Letter to the Editor: Comment on Implications of Ozempic and Other Semaglutide Medications for Facial Plastic Surgeons

Implications of Ozempic and Other GLP-1 Receptor Agonists for Facial Plastic Surgeons

To the Editor:

We read with interest “Implications of Ozempic and Other Semaglutide Medications for Facial Plastic Surgeons” by Humphrey and Lawrence.[1] We believe it is prudent to raise the following two points which should be taken into consideration by readers of this publication.

First, it is important to clarify that, according to its US Food and Drug Administration (FDA) approval, once-weekly semaglutide (Ozempic, Novo Nordisk, Bagsværd, Denmark), administered subcutaneously at 0.5 mg, 1.0 mg or 2.0 mg depending on the level of glycemic control required, is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.[2] It is also approved by the FDA for use in adults with type 2 diabetes and established cardiovascular disease to reduce the risk of major adverse cardiovascular events.[2] It is administered either as monotherapy or in addition to other medicinal products for the treatment of type 2 diabetes. Readers should be aware that Ozempic is not indicated for chronic weight management and the adverse events listed within its Prescribing Information do not include changes in facial features.[2]

Second, Humphrey and Lawrence discuss weight loss throughout the body (including the face) following treatment with glucagon-like peptide-1 (GLP-1) receptor agonists, which can result in changes to skin properties and facial features, potentially causing an aged appearance and negative impact on self-esteem.[1] Indeed, it is known that the appearance of accelerated aging of the face can be an unintended consequence of rapid weight loss (for example, already well described following bariatric surgery), due to volume loss in the face and neck and reduced skin elasticity.[3] Apart from these effects, there are important health-related benefits that follow intentional weight loss, such as improvements in cardiovascular health.[4] As stated by Humphrey and Lawrence, the impact of weight loss on facial appearance is not often measured or commented on,[1] but is likely to gain traction as anti-obesity medication options increase.

While considerations around changes in facial features may be important to some patients taking semaglutide or other GLP-1 receptor agonists, these changes are not mentioned in the Ozempic Prescribing Information.[2] There are, however, studies that demonstrate improvement in quality of life following treatment with GLP-1 receptor agonists, for example, following semaglutide treatment, potentially as a consequence of weight loss.[5] [6] [7]

Yours sincerely,

Marco Bo Hansen, MD, PhD, Global Medical Director,

Katrine Louise Krogh Pedersen, MSc, Safety Surveillance Specialist, and

Ting Jia, MD, PhD, Senior Director, Medical & Science,

Affiliation: Novo Nordisk A/S, Søborg, Denmark

Publication History

Article published online:
11 April 2024

• References

• 1 Humphrey CD, Lawrence AC. Implications of Ozempic and Other Semaglutide Medications for Facial Plastic Surgeons. Facial Plast Surg 2023; 39 (06) 719-721
• 2 Novo Nordisk A/S. Ozempic (semaglutide) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/209637s020s021lbl.pdf (accessed 12 February 2024).
• 3 Waltzman JT, Zins JE, Couto RA. Face and neck lifting after weight loss. Clin Plast Surg 2019; 46 (01) 105-114
• 4 Look AHEAD Study Group and Gregg E. Association of the magnitude of weight loss and physical fitness change on long-term CVD outcomes: The Look Ahead study. Lancet Diabetes Endocrinol 2016; 4: 913-921
• 5 O'Neil PM, Rubino DM. Exploring the wider benefits of semaglutide treatment in obesity: insight from the STEP program. Postgrad Med 2022; 134 (sup1): 28-36
• 6 Jódar E, Michelsen M, Polonsky W. et al. Semaglutide improves health-related quality of life versus placebo when added to standard of care in patients with type 2 diabetes at high cardiovascular risk (SUSTAIN 6). Diabetes Obes Metab 2020; 22 (08) 1339-1347
• 7 Rajamand Ekberg N, Bodholdt U, Catarig A-M. et al. Real-world use of once-weekly semaglutide in patients with type 2 diabetes: Results from the SURE Denmark/Sweden multicentre, prospective, observational study. Prim Care Diabetes 2021; 15 (05) 871-878