After years of feeling like the scale wouldn’t budge, we’re now seeing the complete opposite. GLP-1 medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have completely changed the weight-loss game, but that kind of rapid transformation doesn’t always come without side effects. The good news? Most of them are temporary and manageable. Here’s what you need to know. and what the experts recommend, to stay ahead of the changes.
Featured Experts
- Shab Caspara is a trichologist in New York
- Dr. Rohini Shantharam is a board-certified dermatologist in Fresno, CA
- Dr. Diane Madfes is a board-certified dermatologist in New York
- Dr. Rocio Salas-Whalen is a board-certified endocrinologist in New York
- Dr. Christine DiEdwardo is a board-certified plastic surgeon in Duxbury, MA
1. Hair Loss (Telogen Effluvium)
What happens: Many patients experience significant hair shedding two to four months into rapid weight loss.
Why it occurs: First, let’s clear up a common misconception. “It’s not the drug that’s causing hair loss. It’s the rapid weight loss and not getting the same amount of nutrients,” says trichologist Shab Caspara. Known as telogen effluvium, this is a stress response that causes hair to prematurely enter a resting phase. “If you’re experiencing chronic calorie deficit, you’re not getting any kind of nutrients in the body, the hair system just doesn’t function without proper nutrition,” she explains.
What you can do: The shedding is usually temporary, but regrowth takes time. “It would be half a year before you’ve fully seen the effects,” says Caspara, noting that it can take another several months to start seeing regrowth. To prevent or minimize loss, she recommends being intentional with nutrition from the start of your weight loss journey. “If you’re not going to eat much, be very calculated about what you do eat,” she advises. “Protein is essential. A lack of it is one of the fastest ways to lose hair.” She also stresses the importance of key nutrients like zinc and iron, which are critical for healthy hair growth. “Make sure you’re not losing your zinc or your iron,” she adds, noting that deficiencies in either can quickly trigger shedding.
2. Skin Laxity and Sagging
What happens: As weight drops quickly, the skin may not keep up, leading to looseness, especially on the face, neck, arms and abdomen.
Why it occurs: “The skin, the tissue, just doesn’t have enough time to contract,” explains Fresno, CA dermatologist Rohini Shantharam, MD. “Sometimes I can tell when someone has done rapid weight loss just by feeling their tissue.”
What you can do: New York dermatologist Diane Madfes, MD stresses the importance of early intervention. “Just treat it in the beginning. You really want to get a good start before it starts hanging, because it’s much easier to tighten, tighten, tighten.” She recommends starting treatments like Sofwave within the first four to six weeks of starting a weight loss journey and then doing a second treatment six to twelve weeks later.
Some of the skin laxity may resolve on its own. “That initial phase where they’re losing weight, that laxity looks so much more significant. But then give it a year—some of that settles,” adds Dr. Shantharam.
3. Facial Volume Loss (“Ozempic Face”)
What happens: As fat disappears from the face, particularly in the cheeks, temples and jawline, patients may notice a more hollow, aged appearance.
Why it occurs: “It’s not about Ozempic, it’s an effect of the weight loss, not the medication,” explains Dr. Salas-Whalen. Rapid loss of facial fat, often referred to as “Ozempic Face” happens alongside body fat loss and can be especially visible.
What you can do: Restoring volume can be done with dermal fillers, biostimulatory fillers like Radiesse and Sculptra, or fat transfer. “If the volume loss is mild or the patient is not interested in surgical options, volume restoration can be improved with biostimulatory agents like Sculptra for diffuse volume loss and/or fillers, hyaluronic acid or calcium hydroxyapatite, for restoring facial shape and contour,” says Duxbury, MA plastic surgeon Christine DiEdwardo, MD.
Dr. Madfes often uses fat transfer in this context. “What we’ll do is Sofwave on the face first to get lifting and tightening, and then probably about three months in, they’ll get a little bit of their fat transfer,” she says. “That helps stimulate your own fibroblasts in the skin.”
For patients looking for a needle-free approach, Emface, which combines radio-frequency with HIFES muscle stimulation, may also be an option to lift and contour.
4. Muscle Loss
What happens: Patients may lose lean muscle mass, leading to fatigue and diminished strength.
Why it occurs: A combination of reduced calories and protein intake can cause the body to break down muscle for energy. “Patients can lose muscle by decreasing their caloric intake and protein intake,” explains Dr. Salas-Whalen.
What you can do: Prioritize protein intake and resistance training. Muscle preservation starts with your provider. “Whatever doctor is just measuring the effects of the medication by the number on the scale is missing it,” she adds. A qualified prescriber will monitor muscle retention, not just weight loss.
5. Skin Quality Changes
What happens: Beyond laxity, patients may notice skin that appears thinner, more fragile or crepey.
Why it occurs: Skin support structures like collagen and elastin can be compromised by nutritional deficiencies and reduced estrogen levels, especially during perimenopause and postmenopause.
What you can do: Dr. Madfes recommends initiating collagen stimulation early. “It’s the same mentality when I use it for my GLP-1 weight loss patients—start collagen stimulation early.” She uses treatments like IPL or UltraClear laser, and supports skin with prescription retinoids and hydration. “Long term, prescription retinoids are the best. You’re doing yourself a disservice if you’re not using one.”
The Bottom Line
Side effects from GLP-1 medications are rarely due to the drugs themselves and nearly all of them can be mitigated with early intervention. Dr. Salas-Whalen encourages patients to work with providers who understand how to support long-term wellness during and after weight loss. Rapid results don’t have to come at the cost of your hair, skin or muscle. With the right plan you can manage these side effects and feel confident in your transformation from the inside out.
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