[HN Gopher] Ozempic is changing people's skin, say plastic surgeons
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       Ozempic is changing people's skin, say plastic surgeons
        
       Author : bookofjoe
       Score  : 57 points
       Date   : 2024-08-13 21:52 UTC (1 hours ago)
        
 (HTM) web link (www.allure.com)
 (TXT) w3m dump (www.allure.com)
        
       | cbanek wrote:
       | I wonder if using something like Retinol, which is proven to
       | improve skin and make it look tighter, younger, and get rid of
       | blemishes, marks, and sun damage, could be paired with Ozempic to
       | keep skin more healthy along with a good skin routine?
        
         | Loughla wrote:
         | What are the side effects from that medicine?
        
           | goodJobWalrus wrote:
           | For me it's uncomfortably dry skin on my cheeks.
        
           | sctb wrote:
           | They're minimal; retinol is usually mixed with a carrier oil
           | or cream in various concentrations and applied topically. I
           | would be surprised if it has an impact on the superficial
           | musculoaponeurotic system (SMAS) referred to in the article,
           | however.
        
           | cbanek wrote:
           | There's a few, but they are all pretty minor. It doesn't mix
           | well with water (rash), so make sure to put it on right
           | before you go to sleep. It can increase sun sensitivity of
           | your skin, making it easier to have sun burn or additional
           | sun damage, so again, put it on before bed. It can sometimes
           | cause breakouts especially when you start using it, including
           | a red bumpy rash. But after a few weeks, your skin typically
           | adapts to it and the rash goes away.
           | 
           | The tricky part is there's all sorts of people that sell
           | Retinol products but the amount of retinol is OTC. This isn't
           | typically good enough, but you can go to your dermatologist
           | to get a prescription strength that really works, and it's
           | cheap.
        
             | pnw wrote:
             | FWIW, Adapalene (sold OTC as Differin) is a third
             | generation retinoid that is less irritating than the
             | original formulations.
        
         | jordanb wrote:
         | I'm sometimes reminded of a parable of an old lady who
         | swallowed a fly...
        
           | cbanek wrote:
           | I don't know why she'd swallow a fly? Perhaps she'll die?
        
           | jonplackett wrote:
           | Kinda already on that train with the boat load of sugar to
           | get overweight in the first place.
        
           | arcticbull wrote:
           | The problem is she swallowed everything else too. The obesity
           | is a massive problem that needs to be remedied and yes there
           | may be side effects along the way but literally nothing else
           | works for obesity except roux-en-Y gastric bypass. Palid skin
           | is nothing compared to losing your foot to diabetes.
        
             | andy_ppp wrote:
             | I know someone who lost an eye to diabetes, so your comment
             | is certainly not hyperbole.
        
         | __MatrixMan__ wrote:
         | I don't know much about skin care, but given that Ozempic has
         | side effects that affect the retina, it wouldn't be crazy to
         | get plenty of vitamin A if you're taking it.
        
       | brians wrote:
       | The consensus is clear from the article but doesn't support the
       | headline: rapid weight loss changes the skin, which recovers over
       | more time.
        
         | r00fus wrote:
         | Not unlike the "massive muscle tone reduction" scare about GLP1
         | meds - you lose that muscle because you're also losing the fat
         | you needed the extra muscle for...
        
           | nordsieck wrote:
           | > you lose that muscle because you're also losing the fat you
           | needed the extra muscle for
           | 
           | That may be part of the cause, but it's also true that
           | whenever you lose weight, you always lose some muscle. Even
           | bodybuilders who are following the most aggressive protocol
           | to minimize muscle loss (extremely high protein intake
           | compared to other macros, along with intense strength
           | training) will experience some amount of muscle loss along
           | with fat loss when slimming down for competition.
        
         | mjamesaustin wrote:
         | The relevant quote I saw was this:
         | 
         | "These are changes he hasn't noticed in patients who have lost
         | significant weight in other ways--like through diet or gastric
         | bypass surgery--which makes him think it's unique to GLP-1
         | usage."
         | 
         | Are you suggesting sections elsewhere in the article suggest
         | otherwise?
        
