Q&A: How energy-based devices can improve GLP-1-related skin sagging

PUBLISHED REPORT in HEALIO

Macrene Alexiades, MD, PhD, FAAD

Key takeaways:

• Rapid weight loss with GLP-1 receptor agonists is associated with collagen loss and structural changes to the skin.

• Early intervention with energy-based devices and cosmetic fillers can counter these effects.manufacturing processes.

  
  

As GLP-1 receptor agonists drive unprecedented weight loss, patients are achieving goal weights but face new aesthetic concerns.

Skin laxity related to the use of GLP-1 receptor agonists is now a primary concern in aesthetic medicine, according to Macrene Alexiades, MD, PhD, FAAD, director and founder of the Dermatology & Laser Center of New York and a Healio Dermatology Peer Perspective Board Member. Before or shortly after initiating GLP-1 therapy, patients should consider consulting with a dermatologist or laser specialist to address any adverse skin effects proactively, Alexiades said. Ideally, a patient should schedule a consultation within the first month of GLP-1 treatment.

“It is important for patients to understand that what we are doing is preventing the manifestation of wrinkles and laxity,” Alexiades told Healio. “We can educate the patient and say, ‘At present, you have a stage 2.0 on the laxity grading scale. My goal for you over the course of losing your target of 15 or 30 pounds is that we do not see that progress further.’ And then, to be realistic, once the patient stabilizes their weight, we can begin to see measurable improvement.”

Healio spoke with Alexiades, a global expert in energy-based technologies, about the increased demand from patients to treat GLP-1-related skin laxity, how to properly assess patients and measure treatment progress, and the importance of early intervention. Alexiades recently co-moderated a presentation on managing skin laxity in patients prescribed GLP-1s at the American Society for Laser Medicine and Surgery (ASLMS) Annual Conference.

Healio: What led you to develop this talk?

Alexiades: This is a new course we added to the ASLMS agenda this year. The prevalence of GLP-1 use has become so significant that it is critical we address how to manage the associated skin-related effects. Early intervention is equally essential — that is something I have learned through caring for these patients over the past several years. If we do not intervene early, the window for optimal outcomes narrows considerably. This is why we determined at ASLMS that this topic warranted priority status on the program.

What I have found through my research is that GLP-1s induce an accelerated form of cutaneous aging, manifesting as wrinkles and laxity. The most affected areas are the face and jowls, neck and décolleté, upper arms, abdomen and flanks, and inner thighs. This occurs not solely because of rapid weight loss, but through mechanisms we are still elucidating — mechanisms that appear to cause a direct reduction in collagen, elastin and hyaluronic acid as an effect of the drug itself. It is important for both patients and clinicians to recognize that GLP-1s are not without consequences. There can be significant adverse effects on the skin.

Given all of this, it is imperative that we educate dermatologists and laser specialists accordingly.

Healio: What are some energy-based treatments that can address skin laxity for people taking GLP-1s?

Alexiades: The two forms of radiofrequency (RF) treatments currently in use and most important to GLP-1-related laxity are both skin surface RF modalities. RF technology stimulates neocollagenesis and tissue contraction, remodels elastin fibers and tightens the dermis. My preference is tripolar or fractional RF over bipolar as we achieve more favorable and uniform tissue heating. The other modality is monopolar RF, which provides deep-tissue heating and is best for the neck and body areas where deeper penetration is required. These two modalities can be effective once laxity develops; however, the critical principle remains early intervention. We do not want to wait until laxity has fully established. With early intervention, patients never develop the sunken appearance that has become widely recognized in the field. One can identify it almost immediately — what has been colloquially termed “Ozempic face.” For some patients, even the hair begins to show signs of premature graying. These drugs are depriving the skin of nutrients, while simultaneously altering its fundamental structure.

The next category is minimally invasive RF, most commonly delivered via RF microneedling. This represents a meaningful step up in intervention, as we deliver the RF energy through microneedle electrodes directly into the tissue. It is important we address this modality carefully, as there have been recent press reports regarding its inappropriate use. RF microneedling has the highest percentage of nonphysician practitioners among its administrators. In many cases, those individuals are not authorized to practice medicine. The unauthorized and illegal use of the technology is the central problem.

Healio: How soon should a person who is starting a GLP-1 look into aesthetic treatments like energy-based devices or cosmetic fillers?

Alexiades: As soon as a patient initiates a GLP-1, I recommend they schedule a consultation with a dermatologist or laser specialist. Within the first month, we should have an assessment and ideally begin treatment. The skin renewal cycle is approximately 28 days. That is precisely the interval in which the earliest signs of skin changes will begin to manifest as a result of the drug.

Patients are often surprised when they find out that GLP-1s directly contribute to skin laxity. Most arrive under the mistaken impression that weight loss alone is responsible for these changes.

This is where informed consent becomes essential. It is our professional obligation to inform patients that, as I have noted, there is no consequence-free intervention. We must communicate clearly: “Here are the additional data points we are observing with GLP-1 use. You are not only committing to reducing your weight and your waist circumference, but you may also be accelerating the aging process of your skin.”

Prior to initiating any treatment, it is important to establish baseline metrics using standardized digital photography. In my practice, we employ the Alexiades Laxity Grading Scale. We measure abdominal circumference and thigh circumference as well. It is essential that at baseline and at follow-up, we have objective metrics against which to track outcomes alongside body weight.

Healio: What are the take-home pearls from your presentation?

Alexiades: My goal for ASMLS attendees is that they leave with a clear framework for a multimodal approach with their patients. I rarely treat with a single modality. I almost invariably combine device-based treatment with filler. RF firms. Filler fills.

The ideal protocol should address the face and body in coordinated sessions using a staged approach: RF treatment first, followed by filler 2 to 4 weeks later. RF pretreatment primes the tissue for improved filler integration, with the neocollagenesis it induces, creating a structural scaffold. The filler then restores the lost volume in deflated compartments. The maintenance schedule should be aligned with the patient’s ongoing GLP-1 use, with the protocol grounded in published radiofrequency and filler literature. A comprehensive approach that incorporates both modalities will assure an optimal outcome for the patients.

For more information:

Macrene Alexiades, MD, PhD, FAAD, is director and founder of the Dermatology & Laser Center of New York and a Healio Dermatology Peer Perspective Board Member. Alexiades can be reached on Instagram @drmacrene.

Macrene Alexiades, MD, PhD, FAAD

• Associate Clinical Professor, Yale University School of Medicine

• Director and Founder, Dermatology & Laser Center of New York 

• Attending Physician, Veterans Administration, Yale-West Haven VA Hospital, Yale New Haven Hospital, Northwell Health

• Adjunct Professor, Sigrou Hospital, Athens, Greece

• CEO and Founder, Macrene actives

See published article here https://www.healio.com/news/dermatology/20260424/fda-issues-complete-response-letter-for-trenibotulinumtoxine