye look that makes people look older than they should,” he said. 

For women 50 and up exhibiting this, Schwarcz will typically recommend a facelift, which can cost between $35,000 and $40,000. In more severe cases, he’ll use fat grafting (also called fat transfer or fat injections), which can cost between $4,500 and $6,000, to surgically transfer one area of fat to another. For younger patients, he tends to use fillers (from $1,000 to $1,500 per vial).

Rachel Clewell, a 43-year-old medical assistant based in central Florida, lost 64 pounds after six months on Mounjaro, a tirzepatide injection used to treat Type 2 diabetes that, like Ozempic, is prescribed off-label for weight loss.

The mom of three, who currently weighs 201 pounds, says she’s now seeking out a consultation to address wrinkling from excess skin in the neck area. She’s also continued to get Botox every few months since starting the drug last August to help ward off aging effects.

“I’ve noticed loose skin under the chin and neck area. Other than that, my cheeks have thinned out,” she said. “But before, I felt like you couldn’t even see my eyes because all you could see were my cheeks. It’s definitely a lot to get used to my new body, but I’m enjoying it.”

Similarly, Boca Raton-based registered nurse Ilana Mechoullam, 33, thought her face appeared older after rapidly losing weight. Mechoullam, who runs the medical spa Peace Love Med Aesthetic Rejuvenation, told The Post she shed 50 pounds since starting Ozempic nearly a year ago after gaining weight during the early days of the pandemic. Now, she weighs 110 pounds.

“A lot of millennials are on Ozempic. We’re seeing young people come in looking very aged,” she said.

To treat her own sagging skin, Mechoullam started using filler for her chin and cheeks ($849), as well as under the eyes ($1,000). She also did four sessions of microneedling (totaling around $2,796), a cosmetic procedure that repeatedly punctures the skin with tiny needles to help stimulate collagen production and make the skin appear more youthful.

“It’s a double-edged sword,” she said of weight loss resulting in an older-looking face. “You can’t have your cake and eat it, too.” 

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