Energy-Based Devices for GLP-1 Receptor Agonist–Associated Facial Aging: A Tissue-Specific Safety Framework

Abstract: Glucagon-like peptide-1 receptor agonist (GLP-1RA)–associated rapid weight loss may be accompanied by facial changes resembling accelerated aging, colloquially termed "Ozempic face”. In this review, this proposed phenotype is termed GLP-1RA–associated facial accelerated aging (GLP-1RA-FAA) and is characterized primarily by facial volume loss and skin laxity, with possible but incompletely characterized alterations in dermal–adipose support, adipose-derived stem-cell biology, fibroblast–extracellular-matrix homeostasis, and facial muscle. Demand for energy-based device (EBD) treatment in this population is increasing; however, whether conventional EBD parameters are effective or safe in medication-associated facial volume depletion is unknown. A narrative review was informed by structured searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library from January 2000 through August 31, 2026. Evidence was selected for clinical directness and relevance to radiofrequency, high-intensity focused ultrasound, broadband light, microwave, extracorporeal shock wave therapy, diode laser, and synchronized radiofrequency with high-intensity facial electrical stimulation. Available modalities differ in their intended tissue depth and in the potential relevance of three conceptual targets: preservation of adipose tissue, dermal fibroblast–extracellular-matrix remodeling, and facial muscle–SMAS support. Preclinical body-contouring studies suggest that sustained subcutaneous heating in the approximate 43– 45°C range can be associated with adipocyte injury or apoptosis; however, no facial thermal dose threshold has been established, particularly in GLP-1RA-treated patients. No individual EBD modality has demonstrated simultaneous restoration of adipose, dermal, and muscle-related targets in prospective GLP-1RA-specific studies. Conservative control of treatment depth, careful avoidance of unnecessary deep energy deposition in volume-depleted regions, investigation of low-intensity dermal remodeling strategies, and evaluation of muscle-targeting approaches are proposed as research considerations. These concepts are hypothesis generating and do not constitute clinical recommendations or standards of care. Prospective controlled studies in well-characterized GLP-1RA-treated populations are required before device-specific protocols can be adopted. Keywords: semaglutide, tirzepatide, medication-driven weight loss, pan-facial volume deflation, facial sarcopenia, dermal lipoatrophy