Radiographic Midfacial Volume Changes in Patients on GLP‐1 Agonists

OBJECTIVE: Facial plastic surgeons report seeing an increase in patients presenting with facial deflation and a prematurely aged appearance-a reported side effect of the weight-loss drug semaglutide. No objective data exist to quantitatively characterize midface volume loss in these patients. STUDY DESIGN: Retrospective cohort study. SETTING: Single, tertiary academic medical center. METHODS: Hospital-level electronic medical record data were systematically queried for patients with glucagon-like peptide-1 (GLP-1) agonist prescriptions as well as head and neck imaging (computed tomography [CT]/magnetic resonance [MR]) both before and after prescriptions between 2017 and 2024. Changes in total, superficial, and deep midface volume were measured. Spearman correlation and linear regression were conducted to understand the relationship between weight-loss magnitude and facial volume changes. RESULTS: Twenty patients with available imaging were included in the analysis. The median age of patients was 54 years (interquartile range [IQR] 48-61). The average duration of GLP-1 agonists was 321 days (SD = 291), and the average weight loss was 11.0 kg (SD = 6.9). The median percent decrease in total midfacial volume was 9.0% (IQR 3%-14%). Superficial volume decreased by 11.0% (IQR 5%-15%), and deep volume decreased by 7.0% (IQR -20% to 15%). Spearman correlation showed a relationship between weight loss and superficial volume loss (rho = 0.590, P = .006) but not deep volume loss (r = 0.115, P = .629). Linear regression showed a loss of 7% facial volume for every 10 kg of weight lost (r = 0.063, SE = 0.003, P = .0293). CONCLUSION: Patients on average can expect a loss of 7% of midfacial volume/10 kg of total weight loss, primarily in superficial fat pads. This represents one of the first quantitative assessment of the "Ozempic face" phenomenon.