In recent years, GLP-1 receptor agonists like Ozempic® (semaglutide) and Mounjaro® (tirzepatide) have revolutionized the landscape of medical weight loss. Originally developed to manage type 2 diabetes, these medications are now widely prescribed for obesity and cosmetic weight reduction. However, with rapid and often dramatic weight loss, a new aesthetic concern has emerged—commonly known as “Ozempic face” or “Mounjaro face.”

As facial plastic surgeons, we’re seeing a significant uptick in consultations related to this phenomenon, and the demand for restorative facial procedures is rising accordingly.

What Is “Ozempic Face” or “Mounjaro Face”?

The term refers to the volume loss and skin laxity that can result from rapid weight loss, particularly in the midface, temples, and jawline. While GLP-1 medications are medically effective for systemic health, the face is often one of the first areas to show signs of catabolic changes.

Common features include:

• Sunken cheeks and temples
• Hollowed eyes and under-eye bags
• Sagging jowls and nasolabial folds
• Accelerated appearance of aging

This is especially pronounced in individuals over 35, when collagen and facial fat compartments are already naturally declining.

Why Does This Happen?

GLP-1 medications like Ozempic and Mounjaro work by:

• Suppressing appetite
• Slowing gastric emptying
• Regulating insulin and blood sugar

While the systemic benefits are profound, rapid fat loss in facial areas with thin skin and limited structural support often leads to:

• Loss of deep fat pads (malar, buccal, and periorbital)
• Volume deflation without time for skin redraping
• Laxity exacerbated by aging or sun damage

This can result in a gaunt or aged appearance, despite overall improvements in body composition.

Facial Plastic Surgery & Aesthetic Solutions for Ozempic/Mounjaro Face

Fortunately, there are several effective surgical and non-surgical treatments to restore facial harmony after GLP-1-related weight loss.

1. Facial Fat Grafting

One of the most natural and long-lasting solutions, autologous fat transfer replenishes lost volume using the patient’s own fat harvested from other areas. It’s ideal for:

• Midface and cheek augmentation
• Temple hollowing
• Nasolabial folds

2. Mini Facelift or Deep Plane Facelift

For patients experiencing laxity and jowling, especially over age 40, surgical lifting procedures such as a mini facelift or deep plane facelift can re-suspend tissues and tighten skin for a more youthful contour.

3. Dermal Fillers

Hyaluronic acid and collagen-stimulating fillers offer non-surgical volume restoration and contour refinement, particularly for younger patients or those early in their weight loss journey.

4. Skin Tightening Treatments

Devices like Ultherapy®, radiofrequency microneedling, and laser skin tightening can help stimulate collagen and improve mild to moderate laxity.

Mounjaro vs. Ozempic: Are Facial Effects Different?

While both medications act on the GLP-1 pathway, Mounjaro (tirzepatide) is a dual GIP and GLP-1 receptor agonist and may induce more significant weight loss than Ozempic. This can translate to more pronounced facial volume loss, especially in leaner individuals.

That said, individual responses vary based on:

• Duration of use
• Dosage escalation
• Baseline facial fat distribution
• Age and skin elasticity

Should You Start GLP-1 Therapy If You’re Concerned About Your Face?

GLP-1 medications like Ozempic and Mounjaro are powerful tools for metabolic and cardiovascular health, and their aesthetic impact can be proactively managed. If you’re considering or currently using these medications and are concerned about facial changes, a consultation with a board-certified facial plastic surgeon can help you develop a tailored plan for volume preservation and facial support.

Conclusion

The rise of Ozempic face and Mounjaro face highlights an important interplay between systemic health and facial aesthetics. As weight loss medications reshape the future of obesity management, facial plastic surgery continues to evolve in response, offering solutions that restore balance, youthfulness, and confidence.

Double eyelid surgery, also referred to as Asian eyelid surgery and Asian blepharoplasty, was first described by a Japanese surgeon by the name of Dr. Kotaro Mikamo in an 1896 publication entitled “Plastic operation of the eyelid” in J Chugaii Jishimpo, during the Meiji era. In his publication he describes the prevalent eyelid appearance in the Japanese population to be the “double” eyelid, which occurred by his account in approximately 80% of the population, and sought to emulate and recreate this aesthetic for the minority who did not possess it at birth. He sought to define and enhance a Japanese aesthetic to create natural looking eyes, eyes that look like the patient could have been born that way. One of his before and after photos includes a patient with a natural supratarsal crease (upper eyelid crease) on her left eye, which he successfully recreated with surgery on the right eye.

