From SCALE 2026: Practical Strategies for Treating GLP-1–Related Aesthetic Changes
Key Takeaways
Rapid weight loss associated with GLP-1 agonists may contribute to facial aging, skin laxity, hair shedding, and muscle loss.
Early intervention may mitigate many of the aesthetic changes associated with GLP-1 therapy.
Combination approaches incorporating energy-based devices, collagen stimulators, hair therapies, and body contouring may improve patient outcomes.
At the 2026 Music City SCALE meeting, Terrence Keaney, MD, discussed how dermatologists can proactively address facial aging, skin laxity, hair loss, and muscle loss associated with GLP-1–mediated weight reduction. During a presentation at the 2026 Music City SCALE meeting in Nashville, Terrence Keaney, MD, founder of SkinDC in Arlington, VA, outlined a practical framework for managing some of the aesthetic issues related to the use of GLP-1 therapies.
Keaney emphasized that the GLP-1 story is still evolving and that dermatologists are likely to see a growing influx of patients who may not have previously engaged with aesthetic medicine.
“These drugs have been around for a while,” he said. “They’re going to grow.”
The Face of Rapid Weight Loss
Keaney noted in his presentation that the aesthetic outcomes are often more complex than patients anticipate, despite the demonstrated metabolic and health benefits for many patients.
“The aesthetic consequences of GLP-1 agonists are not all sunshine and rainbows,” he cautioned. One of the most common concerns Keaney is accelerated facial aging associated with rapid weight reduction, sometimes referred to colloquially as “Ozempic face.” According to Keaney, patients frequently perceive themselves as looking older because of abrupt changes in facial volume and skin quality. He then identified 3 primary mechanisms contributing to these changes: accelerated volume loss, skin laxity, and cutaneous alterations.
“I think about those three things, which help guide me in terms of picking noninvasive treatments to help with this,” he added.
Keaney also reviewed histologic observations from bariatric surgery literature demonstrating disorganized collagen architecture after substantial weight loss, including reductions in thick collagen fibers and relative increases in thinner collagen fibers. He suggested that both weight loss itself and potential biologic effects of GLP-1 medications may contribute to skin-quality changes.
Beyond the Face: Hair and Muscle Loss
Hair loss is another increasingly common complaint among patients using GLP-1 agonists. Keaney noted that many patients experience shedding consistent with telogen effluvium after rapid weight loss, although underlying androgenetic alopecia may also become more apparent.
“These patients have this sudden change in hair loss that may be persistent even after they’ve reached goal weight,” he said.
He recommended early intervention, ideally before significant shedding begins. Oral minoxidil was highlighted as a preferred and trusted preventive strategy because of its ability to mitigate telogen effluvium while also supporting androgenetic alopecia management.
Muscle loss represents another important issue. Keaney cited studies suggesting that as much as 40% of weight lost during GLP-1 therapy may be lean muscle mass.
“Muscle is a highly metabolic tissue,” he said. “When they lose a lot of muscle, if they stop the drug, they’ve lost that high-metabolism cell population.”
Resistance training, he said, is central to muscle-preservation counseling. Keaney also pointed to the role of magnetic muscle stimulation devices, which have shown promise in bariatric surgery patients.
Timing Treatment During the GLP-1 Journey
A major focus of the session was timing. Keaney encouraged dermatologists to engage with patients before or early during their GLP-1 journey rather than waiting until substantial weight loss has already occurred.
“I hope GLP-1 use will be sort of how our brides come to our practice,” he said. “When they get engaged, they make their appointment with us.”
Keaney divided intervention strategies into 3 phases: drug initiation, active weight-loss progression, and post–goal weight refinement.
At drug initiation, he focuses on prevention, including skin care optimization, early collagen-stimulating energy-based procedures, hair-loss prevention strategies, and muscle-preservation counseling.
During active weight loss, typically months 1 through 6 or 9, he incorporates collagen-stimulating fillers and skin-tightening procedures such as radiofrequency- or ultrasound-based devices.
“This is the sweet spot,” he said. “As that weight loss comes off, that skin is recoiling with that smaller platform.”
Once patients reach goal weight, treatment shifts toward refinement and contouring, including hyaluronic acid fillers, fat transfer, cryolipolysis, and body-shaping procedures.
Keaney concluded by noting that dermatologists are uniquely positioned to help patients navigate both the medical and aesthetic dimensions of weight loss therapy.
“We have a lot of tools,” he said. “We should be doing well as they lose weight over time.”