GLP-1 receptor agonists and facial volume: PLLA plus hyaluronic acid after weight loss

GLP-1 receptor agonists such as semaglutide and tirzepatide lead to rapid, marked weight loss in many patients. In aesthetic practice, the downside becomes apparent: hollow cheeks, sharper contours, sagging skin – colloquially known as “Ozempic face”. In a survey of 1,226 users, among those with a weight loss of more than 20%, half reported facial volume loss and 72% reported sagging skin (Rao et al. 2026). Controlled data on how these changes can be treated have so far been lacking.

A research group led by Z. Paul Lorenc has now published the first prospective, multicentre study of a combination of poly-L-lactic acid (PLLA) and hyaluronic acid in people on GLP-1 therapy.

Study design

The study was open-label and single-arm – without a control group – and ran from February 2024 to May 2025 at two centres in the USA. A total of 41 people were enrolled (39 women, 2 men; mean age 58.9 years); 35 completed the study. All had lost weight on semaglutide or tirzepatide, on average around 15 kg (6 BMI points), had been taking the medication for an average of 1.7 years and had a stable weight.

• Hyaluronic acid: at baseline, a mean of around 2 ml at the zygoma, with a 25 G cannula; touch-up treatment after four weeks if required (Restylane® Lyft or Contour).
• PLLA: in the lower face and at the piriform fossa, with a 25 G needle; at baseline and after four weeks, optionally after eight weeks. A mean of around 17 to 18 ml of reconstituted suspension per session (Sculptra®).

Skin hydration (Corneometer), gloss (Glossymeter) and skin thickness (ultrasound) were measured – but only at one of the two centres, i.e. in 13 to 19 people. In addition, there were standardised photographs, a satisfaction questionnaire and the recording of adverse events. Follow-up continued until nine months after the last PLLA session.

What did the study find?

• Skin hydration: On the cheek (hyaluronic acid area), it increased by 33.4% after four weeks (p = 0.048) and was still 32.9% above baseline after nine months (p = 0.023). At the jawline (PLLA area), there was no significant change.
• Gloss: At the jawline, it increased – by 13.0% after four weeks and 15.9% after nine months (p = 0.012). On the cheek, by contrast, it decreased (minus 7.6 to minus 10.9% between months 3 and 9).
• Skin thickness: At the jawline, plus 8.2% after three months (p < 0.05); no longer significant after six and nine months. No change on the cheek.
• Satisfaction after nine months (n = 35): 88.6% felt they looked better than before treatment, 85.7% less gaunt; 91.4% would recommend the treatment.
• Tolerability: The authors report no treatment-related adverse events; 17 people reported mild, transient reactions at the injection site (haematomas, swelling, pain, nodules).

Assessment: how robust are the results?

The study provides prospective data for this patient group for the first time – with clear limitations that matter when evaluating it:

• No comparison: Without a control group and without blinding, the effect of the treatment cannot be separated from expectation, season or spontaneous course.
• Sponsor: The study was funded, designed and analysed by the manufacturer of the products used (Galderma); five of the seven authors are or were employed there.
• Contour not measured: The improvement in facial contour – the actual treatment goal – is documented only with before-and-after photographs of four people, without a scale and without blinded assessment.
• Small measurement group, mixed findings: The instrument-based measurements come from fewer than half of the participants and differ by area; on the cheek, gloss actually decreased.
• Not GLP-1-specific: There is no comparison with weight loss without GLP-1 therapy.

Conclusion for practice

A staged approach – hyaluronic acid for projection at the zygoma, PLLA in the lower face in two to three sessions – was feasible and well tolerated in weight-stable people on ongoing GLP-1 therapy and led to high satisfaction over nine months. The objective improvements in skin quality were moderate and inconsistent across areas; the study does not provide proof of efficacy against a control.

In our view, this has the following implications for the consultation: include weight history and medication in the patient history, plan once weight is stable and address material requirements openly – the quantities of PLLA used correspond arithmetically to about two vials per session. How to implement volume restoration and biostimulation in an anatomically safe way is covered in depth in our hands-on workshops.

Frequently asked questions

What does “Ozempic face” mean?

The term is colloquial and describes gaunt facial features and sagging skin after rapid weight loss on GLP-1 receptor agonists such as semaglutide or tirzepatide. Whether the changes go beyond weight loss alone has not been established; the study presented here did not investigate this.

When should treatment be carried out after weight loss?

Only people with stable weight were enrolled in the study; almost all continued to take the medication. Whether earlier treatment during weight loss is useful was not examined.

How much material was used in the study?

A mean of around 17 to 18 ml of reconstituted PLLA suspension per session in the lower face, in two to three sessions four weeks apart, plus around 2 ml of hyaluronic acid once at the zygoma.

Reference: Lorenc ZP, Somenek M, Nguyen TQ, Garimella S, Hicks J, Le JHTD, et al. A Multicenter, Open-Label Study of Combined Poly-L-Lactic Acid and Hyaluronic Midface Filler Regimen Enhances Facial Harmony and Skin Quality in GLP-1 Medication Users. Aesthet Surg J. 2026;46(5):509–519. doi: 10.1093/asj/sjaf240. PMID 41243519. Open access (CC BY 4.0): PMC13064655.

Background: Rao S, et al. Dermatol Ther (Heidelb). 2026;16(9):4749–4760. PMID 42579223 (open access).