Why do you need a dermatologist if you're taking Ozempic?

Ozempic is the new Hollywood buzzword. This injectable weight loss drug originally meant to treat diabetes is – somewhat controversially – now being used as a weight loss aid by everyone from the Kardashians (allegedly) to Elon Musk. While its usage is up for debate, what we want to concentrate on is the skin related saga that accompanies it – ‘Ozempic face’.  As a by-product of extreme weight loss Ozempic face can look gaunt, deflated and saggy.

We dove into the topic with expert Dr Nour Gerbaka. Dr Nour is a Beirut-based medical, surgical, cosmetic Dermatologist and co-owner of Gerbaka Skin Clinic in Beirut with a specialty in aesthetics and lasers. Her practice is mostly oriented towards Integrative Skincare, cosmetic ingredients, non-surgical skin improvement including lasers, Radiofrequency, and broad light treatments, and aesthetic procedures.  She has published articles in the JDP (Journées Dermatologiques de Paris), in the BMC Public Health Journal, and was a speaker at the Lebanese Society of Dermatology. She has ongoing projects with Pierre Fabre Middle East and L’Oreal Middle East. She also consults at the Lebanese Hospital Geitawi with a focus on Internal Diseases, and surgeries.

Here she talks to Tru & Beyond’s founder Miriam Abadi about Ozempic face and how to manage it.

There is so much interest in Ozempic nowadays so let's start with what is Ozempic?

Like many other medications for diabetes that also lead to weight loss, Ozempic is a medicine that is used for diabetes and for weight loss. It targets weight loss by targeting the brain receptors and reducing the sensation of hunger and also increases the time it takes for your body to process that food through your system which keeps you fuller for longer. Because the Kardashians supposedly took Ozempic, it has a huge surge in brand recognition. It is a great medication for those who are obese with BMI over 30. Sometimes it can be prescribed for those who have a BMI of 27 but complicated medical histories and may need the extra help to lose weight. Like every medication, it has side effects e.g. GI symptoms, vomiting, diarrhea etc for the first few weeks but they subside with time. Every extreme weight loss effects the skin and fatty tissues which leads to saggy skin. The tricky thing about Ozempic is that the term ‘Ozempic face’ - which is not a medical term but has come about as a result of its usage -  scares people. However, if you require this medication the accompanying saggy skin shouldn’t be a deterrent. You should work on a treatment plan with your dermatologist to avoid any shocks. 

I keep hearing that Ozempic makes you lose a lot of fat in your face, however, as we grow older we don’t want to lose volume in our face. Many people who are on Ozempic are healthy and fit and taking it to reach their ‘ideal’ body goal. Therefore, extreme weight loss is really taking a toll on their faces. As a dermatologist what can you do prevent this effect?

Just to clarify Ozempic isn’t a medicine that specifically targets fat in the face. However, as we age the facial fat tissue has a tendency to shrink faster than the rest of our body. With age, the muscles and ligaments in the face become looser e.g. someone taking Ozempic at age 25 will have a very different fat loss in the face vs someone taking it aged 45. To restore the fat tissues in the face there are a lot of different techniques. In the face we have the skin which loses collagen over time, we have fat tissue which is under the skin, then the muscle, the deep fat, and lastly the bone. When you lose the fat tissue fillers are a great replacement to help replace the volume. For those who want a more long-lasting solution, fat injections are a good option. This involves taking fat from a patients thighs or tummy and injecting it into the face. More courageous patients who want a durable result, opt for surgeries like facelifts and fat grafting. Gen Z prefers biosimulation and more natural options to restore the collagen. These treatments are most effective when combined e.g. Radio frequency, micro-needling, fillers and Botox together. These are preventative measures that ensure that the skin stays looking younger well into the 40s. With Ozempic usage, it is very important to have a treatment plan in place with your dermatologist.

If I was a patient wanting to drop 7kg quickly, how would that process go?