         | remram wrote:
         | It's not that clear. The article is specifically about this, is
         | it just the speed or something else.
         | 
         | > "We're still waiting to find out," says Dr. Few. "I don't
         | think anybody can tell you definitively that there's not an
         | inherent change to the skin."
        
       | bamboozled wrote:
       | It's strange how there is almost never a shortcut to anything.
       | Like a universal law.
       | 
       | So now you might get free weight loss without making any effort
       | at all, but you'll also look older in the process?
       | 
       | I have to say, my father has been taking it, and I noticed that
       | he does look older all of a sudden...and his weight loss also
       | plateaued. I thought it was just my imagination, but maybe not.
        
         | mym1990 wrote:
         | I have _heard_ that people who lose weight quickly will
         | typically look older due to the development of wrinkles and the
         | development of harder features. Skin simply doesn 't have time
         | to keep up with the weight loss. I don't know if this is true
         | but the theory could have some merit as far as our perception
         | of people. The real question is: does something like ozempic
         | change the biological age of someone?
        
           | swozey wrote:
           | You're going to need to include a weight percentage drop or
           | something. I've wrestled/jiujitsued my entire life and we go
           | up and down weight constantly, 2-30lb swings. We'll water +
           | electrolyte fast for a week or two if we have to and drop
           | 10-20lbs.
           | 
           | We all look 10-15 years younger than we are (35-45s).
           | 
           | But we're also not dropping 150-200lbs or whatever number
           | you're potentially referring to to where skin would stretch.
           | But prolonged, constant rapid dropping hasn't bothered our
           | skin. I'm complimented all the time on mine.
           | 
           | https://old.reddit.com/r/wrestling/comments/2r9nwy/whats_the.
           | ..
        
             | mym1990 wrote:
             | Yeah totally, there would be umpteen different factors that
             | would influence the "age perception" so to say. I also
             | wonder how losing different types of weight(water fast vs
             | longer timeframe fat/muscle loss) could impact this.
        
         | JumpCrisscross wrote:
         | > _strange how there is almost never a shortcut to anything.
         | Like a universal law_
         | 
         | There _are_ win-win tradeoffs. Vitamins, for instance. If you
         | 're running a vitamin deficiency, there isn't a downside to
         | increasing your intake of that vitamin. (Curing acute
         | dehydration via IV is another shortcut that just works.)
         | 
         | The Ozempic story, for me, has been more about how we almost
         | seem to be reflexively against the idea of a win-win. A lot of
         | people _want_ there to be a tragic downside to the drug for
         | reasons that aren 't entirely clear to me.
        
           | xlbuttplug2 wrote:
           | But gluttony is a sin!
        
             | mbrumlow wrote:
             | I thought everybody was saying Gluten was bad...
        
           | ethbr1 wrote:
           | Fat soluable vitamin toxicity?
           | https://www.ncbi.nlm.nih.gov/books/NBK234920/
           | 
           | Because apparently a surprising number of people can't
           | calculate bodyweight doses.
        
           | silverquiet wrote:
           | My perception is that we judge fat people as weak and
           | contemptible and therefore a drug is allowing them to cheat
           | their way out of their sin instead of paying the proper
           | penance (diet and exercise).
           | 
           | It's well known that people treat fat people worse; I
           | constantly wonder how aware people are of their own biases?
           | 
           | For what it's worth I've been fat before and I've been in
           | shape before. I have my own biases that are beyond the scope
           | of this comment. Never taken one of these drugs but only
           | because of cost/access; I'm actually curious to experience
           | them. If they work for people, I say they should take them.
        
           | PhasmaFelis wrote:
           | I think it's pretty simple, unfortunately. A lot of folks
           | have this visceral, instinctive horror of fat people, and
           | instead of examining that, they convince themselves that what
           | they _actually_ despise is laziness and gluttony: inner vices
           | expressed outwardly, like a medieval morality play.
           | 
           | But if there's a way to lose weight without major lifestyle
           | change, it threatens that tidy moral barometer. Someone might
           | _look_ virtuous without actually being so. Cognitive
           | dissonance ensues. So they hope and wish for anything to
           | catch out and punish these  "cheaters."
        
         | armchairhacker wrote:
         | What about people who are naturally thin?
        
           | wiseowise wrote:
           | Harder to gain weight. Getting called skinny, etc.
        
