World-leading plastic surgeons are reporting a huge surge in patients demanding extreme and ‘dangerous’ cosmetic operations – after losing dramatic amounts of weight on slimming jabs such as Ozempic.

The health benefits of the jabs are far-reaching – not only do obese patients shed pounds but studies show the drugs help slash the risk of heart disease, cancer and can even boost fertility. But less talked-about are the body problems they are often left with.

On social media, users of Ozempic and similar drugs Wegovy and Mounjaro complain they are left with sunken, hollow-looking faces; hanging ‘melted candle’ skin on their arms, legs and stomachs; ‘empty’ breasts and sagging buttocks.

These body problems are not a side effect of the medication – glucagon-like peptide-1 receptor agonists, or GLP-1s – but a result of massive, rapid weight loss.

While fat tissues shrink away, the skin – which has become stretched over time – doesn’t simply snap back. And, in a bid to tackle the issue, cosmetic surgeons are rapidly refining their techniques in order to offer fixes.

I got to hear all about it last week, when I attended the American Society for Aesthetic Plastic Surgery annual meeting last week in Austin – the world’s largest industry event showcasing what the future holds for a world hungry for cosmetic surgery. It’s not open to the public, but I was given unprecedented access – and the doctors I spoke to were frank about the impact weight-loss jabs have had.

Christine Burch before and after she lost six stone on Ozempic. She says the weight loss left her face ‘skeletal’ and the skin around her buttocks looser

‘GLP-1s are a new gateway drug for aesthetics – we’ve had an Ozempification,’ Dr Johnny Franco, an Austin-based consultant plastic surgeon, tells me. ‘We are seeing a whole new sub-group of patients with skin issues at a very young age.’

Some enterprising surgeons, I discovered, have even launched their own weight-loss jab clinics, prescribing the drugs to cosmetic surgery hopefuls.

‘These medicines have changed everything for us,’ Kentucky-based cosmetic surgeon Dr Bradley Calobrace adds. ‘When I see a patient who is overweight, potentially too heavy to have the procedures they want, I used to say, “We need to get you at a better weight, I’ll see you back if you do.” And you never see them again. But now we have a programme, a solution.’

However, these operations – which are rarely, if ever, offered on the NHS – are not for the faint-hearted. From boob, bottom and even arm and inner thigh lifts to chin-contouring and tummy tucks these are major procedures with considerable risks.

And this, experts say, is why it’s vital patients opt for experienced surgeons – who really know what they’re doing – to perform them.

Here, we outline just a few of the newest techniques to tackle post-Ozempic faces and bodies…

There’s a no-knife fix for Ozempic face 

It is the most visible and loathed downside of rapid weight-loss on the jabs: the phenomenon dubbed ‘Ozempic face’.

Patients slim down dramatically, but are left looking aged – with sunken eyes, gaunt cheeks, jowls and hollow temples.

Even those in their 30s and 40s are affected. In some cases, only a full face and neck lift will be able to set things right, surgeons say. But a host of non-invasive treatments, showcased last week, could help.

One development generating excitement involves injections of donated human fat.

While this sounds slightly grim, experts say the tissue is purified and processed to form a ‘matrix’ – once inside the face, it acts as a scaffold that encourages the body to build its own fat in the treated area.

This works to gradually restore volume – while avoiding the doughy ‘pillow face’ look associated with older cosmetic fillers. It is undoubtedly a softer option than a face lift. But these fixes, using what is known as biostimulatory products, are not easily reversible, underscoring the importance of finding a vetted and experienced injector, the experts say.

Dr Nora Nugent, president of the British Association of Aesthetic Plastic Surgeons, warns that non-invasive biostimulatory treatments ‘create scar tissue in the deeper layers of the skin’

Dr Nora Nugent, president of the British Association of Aesthetic Plastic Surgeons (BAAPS), adds: ‘If you have a lot of biostimulatory or energy-based device treatments [using heat, sound waves or light to improve appearance], it does create scar tissue in the deeper layers of the skin, making facelifts trickier from a technical and a risk perspective.’

Perfect pick-me-up for droopy busts

Another deflating disadvantage of the jabs is severe sagging or shrinkage of the breasts. Most surgeons I spoke to said they were seeing an uptick in newly slim patients asking for bust-enhancing surgery – although they present challenges.

‘With these patients who lose weight extremely quickly the breast skin can be very thin and loose,’ says Dr Josh Waltzman, an LA-based plastic surgeon. ‘This means we have to treat them differently to regular patients.’

One option is an operation called a mastopexy – a breast lift – with GalaFLEX mesh. Referred to as ‘an internal bra’, this mesh is implanted during the op to provide additional support and reinforce the tissue, helping maintain shape. It can be done with or without a standard size-enhancing breast augmentation.

‘We have to do this, otherwise the breasts may end up stretching again,’ adds Dr Waltzman.

Other lift option after massive weight loss is a op known as a dermal suspension mastopexy with parenchymal reshaping. Instead of mesh, the patient’s own removed excess skin is repurposed to create an internal sling, which provides support.

The underlying breast tissue is also reshaped, however this is a major operation with a 20-fold higher rate of complications than a standard breast augmentation.

‘This procedure is ideal if there is a lot of drooping,’ says Dr David Turer, a plastic surgeon in Pittsburgh, Pennsylvania.

Breast lifts are rarely standalone plastic surgery procedures among GLP-1 patients who have rapidly shed pounds, but often ‘a good starting point’, he adds: ‘We will often do a breast lift first, but many of these patients will go on to have multiple procedures to correct other areas of the body.’ 

