# Ozempic Face: What Can You Actually Do About It?

An episode of [Vain-ish](https://invisiblenetwork.ai/podcast/1824105551), 26 Aug 2026, 36 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/01M0XTFGTBS5MNK3W0KX4C4G71.mp3

Dermatologist Dr Ryan De Cruz explores the facial changes some people experience alongside GLP-1 medicines, including why changes in facial volume can become more noticeable. He breaks down the science behind facial fat, skin structure and volume. He also discusses concerns around unregulated and black-market medicines, what people may consider when they notice changes to their appearance, and the role of aesthetic medicine. This episode features personal experiences, professional perspectives and emerging research. It is for general informational and entertainment purposes only and is not a recommendation or endorsement of any medicine, treatment, procedure or device. Please speak with an appropriately qualified health professional about your individual circumstances. Find us on Instagram: @vainishpodcast and thanks to our guest Dr Ryan De Cruz from The SkinDoctors Hosts: @becjudd and @jessierobertsx Producer: Liza Altarejos Audio Imager: Chris Marsh Video Producer: Justin Hill Find more great podcasts at LiSTNR

## Transcript

[0:02] a listener production.
[0:05] I'm Bec Judd.
[0:06] And I'm Jess Roberts.
[0:07] And we're done with the smoke and mirrors.
[0:09] Fainish shares honest stories about what it takes to look amazing because we did not wake up like this.
[0:15] And you should know the stuff that we chat about on this podcast is based on our personal experiences.
[0:21] We're sharing it for your entertainment.
[0:23] It's definitely not medical advice.
[0:26] And we'll always be clear with you when something is a paid endorsement.
[0:29] Please always chat with your qualified healthcare team before making any decisions about your health.
[0:49] Hello everyone, it's Bec Judd.
[0:51] And Jess Robertson, welcome to Vanish.
[0:53] So Jess, we've talked about the weight loss side of things with GLP-1s on Vanish before.
[0:59] We love that we get to have the best... Of the best.
[1:04] Of the best, the best advice, best doctors come in and really talk about the science behind GLP-1s.
[1:09] GLP1s and other peptides.
[1:11] We had Dr. Jason Chan come in and talk about peptides.
[1:14] Go check out our highlights on peptides for his show.
[1:18] That was really informative.
[1:21] As I was saying, we've talked about the weight loss side of things with GLP1s.
[1:23] But what happens when you start noticing changes in your face as well?
[1:28] And we've noticed it on our friends.
[1:30] Yeah, but there's a lot of people out there and it's almost a little bit of a dead giveaway now.
[1:35] There's the weight loss and the face, right?
[1:38] You've probably heard the term Ozempic face thrown around online.
[1:43] But what does it actually mean?
[1:46] And if you're on GLP-1s and you start to notice changes in your face, what can you actually do about it?
[1:52] So today we are joined by dermatologist Dr. Ryan DeCruz to separate the science from the hype and talk us through what's really happening and what, if anything, can be done about it.
[2:04] Welcome back to Vanish.
[2:06] Thank you.
[2:07] Thanks for having me.
[2:08] Pleasure.
[2:09] So you came on, gosh, a few months back now and broke down GLP-1s for us.
[2:15] GLP-1s are brand names like Ozempic.
[2:18] Monjaro.
[2:19] Monjaro.
[2:19] Monjaro.
[2:20] Monjaro.
[2:20] That's right.
[2:21] There's another one that everyone's talking about.
[2:24] Is Ressa a GLP-1?
[2:25] It is.
[2:26] In fact, it's the triple agonist.
[2:27] Now, really important point here, not available in Australia, not TGA approved.
[2:32] Not available in Australia.
[2:34] Bloody hell.
[2:34] Well, where the hell is everyone getting their Ressa?
[2:37] What did he call it?
[2:37] Really?
[2:38] Retta True Tide.
[2:39] Retta True Tide.
[2:40] That's it.
[2:41] And it's a really good question because where are they getting it?
[2:43] No one knows.
[2:44] It's all black market.
[2:45] Yeah.
[2:46] It's 100% not TGA approved yet.
[2:47] It's still actually finalising clinical trials overseas.
[2:50] Yeah.
[2:51] But, of course, we know and hear of all of these people who are on it.
[2:55] And the question is where are they getting it from?
[2:57] Who's making it?
[2:57] Who's selling it?
[2:58] God knows.
[2:59] Yeah.
[2:59] Yeah.
[3:00] What have you heard?
[3:00] Have you heard things?
[3:01] Oh, well, it's everywhere.
[3:02] You get it online, right?
[3:03] Yeah, you definitely get it online through like market sources.
[3:06] They're compounding it presumably.
[3:08] So the originator company and drug is being manufactured overseas, but they've obviously somehow either leaked it or got –
[3:16] versions, illegal versions being made up in various pharmacies around the place.
[3:21] I would love to know if you can get, you know, those testing strips that you can have for alcohol or for like UTIs, like all that sort of stuff.
[3:28] I wonder if you could like get those strips and pop it in for...
[3:31] These types to see what's actually in it.
[3:34] And what it's cut with.
