Ozempic Butt? Here’s what you and your patients need to know about the truth behind the term.

Recently, diabetes drugs like semaglutide and brands like Ozempic have gained tremendous popularity and buzz for their on- and off-label weight loss benefits. If you search Ozempic, you’ll see articles about celebrities who have purportedly used it and influencers who candidly share their experience.

From this wave of attention, new terms have caught on; terms like Ozempic face and butt refer to some of the unintended results from using these weight loss drugs.

Below, we break down what you need to know about these drugs, and what you can do to help your patients mitigate their unintended effects.

The Semaglutide Landscape

Ozempic is a brand name for the drug semaglutide, which was first approved by the U.S. Food and Drug Administration in 2017 as a treatment for Type 2 Diabetes. Semaglutide works in two ways. It lowers A1C and blood sugar, which is what makes the drug effective for patients with diabetes. The drug also binds to the GLP-1 receptor; this reduces appetite and slows the motility of digestion so patients feel fuller longer.

To break it down simply, when taking semaglutide, the patient ends up operating at a calorie deficit, causing rapid weight loss.

Ozempic is one popular brand name for the semaglutide drug, another well-known name is Wegovy. Unlike Ozempic, which is only indicated for diabetes, Wegovy has a weight loss indication for those with obesity (BMI ≥ 30) or those who are overweight (BMI ≥ 27) with weight-related medical issues. Semaglutide is also available in a compounded generic form for those individuals who don’t meet these criteria.

A newer name to make note of is Mounjaro, which is not a form of semaglutide. Mounjaro is the brand name for tirzepatide, which binds to GLP-1 and GIP receptors. Still in clinical trials for a weight loss indication, early results show that tirzepatide produces better results for weight loss with fewer side effects. Further studies are needed to show if it’s more beneficial for patients than semaglutide.

*As of November 2023, the FDA has approved another weight loss drug - Zepbound. Zepbound is also tirzepatide based, and has received similar indications for weightloss as Wegovy. The FDA approved Zepbound for patients who are obese or overweight with at least one weight-related condition.

YOU DON'T JUST LOSE WEIGHT...

Although we’re here today to talk about beloved terms like “Ozempic Butt” and “Ozempic Face,” it’s worth noting that these are not actual side effects of the drugs as stated by the manufacturer. The most common side effects of these drugs are gastrointestinal – nausea, constipation, diarrhea, and in the worst case, pancreatitis – due to the effects the drug has on the digestive system, appetite, and eating.

When people use these terms, they’re typically referring to sagging, loose skin, worsening skin texture, and a distinct loss of volume in the face and butt. None of these are direct drug side effects, but more so an unexpected or unintended consequence of rapid weight loss.

As reported by NBC News, when a patient is losing dramatic amounts of weight – fat is not the only thing they are losing. About one third of the loss can be lean mass, which is generally from muscle. This type of volume and muscle loss – especially in a region like the glutes – can result in a saggy look and thus has born the “Ozempic butt” label.

In addition, when you lose such a large amount of volume so quickly, the collagen in your skin can’t keep up or bounce back. This increases the occurrence of skin laxity (loose skin) and skin texture issues like wrinkles and crepiness.

“When you’re not taking in enough nutrients and protein and when you’re losing so much so quickly, you can begin to look aged and malnourished due to loss of volume but also because your skin tissue is affected; your tissue will not have the same integrity and it becomes sallow and loses elasticity,” says Dr. Jeffrey Antimarino, MD, a board-certified plastic surgeon based in Pittsburgh.

The reality is any form of rapid and dramatic weight loss can lead to the same result. Patients who undergo gastric bypasss or bariatric surgery often encounter the same problems. However, the rapid proliferation of semaglutide usage is leading us to see these issues en masse and draw specific links back to these drugs.

Another myth is that the face and glutes are disproportionately impacted by semaglutide usage. These drugs do not target specific areas – volume loss can happen throughout the body. Depending on the patient, you may see sagging in the stomach, the arms, and the legs. Terms like “Ozempic face and butt” have caught on and been fueled by the media, but it’s misleading as these issues can happen anywhere on the body.

WHO'S AT RISK?

The bottom line is that each patient will respond to these drugs differently depending on factors like genetics, lifestyle, and how they carry weight. This can then translate to variable amounts of skin elasticity, muscle, and volume loss. For example, those who have been overweight for a long time or have significant weight to shed may see a bigger impact as the skin has likely been stretched out for longer. Areas on the body that have a lot of volume and/or less muscle may be disproportionately affected. Individuals who do not exercise or consume enough protein to support their muscles will likely also see a bigger impact.

Genetics and skin type play a role as well. Patients with darker skin tones have more melanin in their skin, which protects from photoaging and sun damage. These patients are more likely to develop fewer wrinkles and textural issues in general than those with lighter skin types and may see more conservative side effects in their skin. Typically, those who have more oil to their skin – and thus their skin is more hydrated – are less prone to texture and laxity issues. In addition, younger patients will bounce back better than older patients because of greater amounts of collagen and elastin. As we get older, our natural collagen and elastin production slows down, and if this is coupled with rapid weight loss, issues with skin laxity and texture can be exacerbated.

Lifestyle Choices Can Make a Difference

So how does one counteract the loss of muscle and the degradation to skin tissue which leads to “Ozempic butt” and other related changes? First, it’s important for individuals on this category of drugs to work out regularly to maintain and build muscle. It’s also important to consume an adequate amount of protein. Protein feeds the muscle, and when calorie intake is reduced and meals are skipped, protein becomes that much more important whether it be acquired through diet or supplements.

