GLP-1 Receptor Agonists and the Aesthetic Patient: Considerations for the Dermatologist

The impact of glucagon-like peptide-1 agonists (GLP-1), such as semaglutide, tirzepatide and liraglutide, has transformed the healthcare industry and, in particular, aesthetic dermatology.¹ The most common intended use of these medications, namely diabetes management and weight loss, can lead to a multitude of effects that necessitate unique management approaches.     

The most prominent initial impact of these medications is a rapid weight loss to the whole body, and a proportionally more noted facial fat loss. Facial volume is critical in conveying a youthful and healthy appearance. Cadaveric studies from colleagues such as Rohrer and Pessa pioneered the link between changes in discrete facial fat compartments and the appearance of an aging face over time. A premature loss of volume in certain facial fat compartments can lead to an appearance that is not only disproportionately more aged but also gaunt.² Of note, the most common areas that experience volume loss include the midface and temples. The role of the aesthetic practitioner in addressing such changes would be to customize a treatment plan utilizing tissue volumizers, whether it be injectable hyaluronic acid or a biostimulator such as poly-L-lactic acid (PLLA) or calcium hydroxylapatite (CaHA). Fat grafting has also been employed to restore volume in the more depleted areas.   

Secondary effects of the loss of fat on and off the face include the appearance of sagging skin. Often, volume restoration with agents such as dermal fillers as noted above will help with other concerns a patient may raise as part of a “sagging” appearance such as a deeper nasolabial fold. However, many concerns may persist despite use of these agents. A noted decreased ability of the skin to retract or form to a newer facial and body shape commonly appears in the neck, arms, thighs and abdomen. Gradual changes in laxity can be achieved with use of energy-based devices, including but not limited to radiofrequency, radiofrequency microneedling, microfocused ultrasound, and non-ablative fractional lasers utilizing focal point technology. Of note, an overall loss of fat, the role of cryolipolysis and deoxycholic acid for management of focal adiposity cannot be overlooked.     

The skin’s ability to regenerate and preserve elasticity is known to diminish with rapid weight loss. Many of the treatments, including use of biostimulatory agents and energy-based devices, aim to combat some of these deleterious biochemical effects of GLP-1 agonists. Histologic studies have demonstrated the ability of these agents to stimulate the production of elastin.    

Beyond the skin, the impact of this class of medications on other underlying structures has been reported. Although not direct targets, muscles and ligaments are impacted by changes in weight, body mass distribution, and glucose metabolism. Lean muscle mass is believed to be reduced while patients are on these medications. However, current evidence indicates that strength and muscle function can be generally preserved if patients pursue resistance training and have an appropriate protein intake.  

Longevity medicine is an evolving healthcare discipline focused on preventive measures and personalized approaches for healthcare maintenance. This class of medications has garnered significant interest in this field. Basic science studies evaluating cellular markers indicate that GLP-1 signaling can impact both cellular inflammation and oxidative stress. There is indirect evidence at this time of their positive impact at a clinical level. Improved glycemic control and weight loss that can be achieved both combat known culprits in reduced life expectancy. Cardiovascular outcome trials provide evidence in support of a role in reducing the risk of major adverse cardiovascular events (MACE), also known to impact longevity. However, the known reduction in lean muscle mass, if not mitigated, may lead to fragility and a decreased quality of life.  

Emerging data demonstrate the positive psychological effects of this class of medications for patients, especially with respect to physical and mental health quality of life scores and reduced emotional eating for patients with obesity.³ In light of a change in self-image, a key consideration for the aesthetic dermatologist is to bridge the gap between the largely beneficial internal and psychological effects and any incongruity with outward appearance.  

Many questions remain unanswered with respect to management of these patients. The use of GLP-1 agonists not only has reshaped a large part of our population but also has introduced a new cohort of patients seeking care for cosmetic concerns. Knowledge of the impact of this class of medicine should inform the clinician’s management approaches. Further studies with respect to the timing of cosmetic interventions are needed, namely whether they should be initiated around the onset of treatment or at a later time when patients are closer to reaching their goal. Additional studies into skin quality, facial harmony and the long-term effects of this class of medications are also warranted. 

1. Haykal D, Hersant B, Cartier H, Meningaud JP. The role of GLP-1 agonists in esthetic medicine: exploring the impact of semaglutide on body contouring and skin health. J Cosmet Dermatol. 2025;24:e16716. https://doi.org/10.1111/jocd.16716

2. Ridha S, Fabi SG, Zubair R, Dayan S. Decoding the implications of glucagon-like peptide-1 receptor agonists on accelerated facial and skin aging. Aesthet Surg J. 2024;44(11):NP809-NP818. https://doi.org/10.1093/asj/sjae256

3. Pierret ACS, Mizuno Y, Saunders P, Lim E, et al. Glucagon-like peptide 1 receptor agonists and mental health: a systematic review and meta-analysis. JAMA Psychiatry. 2025;82(7):643-653. https://doi.org/10.1001/jamapsychiatry.2025.0812

ARDALAN MINOKADEH, MD, PHD

• Skin Care and Laser Physicians of Beverly Hills, Los Angeles