Glucagon-Like Peptide-1 Receptor Agonist-Associated Facial Changes: A Comprehensive Review of Pathophysiology, Clinical Manifestations, Risk Factors, Prevention, and Management

Abstract Facial hollowing, skin laxity, and more prominent folds are increasingly reported during weight loss with glucagon-like peptide-1 receptor agonists (GLP-1 RAs). The term ‘Ozempic face’ can imply a drug-specific adverse effect, although similar changes occur after other forms of substantial weight loss. This review examines the clinical evidence, proposed mechanisms, and implications for aesthetic care. PubMed, Embase, Web of Science, and Google Scholar were searched for January 2014 through August 2026. Selection was reported using PRISMA 2020 where applicable, followed by narrative synthesis. Of 958 records, 46 reports were included. Serial imaging in 20 patients showed a median 9% reduction in midfacial volume, with greater loss in superficial than deep compartments (11% vs 7%). Regression estimated approximately 7% total midfacial volume loss per 10 kg lost. A FACE-Q short-form has been validated, and a survey of 1,226 participants found more reports of facial volume loss and laxity with greater percentage weight loss. Post-bariatric studies also describe facial deflation and increased apparent age, particularly in older patients and after larger losses. Current evidence favors weight-loss-associated deflation superimposed on baseline anatomy and aging. The independent effect of weight-loss rate and the modifying roles of menopause and hormone therapy remain uncertain. Aesthetic treatment evidence is limited and largely uncontrolled.