Ozempic and its fellow ‘fat jabs’ can add years to your life – but if you’re not careful, it seems they might add years to your face as well. In cosmetic clinics, all the talk has been about how to offset sudden facial fat loss and resulting gauntness and laxity. Now, the publication of an AI-powered study appears to confirm another long whispered-about issue related to facial ageing: GLP-1 agonists appear to interfere with wrinkle-relaxing toxin injections such as Botox.

‘What I and lots of my colleagues have been seeing in-clinic is that patients on weight loss jabs find that their toxin – or “neuromodulator” – stops working sooner than it normally does,’ says cosmetic physician Dr Catharine Denning.

So she was intrigued, but not surprised, that a paper published in the journal Toxicon found evidence that all GLP-1 agonists (Ozempic, Mounjaro and their ilk) reduce the time toxin injections work by up to three weeks, whether for cosmetic purposes (wrinkles) or medical ones (such as migraine treatment). If you think that the effects of toxin jabs normally around last three months, that is a significant reduction.

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Dr Denning points out that this was not a clinical but a ‘computational’ study. These use AI to predict possible clinical outcomes based on large amounts of existing data – in this case from 25,000 GLP-1 and/or botulinum toxin users – ‘which was enough to draw statistically significant conclusions, although the interactions between both drugs need to be investigated further,’ she says.

The running theory for the unfortunate effect is that both drug types act on the same nerve-signalling proteins, and so get in each other’s way. Another, adds Dr Denning, is that the muscle loss that can happen with rapid weight loss may affect the muscles that the botulinum toxin is also acting on.

If true, this is another way the jabs can speed up facial ageing. Fat loss itself, which affects the face particularly rapidly when you’re on GLP-1s, is the main reason users can look older, because our complexions are normally padded out and supported by fat.

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Dr Catharine Denning suggests the muscle loss that can happen with rapid weight loss may affect the muscles that Botox also acting on

‘You have both deep and superficial layers of fat in most areas of the face’, says Dr Denning. When this ‘scaffolding’ reduces in size, contours hollow out and the overlying skin may sag. The hollowing is most noticeable in the temples, just under the cheekbones, under the eyes and in the apples of the cheek.

But the skin itself, it turns out, contains yet another fatty layer: one that plays a role in how hydrated, firm and smooth your skin looks. ‘This so-called ‘dWAT’ (dermal white adiose tissue) seems to also be affected by fast weight loss, causing thinning, crepiness and dryness,’ says Dr Denning. ‘Plus, because fat stem cells (which are linked, via oestrogen, to collagen formation), are also depleted, your skin may age faster than normal going forward.’

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The way to mitigate all this is first and foremost to aim, with your doctor, for slow and sustainable weight loss as opposed to dropping weight at a mad pace. This allows for the entire body to adjust and for skin to ‘snap back’, rather than collapse.

Doctors stress the importance, despite reduced appetite, of eating enough and prioritising protein-rich foods (meat, eggs, pulses), healthy fats (oily fish, nuts, avocados) and green leafy veg, as well as staying hydrated.

Of course, there are plenty of cosmetic interventions to consider as well, with the industry rushing to cater to the new cohort of suddenly-slim GLP-1 enthusiasts. Dr Denning points to bio-stimulating fillers, injectables that rev up collagen growth and can slowly but steadily fill out hollow areas. She is a fan of Sculptra which helps increase fat cells in the face as well. ‘I like starting patients on it quite early on in their weight loss journey (charging £1,100- £3,300 depending on needs, for two to three sessions, spaced six weeks apart) it mitigates volume loss and maintains skin hydration and luminosity,’ she says.

Alternative bio-stimulating injectables with similar re-volumising and radiance-boosting effects include HArmonyCA and Julaine.

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As for targeting fat-depleted skin with topical creams, consultant dermatologist Dr Anjali Mahto (selflondon.com) cautions that ‘no cream can bring back lost fat or significantly restore volume’.

Notwithstanding, Image Skincare Vol.U.Lift cream, £105 (volulift.co.uk), has made a splash with the claim it encourages the regeneration and storage of fat cells in the skin, making it look fuller and firmer. There’s also been a rush on The Ordinary Volufiline 92 per cent + Pal-Isoleucine 1 per cent, £15.01 (theordinary.com), a serum that purports to do much the same thing.

Dr Mahto will only stand by retinoids (forms of retinol), as these can ‘support dermal thickening over time, moderately improving skin density and firmness.’ Three promising recent retinoid launches are Skin Diligent Cel Retinal Serum, £70 (skinidiligent.com), ESK Ultimate A Gold Night Cream, £83 (eskcare.com) and Dermatica Retinal 0.1 per cent Serum, £33 (dermatica.co.uk).