More than half a century later, an American by the name of Dr. Ralph Millard began his rudimentary attempts at double eyelid surgery while stationed in Korea during the Korean War (1950-53), operating primarily on Korean war brides married to American servicemen, with middling results. While he often did create an upper eyelid crease, judged by the lens of today’s cosmetic surgery standards, the aesthetic would have likely made him the center of a bit of derision. Nevertheless, this marked the seminal moment for Korean surgeons to begin developing their techniques and refining their aesthetics. In 1961, the first university department of plastic surgery in Korea was developed at Yonsei University, and in 1974, the Supreme Court in Korea approved plastic surgery for cosmetic purposes as medical practice.

Fast forward to today, and Korea has enjoyed a reputation for decades of being a world leader in plastic surgery and especially cosmetic plastic surgery. K beauty has come to symbolize the blending of leading technology with the most advanced cosmetic treatments. Part of this rapid rise in plastic surgery mirrors the rapid rise of Korea’s economy, technology and infrastructure coming from the ruins of the Korean war. The combination of work ethic, creativity and innovation have helped to push forward development and progress, with increasingly refined results.

In this globalized climate contemporary plastic surgeons occupy, the sharing of knowledge, techniques and ideas through publications, meetings, and instantaneously through broadband connections, allows us all to push each other to even greater heights.

Although a generalization, most Asians patients seeking rhinoplasty desire some degree of augmentation or projection, while most white, Middle Eastern, or Jewish patients will seek out a more reductive rhinoplasty procedure. During traditional reductive rhinoplasty, the existing width, volume and size of the nose can effectively be reduced by removing and excising the pre-existing cartilage and bone. Commonly a white, Middle Eastern or Jewish patient will seek out reduction of a dorsal hump, or bump on the bridge of the nose, which can be accomplished by removing excess bone and cartilage, followed by fracturing and narrowing the nasal bones. These surgical maneuvers require no additional tissue or support to supplement the nasal anatomy.

In contrast, many Asian patients have a smooth and straight dorsum (nasal bridge) naturally, and the shape of the intrinsic anatomy may be preserved. The nasal pyramid often has a wide appearance from frontal view not due to wide nasal bones, but due to the small overall size and projection of the nasal bones. In other words, the base of the nasal pyramid frequently has an optimal width naturally, and thus does not require frequent fracturing. Rather, Asian patients more commonly benefit from augmenting the projection of the nasal pyramid and dorsum, creating a taller profile but also generating a slimmer appearance from the frontal view by establishing the contours of a well-defined dorsal aesthetic line. In order to augment the nasal bridge or dorsum, more volume is needed.

This volume for dorsal augmentation can potentially come from a variety of sources, including synthetic (alloplastic), natural (autologous) or even from a deceased person (cadaveric). Of all the potential options, tissue from your own body (autologous) has the lowest risk of side effects and complications, and produces the most permanent, natural results when used correctly. In white rhinoplasty, Middle Eastern Rhinoplasty or Jewish rhinoplasty, there typically exists an abundance of cartilage within the nasal septum. This cartilage divides the left and right sides of the nasal cavity, and a portion of this cartilage can be removed to support or reinforce other parts of the nose during rhinoplasty. Surgeons will commonly remove a portion of the septum if it deviated in order to straighten it. For a white, Middle Eastern or Jewish patient’s nose this septal cartilage may be sufficient to reshape the nose. However for most Asian patients the available septal cartilage will be insufficient in both quantity and strength to add appropriate volume or reinforcement to the nose to create the desired aesthetic outcome.

Since we know that tissue from your own body produces the best outcomes in rhinoplasty and nose job surgery, the next question that arises is that of possible sources for this tissue. The nose consists of primarily cartilage, bone and fibrofatty soft tissue underneath the skin envelope, so the best source will emulate the existing anatomy of tissue. Bone could be used, but it would also produce sharp contours, an extremely rigid nose, and come with significant donor site morbidity relative to available sources for cartilage. Cartilage can be harvested from very discrete incisions, most commonly from behind the ear or through a tiny (~1 centimeter) incision hidden in the crease below the right chest. Both these sources provide optimal tissue for grafting inside the nose while leaving no changes to the function or form of the harvest sites.