[3:35] Yes.
[3:36] Yeah, so there are labs that sort of do this.
[3:37] You can't do it yourself.
[3:38] I mean, wouldn't that be great to actually know how much of active drug are you actually on?
[3:41] But there are definitely laboratories around that are testing these sources.
[3:44] They'll buy it themselves, get it shipped within two, three days, and then test it.
[3:48] And there's, you know, 10% of it is actually what they say it is on the label.
[3:51] Yeah, put them away.
[3:52] Yeah.
[3:53] I did hear there was a doctor friend telling me that they had heard that two people had presented to ED urinating blood on fake retta.
[4:03] Yep.
[4:03] There's been liver damage, so severe hepatitis.
[4:06] And people have definitely died around the world from taking these illegal and completely fabricated drugs.
[4:12] They have to be really careful.
[4:13] Yeah.
[4:14] Yeah.
[4:14] You know this, Dr. Ryan, because tell us your qualifications.
[4:18] Yeah.
[4:18] Yeah, so I'm a consultant dermatologist.
[4:19] I'm a fellow of the Australasian College of Dermatologists and I work in Melbourne across private practice and the Royal Melbourne Hospital.
[4:26] Very smart.
[4:27] That's why you're on here.
[4:28] That's why we get you on.
[4:29] Oh, it's why we get you on.
[4:31] Speaking about the peptides that you can buy online, I've noticed like when the websites do come up, when you're ad targeted on TikTok or whatever, they have their name of the peptide or the company and then about two weeks later, the name's changed.
[4:44] Yeah, well, that's...
[4:45] It's constantly changing.
[4:45] Why is that?
[4:46] Isn't that a red flag?
[4:47] Yeah, that's a red flag.
[4:48] Because they've obviously been picked up by someone saying, hey, you can't be doing this.
[4:51] And so then suddenly they've got a new shell company and they're operating under someone else's name.
[4:56] I wonder, you know, like Customs and Border Control, they do such a good job stopping illegal things coming into the country.
[5:04] Do they have like sniffer dogs now sniffing out fake peptides?
[5:08] Those dogs would be bloody busy as if they didn't have enough on their plate.
[5:11] I know.
[5:12] Sniffing out drugs and now they're on the lookout for retta and peptides and steroids.
[5:17] Like...
[5:17] It's a great question because I assume that while some of them may be actually manufactured in Australia, there'll be definitely those that aren't.
[5:24] And so, yeah, there will be having to be intercepted somewhere.
[5:27] I don't know.
[5:28] You might not know the answer to this question, but are there big fines for people who are illegally compounding these peptides?
[5:36] Yeah, I believe so.
[5:36] I think the TGA are very much aware and are very much onto it.
[5:40] How difficult it is, though, to source, to find these places and to, you know, apply the fines, I don't know.
[5:46] And I imagine it can be quite hard.
[5:47] Yeah, it'd be almost like you'd be fine, like, as if you're a drug dealer, I would assume.
[5:51] Well, it is.
[5:52] It is essentially an illegal drug that you are manufacturing.
[5:55] It might not have the same kind of complications that certain drugs do, but it has several others that we're seeing present to our hospitals, to our EDs right now.
[6:04] Crazy.
[6:05] Okay, so let's get into it.
[6:07] What actually is Ozempic face or GLP-1 face?
[6:12] Because everyone's kind of talking about it.
[6:15] I'm assuming it isn't like a formal medical diagnosis, but what do you think?
[6:19] No, great point.
[6:21] And I think the fact is we are seeing it everywhere, right?
[6:23] Workplace, socially, we're seeing people's faces change quite significantly.
[6:27] And no, a zempic face isn't the medical diagnosis, but we generally refer to it as lipoatrophy.
[6:33] So we're seeing the facial shape and structure change considerably because of the changing in what we call fat pads that normally sit in our skin or under our skin.
[6:42] And the most well-known ones are in our temples, in our cheeks and in our eyes as well.
[6:48] Oh.
[6:48] So you can determine, you can really kind of pick those people who are on these medications, I think, because you see a substantial change in their face that's actually disproportionate to the rest of their body.
[6:59] And that's what's quite unusual about these medications is that you sort of might think, okay, well, so-and-so has lost 10 kilos, 20 kilos, 30, whatever it is, that their whole body and their face will change synchronously.
[7:10] But that's not the case.
[7:11] Yeah.
[7:12] Why is that?
[7:12] So it's really interesting.
[7:13] It's all still very much in research as we're finding out more about these drugs and how they work on the skin and below the skin.
[7:19] But what we think is that in these little fat pads in the face, they actually may have more receptors so that the drug in question works more effectively on them.
[7:28] And there seems to be this kind of not only hormonal change in the skin that makes the facial fat disproportionately more sensitive to the rest of the body.
[7:38] So they've done some 3D imaging studies that have actually shown, in some cases, up to 70% reduction in the fat pad compared to a fat pad somewhere else on their body.
[7:47] Wow.
[7:47] So crazy.
[7:48] So you're losing it on your face first.
[7:50] It's almost like it's going from top to tail.
