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Regular injections of semaglutide, or more recently tirzepatide, have blown up as medical weight loss catalysts.1, 2 Both emerged to battle type-2 diabetes but were later scientifically demonstrated to cause weight loss, setting off a major trend that shows no signs of stopping.
Along with the media coverage comes controversy. Among the more visible are ‘Ozempic Butt’ or ‘Ozempic Face,’ questionable terms for normal, visibly pronounced laxity accompanying rapid weight loss rebranded as a side effect, say experts. “Any rapid weight loss will cause laxity and loss of volume,” explained facial plastic surgeon Jennifer Levine, MD (New York, N.Y.), “which stems from the loss of fat and concurrent reduction in collagen and elastin in the skin, giving that droopy look.”
“Another issue is loss of lean muscle, which is why resistance weight training and adequate consumption of protein are so important when losing weight,” added Jonathan Schoeff, MD, medical director of The Longevity Lab - Aesthetics & Wellness (Lone Tree, Colo.). Dr. Schoeff enjoys the wellness arm of his practice where the aforementioned drugs are often employed as a tool to achieve weight management goals as part of a total wellness plan. “It is important to remember that while we seem to be seeing a meteoric rise here, this class of medications (i.e., GLP-1 agonists) have been around for almost two decades and are well-studied.”
Leading-edge aesthetic technologies from BTL Aesthetics (Boston, Mass.) are ideal for fighting the natural effects of rapid weight loss, staving off facial and body laxity (regardless of drug involvement), as well as volumizing with muscle and treating overlying skin tissue via a powerhouse multi-vector approach. High-intensity focused electromagnetic (HIFEM) brand plus Synchronized radiofrequency (RF) in Emsculpt Neo® produces profound body contouring via non-invasive muscle hyperplasia and hypertrophy. This is achieved by inducing thousands of supramaximal contractions of targeted muscle groups in the trunk and extremities. Emsella® similarly treats the pelvic floor with HIFEM. The high-intensity facial electromagnetic stimulation (HIFES) brand plus Synchronized RF of Emface® helps restore facial structure by targeting key elevator muscles. At the same time, the RF component treats superficial facial tissue to stimulate collagen and elastin while simultaneously improving local microcirculation.
According to Judson Brandeis, MD, a urologist and sexual medicine and wellness expert in San Ramon, Calif., “the more weight lost, the more profound laxity will be, so we often use BTL technologies to treat multiple body parts. This helps avoid muscle loss, rebuilds the base in areas affected by fat loss, and treats overlying tissue to promote a better overall result.”
“We rely on Emface because it gives us a very natural look and helps restore both natural proportions and volume. There is nothing like it,” Dr. Levine reported. “We regularly use it in combination with Emsculpt Neo and may even add BTL’s Emtone® as well. Using these technologies during, rather than after, weight loss is important because it is much better to be proactive.”
Melinda Silva, MD, founder of Silva M.D. AntiAging and Wellness (Chula Vista, Calif.), uses a comprehensive program including customized bioidentical hormone therapy, nutrition guidance, exercise programs, supplements and limited weight loss drugs to usher patients into a higher state of wellness and optimal health. In addition to Emface and Emsculpt Neo, she uses BTL’s new platform, Exion®. Exion face and body applicators each feature a patented combination of monopolar RF and targeted ultrasound (TUS), creating therapeutic thermal and mechanical stress to fibroblasts in the deep reticular dermis. Among the platforms potential positives: scientifically demonstrated improvement in hyaluronic acid (HA).
“Studies with Exion show increased HA production, which improves skin volume and quality, resulting in natural, healthy-looking plumpness with improved elasticity that elevates the facial results of Emface to help counteract the natural effects of weight loss,” Dr. Silva reported.
This unprecedented HA stimulation has been proven scientifically. Fritz and colleagues3 treated swine on the side of the abdomen (n=12, 9 RF+TUS, 3 RF only) with four weekly, 30-minute sessions. Enzyme-linked immunoassay (ELISA) testing showed an average HA increase of 80 µg/g in the RF+TUS group with no significant changes in the RF-only group. A similar study by Duncan et al. 4 treated pigs (n=12) with RF+TUS (n=6) vs. RF+non-targeted US (n=6), showing an HA increase of 224% vs. no significant change in HA levels, respectively. “A 224% increase is astounding,” Dr. Silva noted.
Dr. Schoeff sees an opportunity. “The media attention surrounding semaglutide and tirzepatide is quite polarizing. This drives many patients to seek these medications but creates negative press around perceived ‘side effects.’ This serves as an opportunity to turn a negative into a positive, allowing us to explain the effects of rapid weight loss – and, more importantly, how we can anticipate and combat them with BTL technologies. We can explain why we want to use these technologies proactively, to help deal with natural aspects of weight loss that frankly, many patients seem unaware of,” he expanded. “It helps give them an overall result that is more satisfying which, in turn, may help motivate them to make more significant and permanent lifestyle changes and maintain their results over time. That is what’s most important to physicians – not just the improvement, but the sustainability and longevity.”
All experts agree, in the end, any weight loss must be accompanied by lifestyle change, and the outcomes seen with BTL technologies can help promote this. “Improved nutrition and regular activity are essential for maintaining your results from muscle building or weight loss,” Dr. Brandeis concluded.
1. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. OnceWeekly Semaglutide in Adults with Overweight or Obesity Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med 2021;384(11):989-1002.
2. Jastreboff A, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of Obesity. N Engl J Med N Engl J Med 2022; 387:205-216.
3. Fritz K, Bernardy J, Jarosova R, Kralova N. Radiofrequency and targeted ultrasound have shown to enhance natural hyaluronic acid production: porcine animal study. Presented at the American Society for Laser Medicine and Surgery (ASLMS) annual meeting, San Diego, California, 27 April 2022.
4. Duncan D, Bernardy J, Hodkovicova N, Masek J. Increased levels of hyaluronic acid in skin after monopolar radiofrequency and TUS treatment: porcine animal study Presented at the American Society for Laser Medicine and Surgery (ASLMS) annual meeting, San Diego, California, 27 April 2022.