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22 SKIN CARE Facial Anatomy Layers 7 6


1. Skin (epidermis and dermis) layer 2. Superficial fat (subcutaneous) layer 3. SMAS (superficial musculoaponeurotic system) 4. Retaining ligaments and spaces 5. Deep fat layer (absent on the forehead) 6. Periosteum, deep fascia 7. Bones


3 2 1


7


6 5 4 3


2 1


Figure 2: Diagram of the layers that make up facial anatomy3


smooth skin is presented visually. A tense SMAS and ample fatty tissue sit beneath these layers, providing a youthful and firm complexion. With chronological ageing, flexibility,


strength, and hydration of skin wanes due to decaying of the dermis. The renewal rate of skin is reduced, which also leads to a drier, uneven outer layer that is susceptible to cracking. Musculoskeletal changes and fat tissue atrophy reduce the face’s ability to counteract sag. Factors such as menopause and UV exposure (photoageing) can accelerate this ageing process substantially. Photoageing specifically can lead to unique ageing attributes, such as rough, leathery skin. Given that brief knowledge of facial and


skin anatomy, we can understand what kind of changes may occur with rapid weight loss. A significant loss of the superficial and deep fat layers will suddenly lead to reduction in cushion or volume of the face. The extracellular matrix cannot properly adjust to this sudden change and a weaker SMAS allows for excess skin to sag.


Figure 3: Illustration of the EGF and HGF pathways in cell biology8


On a more granular level, rapid weight loss also seems to change the extracellular matrix as well. Studies comparing skin samples of patients who have undergone rapid weight loss versus skin samples of clinically obese patients have shown significant differences in the collagen and elastin systems. Patients that underwent bariatric surgeries (weight loss surgery) had significantly more thin and damaged collagen fibres than obese patients that did not undergo bariatric surgery.4,5


The


more chronologically aged or photoaged the skin, the more susceptible it is to these detrimental effects. The ageing effect can be especially drastic


when compounded with menopausal related estrogen decline. Estrogen regulates the activity of several transcription factors and epigenetic regulators which play key roles in skin ageing. Approximately 30% of type 1 and type 2 collagen in skin (the main types) is lost in the first five years of menopause.6 The consequences are far reaching, as


Membrane signaling pathway Estrogen signaling pathways involved in skin wound healing


E2


Non-genomic response


Calcium release


Ca2+ Ca2+


Ca2+ cAMP PKA


Protein kinases P13/MAPK AKT


Transcription factors Me Me Me Ac Ac


Nuclear signaling pathway E2


Genomic response


Dimerization ERK1/2 Epigenetic regulation Binding to ERE


estrogen receptors are linked to many signaling cascades (MAPK, PI3K, cAMP, etc.) and growth factors (EGF, TGFB, etc.) in skin.6


This makes


the 45+ age group especially susceptible to Ozempic face given both weight loss stressors and menopause-related skin decline. Adipocytes (fat cells) are also known to release estrogen,7


it is plausible that rapid weight


loss might accentuate the decline in estrogen availability. However, more research is required to establish this relationship. So far, we have only established the stress


placed on skin due to a loss of weight, however structural stress may also occur with rapid weight gain. Users that stop using weight loss treatments but do not change their lifestyle are susceptible to rapid weight gain. This can excessively stretch the skin, damaging extracellular matrix fibres in the process, and cause stretch marks. Alternatively, women who have recently had a baby might use rapid weight loss treatments to lose fat. In this case, stretch marks caused by pregnancy related weight gain would be compounded by subsequent saggy skin from rapid weight loss.


What can we do about it? The best way to handle Ozempic face is by taking preventative measures to ensure optimal skin quality and more tempered pace of weight loss. This involves using topical treatments such as retinoids or peptides or estrogen mimics (in the case of menopause), which can help offset the decline in skin quality with age. Preserving the skin’s extensibility will help mitigate the visual onset of crepey skin. Additionally, keeping track of the pace


Figure 4: Illustration of estrogen signalling and its multifaceted impact on wound healing9 PERSONAL CARE February 2025


of weight loss can help avoid the sudden shift seen with Ozempic face. Once you have crepey skin it is difficult to treat. The most effective treatment methods require in-office visits to a physician where procedures such as fillers or face lifts can be performed. With these treatments, fillers can help offset the lost volume from facial fat while face lifts can


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