[7:52] It's not usually the other way around, which I would have thought it would be for.
[7:55] And do you know what?
[7:56] I'm sorry, but that's cruel.
[7:57] Because for me, in my personal opinion...
[8:01] you want the fat in your face.
[8:03] And that's what gives you that youthful, more glowing vibrancy, better contours.
[8:11] I've got fat put into my face to make my face, in my opinion, look better.
[8:18] I had fat under my eyes to fill out my hollows.
[8:21] And you do notice it.
[8:23] It's kind of cruel when you see people who are on GLP-1s and one of the first things you notice is fat.
[8:29] how old they look.
[8:31] That's right.
[8:31] They look 10 years older, at least.
[8:33] Absolutely.
[8:36] Absolutely right.
[8:37] And it's not just with the GLP ones.
[8:38] We'll see it with anyone who has rapid, significant weight loss.
[8:42] You notice that there's a distinct change in their skin, but you're 100% right.
[8:45] Because if we think of one of the reasons, just not
[8:48] you know, the whole reason.
[8:49] Obviously, these class of medications are doing pretty incredible things for metabolic health, for type 2 diabetes, for the obesity epidemic around the world, certainly in Australia.
[9:00] But we know that there are many people who will choose to start one of these medications for aesthetic reasons, right?
[9:05] But it is, it's sort of almost contradictory that one of the significant things they'll notice is a change in their face, which actually does age them.
[9:13] It makes them look, you know, significantly older than other peers the same age.
[9:18] Yeah.
[9:18] Yeah.
[9:18] So it's like GLP-1, do you lose all this weight and then you need 100 gram for a bloody face lift after it?
[9:24] Honestly.
[9:24] Like it's something you're going to consider if you're doing it for aesthetic reasons.
[9:29] Think of the effect on your face because you might not like it.
[9:33] No, I agree.
[9:34] So when you see the changes in your face, is there anything you can do to prevent it?
[9:40] So, well, there's a lot of things that I guess are being in research and being used right now.
[9:46] I think the principle here is that there's not much that can genuinely completely reverse facial fat loss.
[9:52] So let's make that clear, that there's no one quick fix.
[9:55] There's no medical treatment that will reverse and put in a whole lot of fat that's going to then do what your natural fat will do.
[10:02] As Beck mentioned, we do have this one of the treatments.
[10:05] Our surgical procedure is fat transfer, macro fat transfer.
[10:08] We'll talk about a newer therapy that's sort of emerging called nanofat in a moment.
[10:13] But the reality is that, no, once you have lost a substantial amount of facial fat, that fat's actually very important.
[10:20] It plays a very important role for facial structure and actually the skin, so the dermis and the epidermis above it.
[10:26] And once it's gone or significantly reduced, it's very challenging to reverse it.
[10:31] Yeah.
[10:32] Why is it, this is just my observation, that fat in your face seems to make your skin look more vibrant.
[10:40] Yep.
[10:40] And when people are on GLP-1s for a long time, you can almost see the grayness to their skin.
[10:46] They lose their spark and their vibrancy and it looks kind of like...
[10:51] Yeah, 100%.
[10:52] So this is a really fascinating area of research, and we've got some answers, not all.
[10:58] So when we think about facial fat, so we've got the epidermis, the dermis, and the subcutis.
[11:01] So everyone knows about subcuticular fat.
[11:03] It's a fat that you can sort of pinch and you can feel.
[11:05] But there is actually a more superficial layer of fat that sits just below the dermis, and it's called dermal white adipose tissue.
[11:13] It's a very thin layer.
[11:15] It sits just below the dermis.
[11:17] Now, have a guess what hormone they've found out is actually produced by that amount of tissue, that bit of fat.
[11:23] Estrogen.
[11:23] Estrogen.
[11:24] Estrogen.
[11:25] Exactly.
[11:25] This is...
[11:27] Okay, that explains menopause skin, right?
[11:29] Yes.
[11:29] Absolutely.
[11:30] So it's so interesting.
[11:31] So this little layer of fat, which seems to be preferentially targeted by the GLP-1s, by the way.
[11:37] So that little thin layer of fat just below the dermis seems to be disproportionately affected.
[11:42] Mm-hmm.
[11:42] then actually thins out even more and it was already thin to begin with, but actually produces not only estrogen, but a whole lot of actually beneficial nutrients for the dermis and the epidermis.
[11:53] So exactly like what you were saying, the skin then starts to dry out.
[11:57] It doesn't turn over as well.
[11:59] It does look gray, does look sallow.
[12:00] And that micronutrient rich little bit of fat is now gone or significantly reduced.
[12:06] So the entire dermis and epidermis suffers, not just the fat.
[12:09] Yeah.
[12:10] I remember there was conversation that when they were losing their weight, I was like, oh, so what are you going to do now?
[12:15] They go, oh, it's only for a little bit of time.
[12:18] And then all of a sudden, like it reverses and comes back, like all your collagen comes back.
[12:23] And so that's obviously a myth.
[12:25] It is a myth.
[12:25] Look, I think there's a few things to say.
