What can be done to minimize the appearance of facial sagging after taking Rybelsus for diabetes? (photos)

Question

Hi, I’ve been taking Rybelsus for my diabetes, been taking medication for two years, my face has aged badly, I’m 47 and my cheeks are long and drooping now, seem flat and facial muscles seem off, my nose looks crooked and big and chin and neck sagging for some reason my face looks long and elongated when I had a rounded face, I’ve only lost 28lbs so not huge loss but my face seems to have lost a lot of excess weight but now look bad, what would you recommend Thankyou

Anna Chacon, MD, FAAD · Answer

Thank you for your thoughtful and honest question. Changes in facial appearance, especially after weight loss or prolonged use of medications like Rybelsus (semaglutide), are not uncommon. Many individuals report facial thinning, sagging, or changes in structure after losing even a moderate amount of weight — what is often referred to as “Ozempic face” or GLP-1-associated facial wasting.

Why Is This Happening?
Rybelsus, like other GLP-1 receptor agonists, helps with blood sugar control and weight loss. Even if you’ve lost a modest 28 pounds, the facial fat pads — especially in the cheeks, temples, under the eyes, and jawline — are highly sensitive to weight changes. This may lead to:

Deflation of mid-face volume (sunken cheeks)

Sagging skin along the jawline and neck

Changes in facial proportions (longer or hollowed look)

A more angular or aged appearance

What Can Be Done?
Here are treatment options to help restore facial volume and improve skin tone and tightness:

1. Dermal Fillers
Strategic use of hyaluronic acid-based fillers can restore lost volume in cheeks, temples, nasolabial folds, and jawline.

Fillers can also help re-balance facial proportions and lift sagging areas.

2. Biostimulatory Treatments
Products like Sculptra or Radiesse stimulate your own collagen production over time, offering more gradual and natural volume restoration.

3. Skin Tightening Procedures
Radiofrequency (RF), Ultrasound (Ultherapy), or microneedling with RF can help improve skin elasticity and lift without surgery.

4. Thread Lifts
Minimally invasive threads can be used to reposition and lift sagging facial tissues, especially along the jawline or cheeks.

5. Fat Transfer (If Willing)
Though you mentioned minimal fat reserves, small-volume autologous fat grafting may still be an option in skilled hands.

6. Skincare Support
Topical retinoids, peptides, and antioxidants can support collagen and elasticity.

Sun protection is essential to maintain improvements.

Self-Image and Emotional Impact
It’s important to acknowledge how impactful these changes can feel emotionally. What you’re experiencing is valid, and many people in similar situations feel the same. Fortunately, non-surgical rejuvenation options today are more refined and effective than ever, allowing you to restore a natural, refreshed look without overcorrecting.

Final Thoughts
Facial changes from Rybelsus are a known side effect of the fat loss mechanism, especially as it affects delicate facial fat compartments. These changes are not permanent and can be managed effectively through individualized aesthetic treatments aimed at volume restoration and tissue support.

Anya Costeloe, DO · Answer

Thank you for the photos and your question. I frequently see this in my practice and have a general list of recommendations I give patients based on amount of weight loss and age. 
Options for 40-50yrs old, greater than 20lbs weight lossFace 1. Neurotoxins for wrinkle prevention and reduction 2. Laser skin resurfacing 3. Facial fat grafting for permanent volume restoration and skin rejuvenation 4. Surgical face lift Neck 1. Minimally invasive neck tightening with MyEllevate neck lift +/- submental liposuction 2. Surgical neck lift Based on your photo, a surgical face and neck lift combined with fat transfer to the temples and midface and possible laser resurfacing would give you the most optimal and long lasting results. Of course, it would be best to schedule an in-person consultation with an experienced facial plastic surgeon.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. If you’re looking to minimize the appearance of facial sagging after taking Rybelsus, Sculptra can be a great option. This injectable treatment works by stimulating your body’s natural collagen production, which can help restore lost volume and improve skin elasticity over time. Unlike traditional fillers that provide immediate results, Sculptra gradually enhances your appearance, offering a more natural look that evolves with your skin. Many people find that the results last for up to two years, making it a worthwhile investment. Combining Sculptra with a good skincare routine and sun protection can further enhance its effects, helping you achieve a smoother, more youthful-looking complexion. I hope this helps and best of luck!

Jourdan Carboy, MD · Answer

Hello Eclectic406782,This is becoming a question that comes up more often now with an increasing number of the population taking diabetic medications that aid in weight loss. Although the exact mechanism is still unknown, it is likely related to the weight loss. Unfortunately as we age, we lose fat from our faces and when you add weight loss on top of that, it can accentuate it even further. This seems especially true in relation to diabetic medications and facial changes. There are a variety of approaches to manage these facial changes and can range from minimally to maximally invasive. Fillers may help efface some of the changes but these are temporary or may not be sufficient depending on what is bothering you the most. It is best to keep in mind that any sagging is, for the most part, not well treated with filling but better treated with lifting. So discussing face/neck lift, periorbital rejuvenation, and facial fat grafting may give you more optimal results. This would best be discussed with a plastic surgeon. I would suggest a consult to discuss your goals and desires so they may be addressed and a plan tailored to your needs. I hope this helps!Cheers,Dr. Jourdan Carboy

Camille Cash, MD · Answer

There are so many options available to help you address your concerns.  You can consider HA fillers to help add volume with immediate effect.  Fillers can be combined with other treatments such as FaceTite, Morpheus8 or Evoke to help improve overall skin tone and texture.  I wrote about this very same concern on my blog.  Visit my website to learn more!

What can be done to minimize the appearance of facial sagging after taking Rybelsus for diabetes? (photos)

Answers (5)

More Dermal Fillers Questions

WE SEND PRETTY
EMAILS

Answers (5)

More Dermal Fillers Questions

Does tear trough filler top-up create complication later? (Photos)

Is there any procedure to fill in/reduce appearance of indented pore? (Photos)

It’s been about two years since I had filler to help lift my jowls (Photo)

What can help with my deep frown line and those big lumpy things in my forehead? (Photo)

Which non surgical and minimally invasive procedures would improve my facial asymmetry? (photos)

Which procedure would minimize the appearance of my deep under eye bags and wrinkles? (photos)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS