After the GLP-1 What Now?

By Dr. Wendy Gottlieb, MD, FACS | Board-Certified Plastic Surgeon, Reston, Virginia

If you've turned on the news, scrolled social media, or sat in a waiting room recently, you've probably heard about Ozempic, Wegovy, Zepbound, or Mounjaro. These GLP-1 medications have helped a huge number of patients lose weight they were never able to lose before — and that's a genuinely good thing. I'm not the physician prescribing these medications, so I'll leave the dosing and medical management to your primary care doctor or endocrinologist. What I see, week after week in my practice, is what comes next: patients who have done the hard work of losing the weight and are now asking, "Now what do I do about the skin? The volume? The way my face and body look after all this change?"

That's the conversation I want to have here.

A Quick Word on the Medications Themselves

In brief: most of these drugs work by mimicking gut hormones that control appetite and fullness. They're effective, and for many patients, life-changing. If you have questions about which medication is right for you, dosing, or side effects, that conversation belongs with your prescribing physician. My focus is on what happens to your body and face once the weight has come off — and what your options are.

After the GLP-1: What Now?

Rapid, significant weight loss changes more than the number on the scale. It changes how your skin fits, where volume has been lost, and how your face and body look at your new size. These changes don't resolve with diet, exercise, or more time on the medication — they require a different kind of care. Broadly, patients tend to notice changes in two areas: the body, and the face.

Your Body: Addressing Loose, Excess Skin

When fat is lost quickly, the skin that stretched to accommodate it doesn't always shrink back down, especially with more significant weight loss or in patients over 40. Research has shown that rapid fat loss is associated with thinning collagen fibers, elastin breakdown, and increased activity of enzymes that degrade skin structure — all of which reduce the skin's ability to "bounce back" on its own.

For patients who reach a stable weight and are left with excess, sagging skin around the abdomen, arms, thighs, breasts, or back, body contouring surgery can address what diet, exercise, and medication alone cannot. Common procedures include:

• • Abdominoplasty (tummy tuck) for excess abdominal skin and muscle laxity
• • Arm lift (brachioplasty) for loose skin along the upper arms
• • Thigh lift for sagging skin on the inner or outer thighs
• • Body lift for circumferential excess skin after major weight loss
• • Breast lift for volume loss and sagging following weight reduction

If you're on one of these medications, the general recommendation is to wait until your weight has been stable for six to twelve months before pursuing surgery. This allows your weight loss to fully settle and gives us the clearest picture of what contouring will actually be needed.

Your Face: Addressing Volume Loss and "Ozempic Face"

Facial changes are one of the most common — and most surprising — side effects of major weight loss. Patients often lose facial fat right along with body fat, and because the face relies on that fat for a smooth, youthful contour, the result can be a hollowed, gaunt, or tired appearance often nicknamed "Ozempic face." Volume loss tends to show up in the temples, cheeks, under the eyes, jawline, and around the mouth and chin, and it can make patients look several years older than they did before losing weight — even though they're thrilled with their new body.

The right treatment depends on how much volume has been lost and how much the skin itself has begun to sag:

• • Dermal fillers or fat transfer to restore volume in the cheeks, temples, and under-eye area — a good option for volume loss without significant sagging
• • Facelift to address sagging skin, jowls, and deeper folds when skin laxity is the primary concern
• • Neck lift to tighten loose skin and banding along the jawline and neck, which often accompanies facial volume loss

Many patients benefit from combining facial and neck rejuvenation with body contouring, since both stem from the same underlying cause: the skin and soft tissue no longer matching the new, smaller frame underneath.

Let's Talk About Your Goals

If you've lost weight on a GLP-1 medication and are wondering what's possible next — for your body, your face, or both — I'm happy to walk you through your options in a private consultation. Reaching your goal weight is only part of the journey; what you do next is what determines how the results look and feel.

Dr. Gottlieb is recognized among Washington DC's top plastic surgeons for excellence in cosmetic and reconstructive surgery, having been named a Washingtonian Magazine Top Doctor for 2025.

Call our Reston, Virginia office at 703-668-9499 to schedule a consultation with Dr. Wendy Gottlieb.

This article is for educational purposes only and is not a substitute for medical advice. Please consult your prescribing physician before starting or stopping any medication.