[12:27] One is that if you're going to embark on this journey and, you know, it's medically indicated and, you know, you've got a prescribing doctor who thinks it is in your best interest to be on one, it's about being slow and steady.
[12:38] Mm-hmm.
[12:39] And what's happening is people aren't slow and steady.
[12:41] They want results yesterday, right?
[12:42] Yeah.
[12:43] So they are hitting the highest dose they can.
[12:45] They're absolutely malnourished.
[12:46] They're not actually consuming the protein, the micronutrients, the macronutrients, the electrolytes that they need to be.
[12:52] They lose a significant amount of weight very quickly.
[12:55] That ain't coming back, right?
[12:57] That's not coming magically back to your face in five years or 10 years.
[13:01] What about the magical thin layer of fat that you just spoke about, which gives you your vibrancy, that one that sits on top?
[13:07] If you lose that, can you get it back if you go off a GLP-1?
[13:10] So we still need to do a lot of research in this area.
[13:13] So it's potentially possible that you'll partially recover it.
[13:17] But my gut feeling, and this is not based on research, this is just my impression, is that if it is lost, you're never going to get it back completely.
[13:26] And that's the difference.
[13:27] Shocking.
[13:28] Now, that's just a hypothesis.
[13:29] Shocking for a vain girl over here.
[13:30] Yeah, that was your hypothesis.
[13:32] Yeah.
[13:33] Yeah.
[13:33] So partial recovery may be possible, but I think it's when people are doing it so quickly.
[13:38] So we talk about the fact that rapid weight loss doesn't allow the facial elasticity and the structure to sort of accommodate for the changes.
[13:47] Mm-hmm.
[13:47] right?
[13:48] So I sometimes use that analogy of a balloon.
[13:51] So if you blow up a balloon really, really taut, it's, you know, nice and shiny and white, if you just let all the air go very quickly, it will leave that kind of rubbery excess feel, right?
[14:01] That deformed shape.
[14:03] And the skin's very similar to that, right?
[14:05] So it doesn't have time to sort of slowly come down to its original shape to then drape the bone structure and the fat underneath.
[14:12] Yep, that makes sense.
[14:13] What about something like, we had Dr. Jason Chan come on and talk about copper peptide, what's it called, GKU?
[14:20] GHKCU.
[14:22] GHKCU.
[14:24] Yep.
[14:25] Would that be a possible medical option?
[14:27] Yep.
[14:27] So the answer is it could be, and it probably is in conjunction with many other things.
[14:32] I don't think it's going to be that silver bullet that magically fixes the skin.
[14:36] The majority of the research with GHKCU is actually to do with bones and joints, muscles more than skin.
[14:43] There is some research in skin definitely, but its greatest body of evidence is for muscle recovery.
[14:48] But the idea is that, yeah, it probably could help to an extent.
[14:51] Is it going to magically fix everything?
[14:53] Unlikely.
[14:54] Okay.
[14:55] What about, I see it on Instagram, I don't think it's TGA approved here, Renuva, and that's different to a traditional filler.
[15:05] So what exactly is it?
[15:07] Have you heard about this?
[15:08] So there are a few of these products around the world.
[15:11] As you said, they're not currently TGA approved or used widespread in Australia, but I think we're going to see them come out over the next two years.
[15:19] We probably have more than one.
[15:20] So that particular product,
[15:23] The ones that we are using more so are the ones that will have got evidence to stimulate the fibroblasts, which are more collagen and elastin production.
[15:32] But you're quite right to have something that then stimulates the oedipocyte, the fat cell, that can then produce all of those good nutrients will be pretty interesting.
[15:39] That could be an absolute game changer if that is seen to be.
[15:43] be scientifically proven, efficacious.
[15:45] That's right.
[15:46] A treatment that's currently used, again, internationally, not in Australia, is this concept of nanofat injections.
[15:52] I don't know if you've heard of those yet.
[15:54] So this is an interesting one.
[15:56] So this takes fat that's harvested from somewhere else in your body, either your thighs or the abdomen.
[16:01] It then uses a mechanical emulsification.
[16:03] So they really break it down into a slush.
[16:04] Like a sitch.
[16:05] Yeah, yeah.
[16:06] They sift it down.
[16:07] They make it a bit of a slushy.
[16:09] So the actual particles are less than 0.1 of a millimetre.
[16:12] So they're not whole cells, but they're sort of lysed cells or broken cells.
[16:16] And they have this really rich biostimulatory matrix that is then injected into the dermis.
[16:21] So deep into the dermis, not deep, deep down into the fat because it's not there to repopulate the fat, but it's there to support the dermis, to give it the glow and to stimulate it to thicken up as well.
[16:31] And can that be used under the ice?
[16:33] Yeah.
[16:33] It can be used under the eyes.
[16:34] It can be used all over the face.
[16:35] I've just found out that they're doing it in lips.
[16:38] Yeah, probably.
[16:39] I can imagine they are.
[16:40] So the idea there, it's probably it's an in-clinic treatment, as I said, not currently TGA approved here, but I imagine we'll be there in not too long.
[16:50] And who could do that?
[16:51] Well, it could be done by any registered medical practitioner.