There are many options on the market for fast weight loss. My first reaction would not be to recommend Ozempic. I would generally recommend a natural path consisting of a healthy diet and workouts. However, if the client is adamant on Ozempic as a dermatologist, I would work alongside an endocrinologist who specializes in diabetes. If they decide to take Ozempic we would do blood tests to see the compatibility of the medicine and monitor the effects on the patient. 7 kg is relative to the patient, for some it's a lot for others it’s not. For you, Miriam, 7kg is a lot so you would lose fat in your face for sure. As we don’t want this loss we would start with the collagen, to create the structure to tighten the skin. I like to use micro-needling – I love the Morpheus machine – Profhilo and Polylactic Acid for thinner skin. We could vary the treatment to include stem cells and exosomes keeping skin types and requirements in mind. Gradually when the tissue and fat loss occurs, we would introduce fillers. With fillers you never go back to zero, there is always more volume than when you started so this can be continually built upon to achieve the required results.

I’m a bit scared to do Morpheus more than twice a year, I feel my skin may get too used to it. How many times would you do Morpheus during this process with Ozempic?

We get this question a lot about Morpheus, patients are often scared that they will lose fat in their face with the machine and they are justified in thinking that. Morpheus goes into different depths of the skin, for someone with very thin skin, their subcutaneous fat will be lost. But it does not make you lose the deep fat. It is very important to consult your dermatologist and explain your personal preferences. This is a machine that needs to be operated by doctors. Beauticians are not trained to handle these machines. And don’t worry your skin won’t get used to the machine. We all have collagen cells in the body that shrink with time, Morpheus heat stimulates the fibers in the skin to encourage collagen production. They need time to produce this collagen, so you won’t see the results straight away. With time and each use the skin will continue to improve. Morpheus alone will not change your skin, you need skin boosters, Profhilo and a rigid skincare routine. Sunscreen is key!

What is your opinion about the Forma machines?

The creators of Morpheus also created Forma. Morpheus’s technology is that the needles deliver the heat deep into the skin both vertically and horizontally. Forma is an integrative part of Morpheus. Morpheus treatments have to have a 6-week gap to allow collagen production. Forma is an RF (Radio Frequency) head that works on the surface of the skin delivering RF under the skin. Between Morpheus sessions, you can introduce Forma sessions, which will not damage the skin but improve it further. The idea is to combine both for the best results. For those who have needle phobia, Forma is a great option. While it won’t give the same intensity of results as Morpheus it is still a great alternative. Machines are all about parameters. If the setting is too low there will be no results, too high and the skin can burn, just right and the results are effective!

How many sessions of Morpheus should one do?

This is dependent on the person. Those with saggier skin need more than those with taut skin. A general rule is to start with 3 sessions.

Can we do Botox and fillers at the same time as Forma and Morpheus?

It is absolutely fine to do Botox and fillers with Forma as the epidermis is intact. However, when you are doing Morpheus, you can technically do Botox at the same time as the results don’t show for 4/5 days so long as the person injecting it knows how to do it well, which needle to use etc. We prefer not to do fillers at the same time as there is skin inflammation, and the results won’t reflect how we would want them to. Even with just Botox and fillers, I would recommend doing them at different sessions. When we inject Botox around the eyes sometimes the cheek already lifts so you don’t want to put the filler in the cheek at the same time. It is better to see the effect of the Botox and then do the filler.

Do the Ozempic results last?

Once you are off Ozempic the hunger suppression will subside, and your normal pangs will kick in. If you continue with an unhealthy lifestyle the weight will come back. After Ozempic you should try to stick to a healthy diet and exercise routine. Slight weight gain after Ozempic will occur for sure as your hunger returns. Even for collagen production, bone broth, and protein will help maintain youthful-looking skin so it's important to eat well.

What are your thoughts on collagen supplements?

Collagen is a very controversial subject. Patients in the clinic always say their skin looks better with the supplements. Collagen is never purely collagen, it contains Biotin, peptides, and vitamins. Studies are often divided on the subject. I was at a conference where they analyzed a piece of skin before and supplements and then the patient took 6 months of collagen supplements (5 mg). When the analyzed the skin post this intake, they saw there was no increase in collagen level inside the skin but they saw the increased effects it had on wound healing and scarring, so collagen was definitely present in the blood. There is no real product that integrates collagen into the skin, however, it is not harmful at all especially if it makes you feel glowy!