           | goodJobWalrus wrote:
           | I see older very skinny women who look old and frail due to
           | being very skinny. You need some fat under that skin to plump
           | it up to look youthful. Catherine Deneuve I believe was the
           | one that said that after the age of 40 you have to chose
           | between your face and your ass. I say all of this as a 40
           | something woman.
        
         | digbybk wrote:
         | Coffee being the only exception.
        
           | lagichikool wrote:
           | Even coffee is without its downsides and risks. There are
           | cardiovascular risks, acid reflux, sleep issues, and probably
           | more.
        
             | Faaak wrote:
             | I though GERD was not caused by coffee [1]: "Drinking
             | coffee or tea and adding milk or sugar was not associated
             | with reflux symptoms or EE"
             | 
             | [1]: https://journals.lww.com/tcmj/_layouts/15/oaks.journal
             | s/down...
        
           | maximus-decimus wrote:
           | coffee definitely ruins my sleep no matter what time I drink
           | it, so there's that.
           | 
           | My father also had headache his whole working life on
           | Sundays, not realizing that drinking coffee all week days but
           | not on the weekend, that was probably coffee withdrawal that
           | was giving him a headache by day 2.
        
         | rexer wrote:
         | I don't know, I think that might be a bias of some kind. The
         | free shortcuts are obvious and so the alternative sounds
         | ridiculous. No one claims to be a genius when they save time by
         | driving instead of walking. But at the margin, of course
         | everything has a trade off.
        
         | bananapub wrote:
         | seems pretty unsurprising to me that when you shift the
         | equilibrium of some extremely complicated system that evolved
         | over an extremely long time to improve some metric, that the
         | side effects are mostly moving down some other metric you
         | liked.
         | 
         | or even more boringly: almost only bad things get called side
         | effects rather than being redefined into the benefits
        
         | cm2187 wrote:
         | What kind of effort are you talking about? Weight loss has very
         | little to do with exercise and mostly to do with how much you
         | eat. Those drugs allow you to combat the carving when you
         | restrict food. Is fighting the carving the "effort" you think
         | people ought to make?
        
           | anakaine wrote:
           | This, and there's seems to be a number of people with a
           | misconception that getting medical assistance is either
           | cheating, or you're not trying hard enough.
           | 
           | As someone who is quite strong and fit, but has a family
           | history of obesity, and who has been packing on the kilos
           | into their 40s - I've recently started with ozempic and it's
           | a breakthrough drug. The incessant never ending demand to
           | eat, that voice which never goes away and pervades every part
           | of the day and task, the call which is almost impossible to
           | ignore ore even after months of dieting and managing macros -
           | it got moderated down from a 10/10 volume to about a 2/10
           | volume. I've started dropping the gut fat, and 6 weeks in my
           | energy is coming back up to levels it was at 10 years ago.
           | 
           | I'm hoping that this isnt a permanent solution, but that it
           | permits me to reset my bodies relationship with food,
           | insulin, fat accumulation and hunger signals in the long term
           | as the signalling cells senesce, the fat is reduced and
           | demands less maintenance, etc.
        
           | Aperocky wrote:
           | > Weight loss has very little to do with exercise and mostly
           | to do with how much you eat.
           | 
           | That's not an accurate statement. Over the past year I have
           | averaged 2 hours of aerobics per day (~1500 active CAL). And
           | I've simply buffeted my way eating multiple portions per day
           | and haven't gained any weight.
           | 
           | It have a lot to do with a lot of exercises - it has little
           | to do if you just had little exercise. It's all about the
           | caloric balance, and it takes a lot of exercise to skew that
           | balance while it's a lot easier to eat more.
        
         | Loveaway wrote:
         | Dude, it definitely is a universal law of sorts. Like it's a
         | zero sum game. Ever wondered how there's no antidepressant or
         | drug, legal or illegal, that just makes you happy? Or anything
         | of that matter? Free bliss doesn't exists. You always have to
         | pay for it. Literally. That's why drugs are bad, you get the
         | high first, but now you're in debt. Exercise is good, because
         | it's the other way around! I actually think that's the whole
         | point of "time", so we can charge our energies one way or
         | another and then experience happiness as a reward!
        