[16:54] So a plastic surgeon, dermatologist, aesthetic physician would be your top three groups, I guess, of people who could do it.
[17:00] And my understanding from colleagues overseas is that it's fairly tolerable.
[17:04] Patients are actually doing it in one sitting and tolerating it pretty
[17:08] And would you need a general anaesthetic for that?
[17:10] Not necessarily.
[17:11] Okay.
[17:12] And how would they harvest the fat?
[17:13] So they'd take it out using a needle and syringe.
[17:16] Yeah, a cannula from a localised area.
[17:18] So as I said, usually in the legs or in a thigh, yeah, lower abdomen.
[17:22] What about skin care?
[17:24] Look, I think skincare is an important lever to pull.
[17:27] Again, it's important that everyone acknowledges that it's not going to magically change everything.
[17:31] I mean, how can you?
[17:32] We're looking really very deep when we're looking at fat.
[17:35] Exactly, which is the most.
[17:36] That's good.
[17:37] It's not fat.
[17:37] Yeah, it might help.
[17:38] That's right.
[17:39] with breakouts and keeping your skin hydrated.
[17:43] Exactly.
[17:43] So I think that it forms part of the armamentarium.
[17:46] So we start, our usual, of course, we always talk about SPF, we know why, but I guess the theory here is that if we can really enhance the dermis and the epidermis, we're at least going to protect the skin.
[17:56] We're going to return its glow.
[17:57] So we think antioxidants, we think the topical peptides, and of course, your sunscreen has to be there with hydration.
[18:03] So I do think that it is an important part, but it's not going to fix everything.
[18:07] Yeah, what about red light therapy?
[18:09] Again, you're looking at the 1% or 2% here that might confer some degree of benefit.
[18:14] I wouldn't hang my hat on any of these as a single standalone treatment.
[18:17] Is there anything else, any other treatment options that are out there now or that you see in the future coming?
[18:24] Yeah, so I think the energy-based devices, so our lasers, right?
[18:27] And I generally divide this into three classes, and you probably have heard of these, but you've got your ultrasound-based devices, sort of thermodynamics.
[18:36] think Ultraforma, Ulfira, those sort of brands you might have heard of.
[18:40] And Softwave, you've got then radiofrequency-based devices.
[18:44] So these are some are new, some have been around for a while.
[18:47] So it can be either with RF needling or actually just the radiofrequency waves themselves.
[18:52] So Zerf's one of the newer ones that doesn't have as much research as some of the older ones.
[18:57] But these sorts of devices have been proven to be helpful for collagen and elastin stimulation in mild skin laxity.
[19:04] And I think that this is the point.
[19:06] It has to be mild.
[19:07] Once you've lost your 10%, 15%, 30% body weight, it's going to be very hard.
[19:12] It's a facelift and $100,000.
[19:14] It's a lot of money.
[19:16] Are you seeing that?
[19:17] Are you seeing people who have had drastic weight loss and then going, all right, I want to go and get surgery, fat transfer, fat transfer?
[19:24] Definitely.
[19:25] I think particularly the plastic surgeons are seeing it more than I am personally.
[19:28] So I'm probably catching them a little bit earlier when they're hopeful that some form of either cosmetic injectable therapy, topical or laser-based devices.
[19:35] Or coming for a referral for the plastic surgeon.
[19:38] Where are they harvesting the fat from though if all the fat's gone?
[19:41] The stubborn fat.
[19:42] It's really not moving that no one can get rid of in the inner thighs.
[19:46] Yeah.
[19:47] This is it.
[19:47] It depends how much GLP-1 they took, I guess.
[19:50] Yeah.
[19:50] Yeah.
[19:57] One thing we are seeing a lot of, and it's been a while now, and this throws back to the first time you came on and spoke about GLP1 and having an exit strategy.
[20:10] So making sure you had enough protein, make sure you're doing strength training.
[20:15] And what we're seeing out in the community is that people just aren't going off it.
[20:20] Or they try for a small amount of time.
[20:23] They put on more weight than they lost.
[20:24] You know, heaps of people that this happened to.
[20:26] Now they are shit scared of going off it.
[20:29] So they just micro-dose and it looks like they're happy to stay on it forever.
[20:34] Yeah.
[20:35] And like all these people we know, they're not going off it.
[20:38] No, but I think it's also they haven't learned the discipline of...
[20:41] exercise.
[20:42] And also, you know, being able to do their breakfast, lunch and tea or their meal preps because there's just been a quick fix.
[20:51] So your mindset's really different.
[20:52] Yeah.
[20:53] So long term, how does this look long term?
[20:56] It's a really good question.
[20:57] And I think even when I'm prescribing them for my patients, which I do quite regularly these days, I make it really clear.
[21:04] This is a structural tool.
[21:06] It's like a scaffold for your building.
[21:09] And the concept, and it is very much a concept or a theory, is to then create a really solid foundation that's based on great mental health, great eating habits, regular exercise that you build into your lifestyle.
[21:22] And then you might slowly, very slowly be able to deconstruct that scaffolding and then the building stays standing.
