After significant weight loss, the face often looks thinner, older or more tired because facial fat is lost along with body fat and the skin may not shrink back fully. The effect has been nicknamed online after a brand of weight-loss medication, but it can follow any substantial or rapid weight loss. Options include waiting for weight to stabilise, then restoring volume with filler or fat grafting, or lifting loose skin with a facelift and neck lift.
Why the face changes
The face contains a number of fat compartments that give it softness and shape. When body weight falls significantly, these compartments shrink too, particularly in the cheeks, temples and around the eyes. The skin that was stretched over a fuller face may not contract fully, especially in older adults or after a large loss. The result can be hollowing high in the face with looseness lower down, around the jowls and neck.
Why it is more noticeable with medication
Weight-loss medication can lead to substantial weight loss over a relatively short period. Rapid change gives the skin less time to adapt, and many people taking these medicines are older, when skin elasticity is already reduced. There is nothing unique about the face changes themselves; they reflect the speed and amount of weight lost. Any questions about your medication, dose or side effects should be discussed with the prescriber managing it.
Common features
- Hollow cheeks and temples: loss of the soft curves over the cheekbones and at the sides of the forehead.
- Under-eye hollows: the tear trough becomes more defined, which can look tired.
- Jowls and loose neck skin: skin that no longer fits the smaller volume beneath it.
- Deeper folds: more prominent nasolabial folds and marionette lines.
- Crepey skin: a finer, less elastic skin texture in some people.
When to act
The face usually continues to change while weight is falling, so it is generally best to wait until your weight has been stable for several months before considering surgery. Non-surgical volume treatments can be performed earlier if you understand they may need adjusting as your weight settles. If weight loss has been unintended, or you are losing weight faster than expected, speak to your GP or prescriber before considering any cosmetic treatment.
Restoring volume
For people whose main concern is hollowing and whose skin still has reasonable elasticity, hyaluronic acid dermal filler can restore support to the cheeks, temples and under-eye area in carefully measured amounts. Results are temporary. Fat grafting uses your own fat, harvested from another area, and can be longer lasting, though not all of it survives. After major weight loss there may be less fat available to harvest, which is considered at assessment.
Lifting loose skin
Where the skin of the lower face and neck has become loose, adding volume alone can look heavy. A facelift or deep plane facelift repositions the deeper tissues and removes excess skin, and a neck lift addresses loose neck skin and bands. Fat grafting is often combined to restore volume at the same time. Mr Nassab will look at skin quality, the degree of laxity and your overall health before recommending an approach, and may suggest a staged plan.
Recovery, risks and cost
After a facelift, most people need two to three weeks before they feel comfortable socially, with swelling settling over several months. Risks include haematoma, infection, scarring, numbness and uncommon nerve injury; your nutrition and general health after weight loss are also reviewed, as they affect healing. A facelift costs from £14,500. A deep plane face and neck lift costs from £18,500 and a mini facelift from £8,000; filler and fat grafting are quoted at consultation. The £150 consultation fee is separate, and treatments are only for adults aged 18 and over.
Frequently Asked Questions
Will the face recover once weight loss stops?
Some fullness may return if you regain a little weight, but lost elasticity does not recover fully on its own.
Should weight-loss medication be stopped to protect the face?
Decisions about medication should be made with your prescriber. Facial changes can be addressed once your weight is stable.
Is filler enough after weight loss?
Filler can help if the main issue is volume and the skin is still elastic. Significant loose skin usually needs surgical lifting.
How long should my weight be stable before a facelift?
Usually several months at a weight you can maintain, so that the result is not affected by further loss.
Can the body be treated at the same time as the face?
Some people also have loose skin on the body after weight loss. Facial and body procedures are usually planned separately so that each recovery is manageable and safe.