Undereye bags can result from a number of issues, but one of the most common reasons is the presence of excess orbital fat within the lower eyelid that protrudes or herniates into the cheek. All of us have multiple orbital fat compartments that serve to cushion and lubricate the movement of the eye, but as a result of age or genetics for some of us this lower eyelid fat, which normally resides below the eye and behind the cheek, begins to bulge forward, or pseudoherniate, thus creating a visible eye bag and a tear trough below it.

Protrusion of the eyelid fat will typically accentuate the hollowing that naturally occurs below the eyes and along the cheeks with age, as it creates a convexity above this depressed area below the orbit and eyes. When the amount of fat is minimal but there exists a significant volume deficit or hollowing in the infraorbital area and tear troughs, then adding volume by way of filler injections or fat grafting are viable options that can produce significant improvement. Volume may also be replenished with newer options such as Juvelook or platelet-rich plasma (PRP) and platelet-rich fibrin (PRF).

For patients with a significant amount of lower eyelid fat, the lid-cheek contour can only be fully improved by addressing the lower eyelid fat, either by repositioning or by removal during a lower blepharoplasty surgery. The traditional surgery involved making an incision through the lower eyelid skin (subciliary approach) and orbicularis muscle to expose the orbital fat, with a subsequent removal of various portions of fat, muscle and skin. Some of the marked disadvantages of this approach included a hollow appearance to the lower eyelids with advancing age, lid malposition as involutional volume changes occurred or as cicatricial scarring forces caused the lower eyelid to evert with a resultant ectropian. Even in the best outcomes, a visible scar remained along the lower lash border.

For these factors many contemporary surgeons choose to approach the lower eyelid via a transconjunctival approach (an incision made in the back of the eyelid along the pink conjunctiva, where it is completely hidden) so as to obviate the appearance of a scar. Since the anterior lamella of the eyelid is not violated, this approach has also significantly minimized the risk of eyelid malposition and eyelid retraction post surgery. Another generational paradigm change has been that of volume preservation versus simple excision and removal of fat. Studying the anatomic changes that occur with aging has taught us that we lose fat volume in our face as we age. For this reason most contemporary surgeons have transitioned to repositioning this precious fat volume into an area that needs it, namely the tear trough. By reducing volume in an area with excess, the eyebag, and instead applying it to an area of hollowing, the tear trough, the lid-cheek contour becomes smooth and a youthful appearance is restored.

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The anatomy of the upper eyelid in Asian patients tends to have some differences relative to patients of other ethnicities with regards to a few aspects. One concerns the appearance, depth and height of the upper eyelid crease, or the supratarsal crease. In patients with a distinct crease, there exists a strong connection between the skin and underlying levator aponeurosis as the distal ends of the muscle interdigitate with the dermis of the skin. In these patients, as the levator lifts open the eyelid the skin folds predictably and reliably along this connection to create the appearance of the upper eyelid fold. In traditional upper blepharoplasty these patients as they age will develop an increase in excess skin above the upper eyelid crease, thereby covering the amount of visible pre-tarsal skin. This results in a tired and aged appearance, and also decreases the amount of eyelid to place eye liner and eye shadow.

During traditional blepharoplasty an incision can be made along the crease, excess skin and fat removed, and the skin re-approximated without much consideration for stabilizing or reinforcing the upper eyelid crease. Since the levator aponeurosis has such a strong and adherent connection to the skin, the supratarsal crease will continue undisturbed. For Asian patients, there exists a variable connection between the levator and skin, resulting in a fold that may be well-established and stable, or an upper eyelid fold that may only intermittently be present, or may present at different heights and shapes depending on a patient’s condition. This unpredictability will lead some patients to utilized eyelid tape or eyelid glue to more reliably establish a consistent height and shape to the upper eyelid or “double eyelid”.

Asian patients undergo a similar aging process in terms of developing excess skin and sagging of that excess skin along the upper eyelids, sometimes with the development of pseudoherniation of orbital fat causing fullness in the upper eyelids. In a similar manner then, the eyelid surgery specialist must take into account addressing any excesses in skin and fat to account to optimize symmetry between the two eyes, just as in traditional blepharoplasty. Where the surgery diverges relates to the establishment of the supratarsal crease, upper eyelid crease or “double eyelid” with anchoring sutures placed between the tarsal plate or levator aponeurosis and the dermis of the skin. The size, shape and height of the crease can have dramatic effects on a patient’s appearance, therefore detailed and comprehensive discussion of the desired aesthetic during consultation and prior to surgery is critical to a successful outcome that is pleasing to the patient and surgeon alike.

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