[21:29] Now, what research is showing us is that for most people, that does not happen.
[21:34] And the reality is that once you start to withdraw a drug, that their body's natural hormonal state, their lifestyle choices and what they're eating do sort of start to slowly regress.
[21:46] So yes, are there people who will need to stay on this forever?
[21:49] Absolutely.
[21:50] There'll be people who very quickly notice that they start to regain weight.
[21:54] Then there'll be others who are able to maintain for a period of maybe months to years, but slowly, slowly their own genetic hardwiring, their hormonal disbalance then sort of starts to recur.
[22:05] So I will always say to patients, look, whilst in an ideal world, we may be able to withdraw a drug after two or three years, it is not a failing that you may need to stay on it long term.
[22:16] That just may be life and how it is for you.
[22:19] But we will reassess things once you've reached a period of stability on drug at the lowest dose possible, simply because A, it's going to cost you a whole lot less if you can be on the lowest dose.
[22:29] And it may be that you do it every 10 days or every 14 days, not every week.
[22:33] So this is all off-label stuff, so just let's be very clear, this is not what the TGA has approved these drugs for.
[22:39] This is just in the real world how these medications are being used internationally and to actually support people long-term.
[22:45] Yeah, right.
[22:47] When is the point that they come in?
[22:49] Is it when they've lost all their weight and they're like, okay, I've lost it all now?
[22:54] Or are you noticing that they are aware of those Olympic phase and they're coming in a bit earlier to be like, okay, how do we keep this going?
[23:03] I think I am starting to see it earlier now.
[23:05] And I think because it's now such a prolific medication, we know that so many people are on it, right?
[23:11] Everywhere.
[23:12] As I said, you go to the school, pick up, go to work.
[23:14] You can really pick up.
[23:15] You go out to a country town in the bloody Pilbara of WA.
[23:21] They're all on it.
[23:21] They're all on it.
[23:22] Like it's out.
[23:23] It's everywhere.
[23:25] It's not the cities.
[23:26] No.
[23:26] It's everywhere.
[23:27] It's everywhere.
[23:28] I used to love it, like,
[23:29] a few years ago, like, oh, you've lost so much weight.
[23:31] Oh, you know, it's just the divorce diet.
[23:33] And I'm like, nothing.
[23:36] You don't lose that in two weeks after divorce, baby.
[23:38] No, that's right.
[23:39] So it is just so common that I think, and people are starting to pick it up and recognize it in other people.
[23:45] So they are probably starting to reflect and say, okay, well, I'm noticing these changes.
[23:49] What can I do?
[23:49] A little bit earlier than they were.
[23:51] Yeah.
[23:51] Yeah.
[23:52] We're talking about aesthetic reasons here.
[23:55] Just off topic a little bit.
[23:57] Are there any other medical trends we are seeing as GLP-1 use becomes more common related to other disease?
[24:08] So certainly we are now seeing it play a role or what we're learning about are the roles in other diseases.
[24:15] Absolutely.
[24:15] So I think I spoke about skin, you know, some months back because I now really recognize how important it is to have a really healthy weight, have a great metabolic system, you know, the hormonal system reset by these medications for so many different skin diseases.
[24:31] So that's what I'm seeing.
[24:32] I know that almost every other medical specialist and general practitioners are seeing it for various reasons.
[24:38] So cardiac health.
[24:39] So we know huge amount in terms of high blood pressure, high cholesterol, stroke reduction, diabetes.
[24:47] So we're seeing all of that.
[24:48] I'm learning about its role in other mental health conditions.
[24:51] So let's talk about neurodiversity.
[24:53] For example, ADHD.
[24:54] I think there's evolving evidence here that is going to be helpful for some people who suffer from ADHD because of, again,
[25:01] They talk about that food noise with a whole lot of other distractions.
[25:04] So many other disease profiles we'll start seeing.
[25:08] And there'll be lots of research obviously going into that and we will know more in the future.
[25:12] One person I heard, actually there's a few, is for addiction issues.
[25:18] Yes.
[25:19] Yeah, so alcohol addiction, potentially gambling, potentially cigarette smoking.
[25:23] It's growing in evidence.
[25:26] Yeah, yeah.
[25:27] I just find it fascinating.
[25:29] I just find medicine and science and research so fascinating.
[25:33] Especially one medication that can maybe tick off a lot of boxes.
[25:36] So many things.
[25:37] But we've had, you know, like a Zen pick we've had for a very long time for, you know, for diabetics.
[25:43] Yeah.
[25:43] And then to know that this...
[25:44] medication was here that could possibly be compounded differently or whatever to help in other areas.
[25:50] That's right.
[25:51] And so when, if and when, which will be your question, when reticuletide is TGA approved, which will happen, we're going to say, yeah, it's the third evolution of this medication, which now has three different targets.
[26:05] Research and the early clinical trials are very promising.
[26:07] There's some big things on inflammation and tumour growth.
[26:10] Exactly.
[26:11] Yeah.
[26:11] Yeah.
[26:12] Oh, gosh.
[26:12] It's an exciting time in medicine just seeing what new things can do.
[26:17] I know.