“With any extreme weight loss methods, protein intake is extremely important. For example, if I’m planning surgery for a patient who has undergone a gastric bypass, I start them on two protein shakes a day (60g+ per day) prior to surgery and continuing after surgery – they need the protein to heal,” says Dr. Antimarino.

Hydrating, sunscreen, and a good skincare regimen may help protect the skin’s elastic and collagen integrity, but in the face of drastic body changes, it may not be enough.

Aesthetic Treatments: Effective Intervention & Prevention Options

Non-invasive or invasive aesthetic treatments that target muscle growth, skin laxity and texture, as well as collagen and elastin production can help patients mitigate the unintended effects of rapid weight loss.

“We’re seeing a new wave of patients coming in because of these drugs. Everyone loses weight differently. You can lose weight and still have lipodystrophy, which I would treat with surgical or non-surgical modalities like LipoAI and PHYSIQ” says Dr. Antimarino, who performs surgery and offers non-invasive treatments at his practice. “With isolated pockets of fat, technologies like PHYSIQ, which uses heat on tissue and electric muscle stimulation, are helpful to improve those areas.”

“When you’re losing weight, procedures like tummy tucks and lifts are still on the table. It’s important to educate my patients that after this kind of weight loss, your skin elasticity is not the same anymore. I can tighten the skin, but they may need touchups in the future,” adds Dr. Antimarino.

Stimulate Muscle Growth & Debulk Tissue with PHYSIQ

For patients experiencing rapid weight loss, taking measures to maintain and build the muscle can help improve the end result. Exercise is important, but there are benefits to using aesthetic treatments that help stimulate muscles.

PHYSIQ is an award-winning multi-modality body technology that uses deep heat to target tissue and electrical muscle stimulation (EMS) to re-educate muscles. The deep heat can be beneficial to target tissue in both small and larger areas of the body. PHYSIQ’s muscle re-education is particularly important to help maintain and build the muscle that can be lost when using a weight loss drug. Furthermore, PHYSIQ’s ability to contract both slow twitch and fast twitch muscle fibers in a single treatment is difficult to achieve with working out alone.

Another key benefit to PHYSIQ is the ability to customize treatments based on patient body type and goals. For patients looking for tissue debulking and muscle stimulation, PHYSIQ’s exclusive STEP (Sequential Thermal & Electrical Pulse) Technology is recommended. The STEP protocol alternates between deep heat and EMS in a single session. For patients with more volume, a protocol may start with heat only, then switch to STEP to bring in muscle re-education. On the other hand, some patients may only need muscle stimulation to ensure they are maintaining muscle mass as they lose weight. PHYSIQ is unique in its ability to be truly customized for the patient.

After an initial series of five PHYSIQ treatments, we recommend maintaining EMS muscle stimulation treatments on a weekly basis for the duration of their weight loss plan. If the patient does not continue with PHYSIQ treatments, it’s important they maintain a rigorous workout regimen on their own.

Talk to your patient about a more comprehensive holistic approach to reach their goals, one that might be inclusive of PHYSIQ as well as other lifestyle changes. Patients should understand the potential side effects and what is available to help them mitigate such concerns.

Tighten Skin & Improve Texture with Virtue RF

In addition to supporting the muscle, addressing skin texture and activating collagen remodeling is an important countermeasure to weight loss.

VirtueRF microneedling is the most powerful and versatile RF microneedling platform technology to help address skin laxity and textural issues that may result from rapid weight loss. RF microneedling creates micro-injuries in the skin to stimulate the natural production of collagen and elastin, which helps tighten skin and smooth texture – two of the common issues seen. VirtueRF has three different handpieces – SmartRF to treat the face, neck and decollete; ExactRF for precise applications like the jowls and under-eye; and DeepRF which is specifically designed for body applications. All handpieces can help tighten and smooth skin across the face and body, targeting those tricky areas such as the arms, thighs, and abdomen.

We recommend a series of three to five VirtueRF treatments once a month to go alongside semaglutide or other weight loss drug usage to help mitigate the sagging, skin laxity, and textural issues (such as crepiness) that can occur.

VirtueRF microneedling and PHYSIQ body treatments can also be combined for an optimal effect. This combination – also known as the BodyRight treatment – of DeepRF microneedling, deep heat to tissue, and electrical muscle stimulation transforms the body layer by layer by addressing volume, muscle, and skin laxity & texture – making it a great partner to weight loss patients. Learn more about BodyRight here.

The Long-Term Impact of Semaglutide

For diabetic patients, these drugs to help lower A1C levels are lifelong therapies. However, weight loss patients cannot stay on them forever; once they reach their desired weight, they should be titrated off the drug slowly. But as soon as the dosage lowers, the hunger will come back, and so might the weight. Some patients can maintain their new weight with exercise and portion control, but many gain back some of the weight while some gain all of it back and more.

When your patient is transitioning out of the weight loss drug, a treatment like PHYSIQ can help them maintain their desired results by continuing to address tissue and muscle; maintaining muscle is extremely important as more muscle mass leads to a better resting metabolic rate, which burns calories faster and can help patients hold on to their weight loss in the long run. Therefore, you as a provider have the ability – with technologies like PHYSIQ and VirtueRF – to help customize your patient’s weight loss journey, help control this process and how it turns out for your patients.

“As more data becomes available and as people learn more about the side effects, I think the craze will die down, but the drugs are here to stay” says Dr. Antimarino. “There will be more educated, controlled usage, and monitoring is key. It’s a good tool in the right hands with the right person looking after their patients.”