Beverly Hills -- A peer-reviewed narrative review published September 11, 2026, in Aesthetic Surgery Journal Open Forum identifies nutritional deficiencies as an overlooked factor in skin changes among patients using GLP-1 receptor agonists such as semaglutide and tirzepatide for rapid weight loss.
Claims data show one in five patients develops a nutrient deficiency within a year
A large claims analysis cited in the review found that 22.4% of patients received at least one nutritional-deficiency diagnosis within 12 months of starting GLP-1 therapy, including 13.6% diagnosed with vitamin D deficiency. The broader literature reviewed also flags inadequate protein intake and shortfalls in iron, vitamin B12, folate, zinc, and copper as recurring concerns, nutrients tied to collagen synthesis and tissue repair.
Researchers describe a biological paradox during rapid weight loss
Human biopsy studies following massive weight loss have documented reductions in thick, organized collagen fibers and increases in thinner, loosely arranged fibers, indicating active structural remodeling in the skin. GLP-1 medications simultaneously suppress appetite and reduce caloric intake, potentially limiting the protein and micronutrient supply needed to support that remodeling.
"During rapid weight loss, the skin is undergoing major structural remodeling," said coauthor Dr. Kami Parsa, an oculoplastic and reconstructive surgeon in Beverly Hills. "The paradox is that just when the skin may need nutritional support the most, the patient is often consuming substantially less."
Authors stop short of claiming direct drug-induced collagen damage
The review states that direct effects of GLP-1 receptor agonists on dermal cells remain preclinical and that prospective studies are needed to confirm whether correcting nutritional deficiencies improves skin or surgical outcomes. The paper attributes facial changes commonly labeled "Ozempic face" to multiple factors, including facial fat loss compounded by potential nutritional shortfalls, rather than to a single mechanism.
Paper proposes a risk-stratified clinical framework for practitioners
The authors recommend that aesthetic practitioners review dietary intake, prioritize protein consumption, apply targeted lab testing in higher-risk patients, correct identified deficiencies, and coordinate care with the physician prescribing the GLP-1 medication before planning elective procedures. The review was coauthored by Justin Karlin, MD, MS, of the UCLA Stein Eye Institute/Doheny Eye Center, and Zhaoping Li, MD, PhD, of the David Geffen School of Medicine at UCLA's Division of Clinical Nutrition.