[26:17] Just like in the last five years, like from, you know, 2020 to now.
[26:20] Yeah.
[26:21] Like I wouldn't even know what a peptide was.
[26:23] But also this, we also don't know, like –
[26:27] You need long-term studies to also look at risks and side effects.
[26:30] Oh, yeah.
[26:30] For sure.
[26:31] For sure.
[26:31] Yeah.
[26:32] So something that I think this area of medicine, certainly from a dermatological point of view, has really, I guess, progressed and stimulated was the use, and I think you guys spoke about it recently, was the whole class of biostimulators.
[26:44] So, you know, these are, again, prescription injectable medication, and like any medication, they come with their risk versus benefits.
[26:51] But what we're seeing is this funny, an initial, sorry, a new trend away from the traditional hyaluronic acid and dermal fillers, which, you know, I think as a society, we're starting to say, do we really want to necessarily inject these and keep them in our faces?
[27:04] And there's a question of the artificial sort of look of it for some people.
[27:09] We know that actually volume replacement is going to be very important, regardless of what you say, for a lot of these patients.
[27:14] But I think a really interesting area where we're starting to see good published research now is on these so-called biostimulators.
[27:20] I think PLLA, I think PDLLA.
[27:23] We've got
[27:24] What do they look like in brand name examples?
[27:26] Yeah, so in brand name, we've got in Australia Sculptra, which is their PLA.
[27:31] We've got Juve look also known as Linizna, which is a very similar molecule.
[27:36] So these are interesting ones because what the research is showing and has proven is that we can help stimulate deep dermal collagen and epidermal remodelling together with that hydration, so the use of hyaluronic acid as a dermal hydrator and...
[27:52] And that combination over time is now proving to be a very nice adjunct to skincare and to good habits and potentially energy-based devices.
[28:01] So I think these group of medications have evolved almost simultaneously with the GLP-1 medications.
[28:08] And this is all published out of nothing I'm saying here is kind of just anecdotal.
[28:11] It's got good research.
[28:13] So when you have a patient that you've maybe put on a GLP-1, will you have like a skincare...
[28:21] plan as well and be like, okay, this is what you're doing.
[28:24] This is when you need to come in.
[28:25] These are the things that you possibly should have.
[28:28] There's a full system in place.
[28:30] I think there has to be.
[28:31] And that's because there's not just one product.
[28:34] There's not one injectable therapy or laser.
[28:36] That's a magic fix for any of these patients.
[28:39] Even if they do go on and have a full facelift, as Bec mentioned, even then...
[28:43] you still need to look after their skin, right?
[28:46] So you still need to look after their epidermis and their dermis.
[28:49] So no point in having a really taut face if the actual quality of the skin is terrible, right?
[28:54] If you're super sun damaged and, you know, still wrinkly or still dispigmented, it doesn't look good, you might be taut, but still, that does not, yeah.
[29:02] Just thinking about facelift and doing the fat grafting,
[29:05] If you're still taking the GLP-1, you're going to lose the fat again.
[29:08] Yeah, so what happens with that?
[29:09] Yeah, so you'll have to go on the low maintenance dose and stabilize your weight.
[29:13] Okay.
[29:13] That's the idea.
[29:14] So this is a good question.
[29:16] It's like a when do you embark on this?
[29:18] So I generally say you don't want to be coming in too early
[29:22] such that you're continuing to lose weight because exactly as you mentioned, you're not going to get the best out of all the money that you've just invested into your face.
[29:30] So it's probably better when you're stabilized.
[29:32] So towards the end of your sort of weight loss journey, you need to have a goal weight, but more importantly, a goal weight.
[29:38] It is a percentage body comp that you actually should be aiming for rather than what the scales say.
[29:42] So you want a good muscle mass, you want a decent fat mass.
[29:46] That is still very important for human function.
[29:48] So it's not about being 0%.
[29:51] It's actually about being healthy and then actually saying, okay, this is where I want to be.
[29:56] And now I'm going to start embarking on just a few treatments to help me feel and look as good as I feel on the inside now externally as well.
[30:03] Is there a ballpark of like how many months?
[30:05] Like, so when you stabilize a weight, they're wanting to do a facelift or do fat grafting or whatever.
[30:11] Are you kind of doing the whole like, well, you need to stabilize this exact weight, this exact body mass, like for a particular amount of time?
[30:18] I think every clinician is going to be slightly different and have a different take on this.
[30:22] I'd say you'd want to be stable for at least six to 12 months at a minimum.
[30:25] Mm-hmm.
[30:26] I don't think it's worth, you know, at the two-month mark going, great, lost the weight, now let's do a facelift, because who knows what's going to happen, you know, six to 12, 24 months down the track if you haven't stabilised.
[30:37] So I think stabilisation is important as much for the patient as it is for the clinician to get the best outcomes.
[30:43] Yeah, yeah.
[30:44] So finally, if you're listening, you've lost a significant amount of weight on a GLP-1.
[30:49] You're really happy with that achievement, but you're not happy with what you're seeing in the mirror with the skin laxity.
[30:54] What is the first thing, Dr. Ryan, that you'd recommend them to do?