         | throwup238 wrote:
         | IMO GLP-1 agonists are obviously not free, from first
         | principles. They might be for diabetics who carefully manage
         | their diet, but many (most?) people using them for weight loss
         | usually already have shitty diets with poor macronutrient
         | balance and micronutrient deficiencies. Eating less of the
         | crappy food they were eating before just makes the true
         | situation worse.
         | 
         | This is just the latest [1][2] evidence for the obvious muscle
         | wasting that will happen to a human body that is starved of
         | protein and micronutrients. The muscles under the skin are
         | being cannibalized for protein that's missing in the diet and
         | other biochemical processes that restore them are starved of
         | the nutrients they need to function.
         | 
         | [1] https://news.ycombinator.com/item?id=37558780
         | 
         | [2] https://news.ycombinator.com/item?id=39326333
        
           | cameronh90 wrote:
           | Why do you think they just eat less of the same crappy food?
           | 
           | In my experience, it turned down the reward feedback for
           | calorie dense food, and I would usually now prefer something
           | like a lentil daal over a Dominos.
        
       | exabrial wrote:
       | here's my casual armchair analysis about some thing I know
       | nothing about: Is this correlation instead of causation? I mean,
       | if you're dumping pounds rapidly and then your skin is all been
       | stretched out...
        
         | throwup238 wrote:
         | From TFA:
         | 
         |  _> These are changes he hasn't noticed in patients who have
         | lost significant weight in other ways--like through diet or
         | gastric bypass surgery--which makes him think it's unique to
         | GLP-1 usage._
        
         | hypercube33 wrote:
         | They aren't seeing it with other rapid weight loss so seems
         | like no however this isn't a scientific study so it's just an
         | observation.
        
       | dark-star wrote:
       | A quick explanation about what Ozempic is would be helpful in
       | this case. Not every country uses the same name for their drugs
       | and the brand names are often very different
        
         | istultus wrote:
         | That's an interesting remark, considering this is most famous
         | drug on the face of the Earth, and only has one brand name
         | worldwide (in a different dosage it's called Wegovy, and when
         | it's released as a pill it will be called Rybelsus). Its
         | generic name is Semaglutide.
        
           | vintagedave wrote:
           | Wouldn't the most famous drug be: aspirin, heroin, cocaine,
           | paracetamol, or maybe viagra?
           | 
           | I don't know from your comment what it is, and it was
           | unhelpful. Not really in the HN spirit. For future readers,
           | it seems to be an anti-diabetic drug or artificial hormone
           | originating in the 70s. More educated comments than mine are
           | very welcome.
        
           | bgnn wrote:
           | This is the first time I'm hearing about it. It seems here
           | it's only prescribed to type 2 diabetes partients and doctors
           | are strictly prohibited from prescribing it for weight loss.
        
           | Arubis wrote:
           | I had never heard of this drug before today.
        
         | azinman2 wrote:
         | It literally says this in the article.
        
       | metadat wrote:
       | Was this article written by an LLM? I had to scroll so far to get
       | to the core content it kept promising, it's like it wasn't
       | written for human consumption.
       | 
       | Ultimately this article is kind of a FUD nothing-burger. People's
       | skin behaves the same anytime there is rapid weight loss.
        
         | throwup238 wrote:
         | _> These are changes he hasn't noticed in patients who have
         | lost significant weight in other ways--like through diet or
         | gastric bypass surgery--which makes him think it's unique to
         | GLP-1 usage._
        
           | metadat wrote:
           | TFA contains mixed messaging. The part you quoted is
           | discussing face skin, then later, also talking about face
           | skin:
           | 
           |  _> ("We see a similar pattern in other causes of rapid
           | weight loss, including gastric bypass surgery, he says.) In
           | some cases, the loss of subcutaneous fat is significant
           | enough that it impacts a patients' ability to get injectables
           | .._
           | 
           | So which is it?
           | 
           | My takeaway was that losing weight fast == problematic.
           | 
           | The article dials up the FUD factor to the max, which makes
           | me question the quality of reporting and any intent to
           | accurately inform vs. just get clicks.
        
