The face goes first. Around month two on a GLP-1, before the scale has done anything dramatic, patients start catching themselves in the mirror and not liking the temples.

That window, between “I look tired” and “I am ready for surgery,” is the med spa’s job. I talked through it this week with Marc McKee, host of the UK podcast This Is My Journey, who lost 126 pounds himself and wanted to know what actually helps along the way.

The episode is below. The non-surgical half is underneath.

Why the face melts before anything else

“The face doesn’t have a lot of fat, but the fat it does have is the good fat, the baby fat, what makes you look young. In the face you see the loss of the fat under the eyes, the temporal areas, temporal wasting, the buccal fat. We see the face just melt down because it’s lost all that volume. That’s usually the first thing they notice in the early stages of the weight loss.”

“In the face it’s multi-layer, the superficial fat but also the deep fat, combined with the fact that we’re all aging anyway. We have some bone resorption with age, we lose fat with age, and the skin loses elasticity and thickness with age.”

What we do in the window

“As we’re losing weight, the first thing patients notice is the face, usually at two months. That’s when we start using fillers or Sculptra and radiofrequency treatments like microneedling with radiofrequency for skin tightening, just to get them through to the later stages.”

“We do a lot of things to help them out: topicals, radiofrequency for tightening, adding volume with fillers or biostimulators like Sculptra, or now donor fat or the patient’s own fat that we transfer.”

The order of those choices matters, and I went into it in the face after weight loss. Short version: fat is the best filler for a deflated face, and the med spa options are how we get you there while the weight is still moving.

What a cream can do, and where it stops

Marc asked me to be honest about topicals. I was.

“It’s not going to remove the excess skin. But we have to do everything we can to make the process the best possible and to try to minimize how much surgery we’re going to need.”

“Topicals definitely have a place in weight loss. We’re having less fat consumption, and fat is an emollient that helps with barriers in the cell membranes. We’re taking less protein, which generates collagen. And we’re usually taking a lot less fluid, so we’re dehydrated. All three decrease the moisture in the skin, which makes it look older a lot quicker.”

“The topicals have two functions: barrier and attracting moisture, and then the antioxidants, which keep the skin looking younger, and retinoids, which can speed up turnover. So the skincare helps with fine lines and wrinkles, makes the skin appear firmer, helps with texture, helps with comfort, because with weight loss we also have problems with dry skin and itchiness.”

“Skincare is part of any surgery I do. Even for a breast augmentation or a tummy tuck, I put my patients on a special moisturizer, because when there’s inflammation and recovery you lose that moisture, and that really hurts you in the end.”

Where the med spa hands off

“If you’re losing 40 pounds, I think you’re going to need a surgical procedure.”

“Everybody retracts some, probably not as much as we would want, and it’s also sooner than people think. It really happens in the early stages, and I think at a maximum of a year it’s all done.”

That handoff, and the timing behind it, is covered in body contouring after weight loss.

Who should watch

Anyone on a GLP-1 who has noticed their face before their waistline. Anyone who has been told a cream will fix loose skin. Anyone trying to decide whether a treatment now is worth it if surgery is coming later. Marc asked those questions the way a patient asks them, and I answered the way I do in the exam room.

Why Southwest Plastic Surgery

The Medspa at Southwest Plastic Surgery sits inside a surgical practice, so the person planning your Sculptra or RF microneedling is the same one who will plan the surgery if it comes to that. Dr. Agullo is double board-certified, Mayo Clinic fellowship trained, and a Clinical Associate Professor of Plastic Surgery at Texas Tech’s Paul L. Foster School of Medicine.

Ready to talk?

If your face went first, call (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com. #StayBeautiful

Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.