[30:59] Getting an opinion from a health professional whom you trust, whom you've had good either recommendations for, you've read actually their credentials is really important.
[31:07] I think a lot of people go online, they're going to ChatGPT, to Claude and whatnot and Instagram to kind of come up with their program.
[31:15] And this is going to be generic advice based on what's out there on the internet.
[31:19] It needs to be personalized to you.
[31:21] So there's no two patients that are exactly the same.
[31:24] So there are those who may actually have very little in terms of skin laxity, but it's their dullness or their skin turnover that needs to be addressed.
[31:31] And that might just be through skincare and through laser.
[31:34] Or it might be someone who's actually lost significant facial volume.
[31:37] And the truth is that they are likely to benefit from a combination of laser
[31:41] and injectable therapies, whatever they may be, whether they're biostimulators or other.
[31:45] So get a good opinion and maybe get two if you're not 100% sure.
[31:49] There's absolutely no harm in that.
[31:51] I think it's about making a connection with a provider whom you trust and who can then see you through the whole journey and is not going to promise you the world.
[31:58] That's the other thing.
[31:59] I caution patients all the time.
[32:01] And I say, look, if someone has told you that they can fix this problem with a laser treatment,
[32:06] and you only need two sessions.
[32:08] The reality is, in all of my experience, that is not true.
[32:10] That is a lie.
[32:11] And they're purely trying to push this treatment onto you.
[32:14] Please don't fall for over-promises.
[32:18] So actually have a degree of skepticism and caution about it.
[32:21] Be a critical thinker.
[32:21] Be a critical thinker.
[32:22] And as I said, I have no problems with my patients getting second opinions.
[32:25] I believe in what I say and based on evidence and my clinical experience, but I have no problem.
[32:31] So it's actually about making that decision for yourself and then, you know, agreeing or disagreeing and then seeking assistance elsewhere.
[32:38] Nice one.
[32:39] Well, that was great.
[32:40] I know.
[32:40] Yeah.
[32:40] I've got something really, really, like it's, it's just something unhinged.
[32:44] I know unhinged.
[32:45] It's not unhinged.
[32:46] Like I know as like my husband being a dentist, he'll have a patient in the chair and he'll know if that patient vapes.
[32:51] Yeah.
[32:52] And they'll be like, so do you vape or do you smoke?
[32:55] Like, no, no, no.
[32:56] Then Val's like, oh, okay.
[32:59] When a patient comes in, can you see straight away and know if they've been on a GLP-1?
[33:06] Like, is there signs?
[33:09] Great question.
[33:10] I thought you were going to ask something else.
[33:13] Are your heads always in the gutter?
[33:16] Great question.
[33:17] I thought you were going to say, do you know if they've walked straight in from revs or something?
[33:22] Oh, revs.
[33:24] No, no, no.
[33:24] I just, like, want to know, like, you know, can you see when someone walks in just from their skin quality and they're like, no, no, no, I've just lost weight normally, like naturally in, you know, the safest way.
[33:35] You're like, no, mate.
[33:36] You are definitely, and you just know.
[33:39] Yeah.
[33:40] That's a great question.
[33:41] I think, no, so the truth is no, I can't always tell.
[33:45] In reality, however, if someone has lost significant rapid skin weight, you can genuinely pick it.
[33:51] Yeah.
[33:52] Generally pick it.
[33:52] You look way different from your skin, from me doing it.
[33:56] Six weeks ago.
[33:57] Six weeks ago.
[33:58] Correct.
[33:58] But then you've got those many other patients who've been doing it very sensibly, low doses under good medical supervision and guidance over a period of six to 12 months, so it's been a very gradual change.
[34:09] And they're often very honest.
[34:10] They'll say, yeah, yeah, I've been on this, whatever therapy it's been, Munjaro, Ozempic, Wagovi, whatever.
[34:15] for, you know, X number of months or I was on it.
[34:18] That's really an interesting one.
[34:19] I've had many patients who I think, oh, this patient probably would benefit for these reasons.
[34:24] And then I asked them, I was like, oh, so, you know, is this something you've thought about?
[34:27] Have you heard about them?
[34:28] And they'll say, yeah, yeah, yeah.
[34:28] I was on that.
[34:29] I was on whatever it was.
[34:30] Yeah.
[34:30] insert drug here for two years or whatever.
[34:33] I didn't like it because of this, that and the other.
[34:34] It's very funny.
[34:35] So many have already been on it, tried it, and then have come off it for whatever reason.
[34:40] And so, yeah, you can often guess definitely when it's going to help a patient, but when they've been on it at some point.
[34:46] Yeah, yeah.
[34:47] It's good that they're honest.
[34:48] Yeah, absolutely.
[34:48] Well, I hope so.
[34:49] It seems to be because it's a medical...
[34:52] drug and there's people buying on TV so all right thanks for that that was awesome if you haven't listened to the GLP1 episodes check out the links in our peptides highlights section on Vanish podcast Instagram can't wait to get you back on for the next topic I've already written some notes down thanks guys that was awesome so good thank you bye for now
[35:25] Same.

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