One in eight Americans is now on a GLP-1 medication like Ozempic, Wegovy, or Zepbound. The weight loss can be life-changing, but there is a side of this story that rarely gets talked about openly: what these medications are doing to your face, your skin, your muscle mass, your bone density, and your body contour.

In this episode, board-certified plastic surgeons Dr. Sam Jejurikar (Dallas, TX) and Dr. Sal Pacella (San Diego, CA) bring a combined four decades of surgical experience to one of the most pressing topics reshaping their practices today.

They break down the predictable patterns of facial volume loss they are seeing, including hollowing of the cheeks, temporal wasting, dark circles from mid-face descent, and loss of skin elasticity that goes beyond what you would expect from weight loss alone. They discuss why fat grafting results in GLP-1 patients may not be as durable as expected, and why GLP-1 receptors expressed on fat cells themselves may be to blame.

The episode features a lively disagreement on Sculptra: Dr. Pacella is firmly in the skeptic camp, calling it a reverse ATM machine, while Dr. Jejurikar makes the case that conservative, layered treatments delivered every six to eight weeks can serve as an effective volumizing foundation for the right patient. They also explore the promise and limitations of AlloClae cadaveric fat grafting, currently FDA approved for the breast and body but generating serious interest for facial applications.

The conversation then shifts to the body, covering the underappreciated impact of GLP-1s on muscle mass and bone density, why resistance training is now a clinical conversation happening in plastic surgery offices, and why brachioplasty and thigh lift volumes have increased fivefold in recent years. They also tackle Ozempic butt directly, explaining the combined role of fat loss, muscle atrophy, and pelvic structural changes, and why excisional lifting procedures are increasingly replacing the Brazilian Butt Lift for this growing patient population.

GLP-1 medications are not going anywhere. Newer agents, oral formulations, and triple-mechanism drugs like Retatrutide are already in the pipeline. For patients and surgeons alike, understanding the downstream effects is no longer optional.

Dr. Sam Jejurikar is a board-certified plastic surgeon and President of Dallas Plastic Surgery Institute. Dr. Sal Pacella is a board-certified plastic surgeon in private practice in San Diego, California. Together they host Beauty and the Beasts, a podcast dedicated to honest, unfiltered conversations about plastic surgery, aesthetics, and the science behind looking and feeling your best.

Follow Dr. Jejurikar on Instagram: @samjejurikar Follow Dr. Pacella on Instagram: @sandiegoplasticsurgeon