             | ineedaj0b wrote:
             | I had an internship with a researcher who swore skin had
             | different properties between races (not including color).
             | Black populations had a different feel to adipose tissue. I
             | think I could tell but he had examined thousands, he didn't
             | want to be the guy publishing a paper on that.
        
         | PhasmaFelis wrote:
         | I've got no dog in this fight, but the article explicitly says
         | this is different from the normal effects of rapid weight loss
         | on skin.
        
       | cm2187 wrote:
       | And if that's true, what is the conclusion? Stay obese to have a
       | beautiful skin (and deal with the associated health effects)?
        
         | ikurei wrote:
         | There are more options. Many medications are usually prescribed
         | together with other meds, to help with the side effects. We may
         | adjust the formulations, or learn what to compliment it with.
        
         | readthenotes1 wrote:
         | You remind me of a quote from a book whose name I can't
         | remember:
         | 
         | She had the unwrinkled face of a woman who had never been
         | calorically challenged.
        
         | Saline9515 wrote:
         | The article explains that this happens also with patients who
         | aren't obese but are using ozempic to lose 20 pounds.
         | 
         | It's an important side effect that ought to be researched.
        
           | rtsil wrote:
           | I'd say a more important side effect that ought to be
           | researched is possible thyroid tumors, including cancer.
           | 
           | > In studies with rodents, Ozempic(r) and medicines that work
           | like Ozempic(r) caused thyroid tumors, including thyroid
           | cancer. It is not known if Ozempic(r) will cause thyroid
           | tumors or a type of thyroid cancer called medullary thyroid
           | carcinoma (MTC) in people.
           | 
           | https://www.ozempic.com/how-to-take/side-effects.html
        
         | irusensei wrote:
         | Hit the gym eat healthy and get fit while retaining your
         | beautiful skin?
        
           | cm2187 wrote:
           | Let them eat cake
        
       | mistercheph wrote:
       | There's no shot that the cure everything pill will have any
       | negative health consequences, it's been working so well for me
       | that I just spoke to my pharmacist and we're doubling my dose.
        
       | brigadier132 wrote:
       | Two guesses:
       | 
       | - it's just stretched skin
       | 
       | - people get on ozempic but are not eating nutritious diets, so
       | now they are malnourished
        
         | ceejayoz wrote:
         | This is a challenge for the first hypothesis:
         | 
         | > These are changes he hasn't noticed in patients who have lost
         | significant weight in other ways--like through diet or gastric
         | bypass surgery--which makes him think it's unique to GLP-1
         | usage.
        
       | comice wrote:
       | Worth keeping in mind that many plastic surgeons are in
       | competition with drugs like Ozempic.
        
       | cosmicvarion wrote:
       | Don't these plastic surgeons have a conflict of interest if they
       | perform liposuction? Liposuction is probably wildly more
       | profitable than prescribing a GLP-1 inhibitor.
        
         | Saline9515 wrote:
         | As the article says, they have patients come anyway to reduce
         | the side effects of GLP-1.
         | 
         | Plastic surgeons are like the bank in casino: they always win
         | in the end.
        
       | arcticbull wrote:
       | > "Fifteen years ago, I would never have done a lower body lift
       | on a patient unless they had gastric bypass, a lap band, or a
       | gastric sleeve," he says.
       | 
       | Right, because 15 years ago nobody else lost any weight. GLP-1s
       | and roux-en-Y are literally the only two treatments shown in
       | clinical studies that cause people to lose weight and keep it off
       | indefinitely.
       | 
       | Maybe the skin is saggy because there's nothing under it, maybe
       | not? But at least they won't have a stroke, heart attack, cancer
       | or type 2.
       | 
       | Chemo is going to make you look much worse.
       | 
       | The new category of patient is "person who successfully lost
       | weight and kept it off without gastric bypass."
       | 
       | [edit] if you think I'm exaggerating there's a great study from
       | 2023 that tracked how many people lost more than 5% body weight
       | in a given year.
       | 
       | Answer: 1 in 10, skewing mostly to people who had more to lose.
       | 
       | If you were morbidly obese your probability of achieving a
       | healthy weight is 1 in 1667.
       | 
       | And if you manage to thread that needle your average weight
       | regain over 5 years is 80%.
       | 
       | https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
        
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