Beyond Weight Loss: Association Between Glucagon-like peptide-1 Receptor Agonist Therapy and Incidence of Facial and Oculoplastic Procedures

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used for type 2 diabetes mellitus (T2DM). GLP-1 RA therapy has been linked to facial soft-tissue changes, potentially increasing demand for corrective or aesthetic procedures. This study aims to evaluate whether treatment with GLP-1 RAs in patients with T2DM is associated with an increased long-term incidence of facial and oculoplastic procedures. METHODS: We conducted a retrospective cohort study using the TriNetX database. Adults aged 50-60 years with T2DM were included and divided into GLP-1 RA users and non-GLP-1 users. The occurrence of oculoplastic and facial procedures was assessed over a 10-year follow-up period. Propensity score matching was applied to balance baseline characteristics. Survival analyses were performed using Kaplan-Meier curves and hazard ratios (HRs) were estimated using Cox proportional hazards models. Positive (3P-MACE) and negative (clavicle fracture, rheumatoid arthritis) controls were included. RESULTS: After matching, 297,210 patients remained in each cohort. Over a 10-year follow-up, GLP-1 RA therapy was associated with higher event rates for multiple procedures: upper eyelid blepharoplasty (HR=1.81; p<0.0001), blepharoptosis repair (HR=1.84; p<0.0001), brow ptosis repair (HR=1.87; p=0.0001), lower eyelid blepharoplasty (HR=1.78; p=0.0264), ectropion repair (HR=1.48; p=0.0153), and rhinoplasty (HR=1.96; p=0.012). Entropion repair did not differ significantly (HR=1.25; p=0.387). Positive and negative controls behaved as expected, supporting the robustness of the study design. CONCLUSIONS: GLP-1 RA therapy was associated with an increased long-term incidence of facial and oculoplastic procedures among T2DM patients. Clinicians and surgeons should recognize these effects when counseling patients and planning treatment.