Tummy tucks are no walk in the park

Skin changes aren’t just limited to the face, breasts and bottom – they’re showing up on the arms, legs and stomachs too.

While patients are often distressed at being left with bodies ‘like a melted candle’, these issues aren’t simply cosmetic. Folds of skin can hinder movement and are at risk of chafing – leading to sores and infections which can be serious.

‘Tackling excess skin on the abdomen is the number one post-GLP-1 procedure we do,’ Dr Waltzman says. ‘The fat goes away, yet the skin doesn’t always shrink back.’

UK-based plastic surgeon Patrick Mallucci says tummy tucks are ‘the most dangerous operations we carry out’ and so finding an experienced surgeon is vital (File image)

The answer is an abdominoplasty – or tummy tuck – which involves surgically removing excess skin and fat from the abdominal area, while tightening the underlying abdominal muscle.

Similar operations can trim away excess skin from the under-arms and inner thighs. And then there is the notorious ‘body lift’ – also known as a circumferential body lift, in which some or all of these procedures are combined in a single major operation costing up to £35,000.

UK-based consultant plastic surgeon Patrick Mallucci warns: ‘These are the most dangerous operations we carry out.

‘There’s a high risk of venous thrombosis, when a blood clot forms in a vein, potentially blocking blood flow. This can be life-threatening if left untreated.’

Finding an experienced surgeon is vital, he adds: ‘You shouldn’t be scrimping and saving on a treatment like this.’

Definitely don’t opt for the dreaded BBL

Alongside Ozempic face and Ozempic breasts, there’s also Ozempic butt – a deflated, saggy backside.

The answer? Not a Brazilian butt lift, say experts. The procedure, also known as a BBL, involves taking fat from the hips, abdomen and other areas via liposuction, before injecting it into the bottom.

The result is a bigger, more pert behind – theoretically at least.

But women undergoing BBLs have a one in 4,000 chance of dying following the procedure – making it the deadliest of all cosmetic surgeries.

This is because fat injected into dense buttock muscle does not stay there. Instead, the liquid squeezes through the muscle fibres, stretching delicate blood vessels and causing them to rupture.

The procedure could also leave Ozempic patients’ bottoms looking even worse, doctors told me.

Cosmetic surgeon Dr Franco says: ‘Filling isn’t always the way to combat skin laxity issues. Like an overdone breast, if you’ve just created a butt that is too big, so it will sag again over time.’

Instead, GLP-1 weight-loss patients may benefit from a standard buttock lift – which involves removing excess skin and repositioning muscle. Non-surgical treatments include radiofrequency microneedling – a treatment that transmits heat through fine needles into the skin, helping to tighten it.

A blast of heat that firms the skin

Cosmetic device manufacturers were also hard at work last week, unveiling new machines that, they claimed, could offer quick fixes to GLP-1 patients – and spare them from going under the knife.

‘People on the jabs are by far our biggest target market,’ says one company rep.

Among the innovations showing promise are Sofwave, a device that has been shown to improve skin laxity and lift and tone the face and neck. It emits ultrasound energy which creates heat, stimulating production of collagen and elastin – proteins that help keep the skin firm and supple.

Another popular machine, Renuvion, involves a unique type of energy which its manufacturers call J Plasma – a heated helium gas – to tighten loose skin.

Mr Mallucci says they began using Renuvion ‘around six months ago and we’ve seen a huge increase in demand’, adding: ‘A lot of patients on Ozempic come because they’ve now got a nice figure but some skin laxity, which isn’t necessarily bad enough to treat with surgery.’

Experts, however, cautioned that the margin for error is small – and in the UK there is little regulation over who can use such machines. In the wrong hands the ‘results could be disastrous’, says Marc Pacifico, UK plastic surgeon and former BAAPS president. ‘Heat-producing devices, including skin-tightening devices, could cause burns and a host of other complications.’

I lost six stone… and my bottom

Christine opted against surgery, instead having the skin-tightening procedure EmSculpt Neo, which uses radiofrequency and electromagnetic energies

Christine Burch, 57, started taking Ozempic in 2021 on the advice of her doctor – at the time, she weighed almost 15st.

At 5ft 4in, this put her body mass index at 36, firmly in the obese category and at increased risk of diabetes, heart disease and a range of other health conditions.

Within a year and a half of being on the treatment, she had dropped an astonishing six stone – and her doctor was delighted.

But the weight loss left her face ‘skeletal’ and skin around the buttocks looser. Her wrinkles were more pronounced and her eyes hollower.

‘Ozempic face is real. It really does happen,’ says Christine, a senior business manager from Austin, Texas. ‘My butt also just vanished.’

She visited plastic surgeon Dr Johnny Franco who offered dermal fillers in her lips and jaw, Botox and the biostimulator treatment Sculptra to restore facial volume and soften wrinkles.

Christine says: ‘The Sculptra was phenomenal. It’s been a year and a half since I started, and I still see great benefits from it today.’

Despite a consultation with Dr Franco on surgical options, liposuction and a neck lift to combat her ‘turkey neck’, she opted against surgery. Cost aside, the risk of complications of such procedures and heavy downtime recovering weighed heavily on her mind.

A BBL to treat ‘Ozempic butt’, was also firmly off the table.

‘There’s too much of a risk of it going wrong. I just didn’t want to have any surgical procedures,’ she says.

Instead she underwent the skin-tightening procedure EmSculpt Neo, which uses radiofrequency and electromagnetic energies, to help firm up her bottom.

‘I didn’t see any immediate results, but three months in I suddenly stopped and thought, “I’ve got my butt back”,’ she says. ‘These procedures really have been life-changing.’