GLP-1s and Skin Health: Clinical Pearls From Gold and Lal

The 2026 South Beach Symposium session led by Michael Gold, MD, and Karan Lal, DO, MS, reflected a moment many clinicians are currently navigating: glucagon-like peptide-1 (GLP-1) receptor agonists are no longer peripheral to our practices. Whether we prescribe them, manage downstream effects, or counsel patients already taking them, these agents are reshaping both medical and aesthetic dermatology.¹

Beyond Weight Loss

Originally developed for type 2 diabetes, GLP-1 receptor agonists—most notably semaglutide and tirzepatide—have rapidly expanded into obesity management and are now intersecting with inflammatory skin disease, aesthetics, and body contouring. As Gold highlighted through personal experience, these medications are often “game-changing” for patients in terms of metabolic control, energy levels, and quality of life. That improvement alone warrants attention. But the dermatologic ripple effects are increasingly hard to ignore.

From a medical standpoint, both speakers emphasized growing evidence that GLP-1 agents may accelerate improvement in inflammatory conditions such as psoriasis and hidradenitis suppurativa (HS), particularly in patients with obesity. Early data suggest reduced systemic inflammation may augment traditional biologic therapies. While this is not yet standard of care, it signals a future in which metabolic modulation becomes an adjunctive strategy in inflammatory dermatoses.

The Aesthetic Tradeoffs

The aesthetic consequences—popularized by terms like “Ozempic face”—are more clinically framed as facial lipoatrophy and soft tissue redistribution. Rapid fat loss unmasks volume deficits in the temples, cheeks, periorbital region, jawline, and neck. These changes can mimic patterns previously seen in HIV-associated lipoatrophy, a comparison that resonated with many clinicians in the room.

Importantly, both speakers cautioned against assuming patient distress. Gold underscored a critical lesson: clinicians often project their own aesthetic priorities onto patients. Some individuals welcome a leaner, more angular appearance and are unbothered by findings a clinician might instinctively want to “correct.” The clinical takeaway is simple but powerful—ask what bothers the patient before proposing interventions.

Muscle loss was another recurring theme. GLP-1–induced weight reduction is not purely adipose; lean muscle mass is also affected, particularly without adequate nutritional counseling and resistance training. This has downstream implications for both function and appearance, especially in the arms, abdomen, and gluteal region.

Management Strategies

From an aesthetic intervention standpoint, timing emerged as the key variable. Early treatment—before severe laxity or redundant skin develops—offers non-surgical options a realistic chance of success. Once patients progress to significant pannus or extreme skin excess, energy-based devices and injectables have limited utility, and surgical referral becomes appropriate.

For facial lipoatrophy, hyaluronic acid fillers provide immediate volume restoration, while biostimulatory agents such as poly-L-lactic acid offer longer-term collagen stimulation. Data presented from a multicenter prospective study suggest that combination approaches, including leveraging the immediacy of HA with the durability of biostimulators, may offer optimal outcomes. While published data are still emerging, this aligns with real-world clinical experience.

Body contouring technologies, including ultrasound-based skin tightening and muscle-stimulating devices, were discussed as adjuncts rather than replacements for weight loss. These modalities appear most effective when deployed early and in combination—addressing skin laxity, residual adiposity, and muscle tone simultaneously. Upper arm laxity, in particular, was highlighted as a frequent and distressing concern in GLP-1 patients.

Prescribing Realities and Safety Considerations

Lal shifted the conversation toward prescribing nuances. Gastrointestinal adverse effects remain the most common barrier to adherence, and dosing strategies, such as splitting weekly doses into smaller, more frequent administrations, may mitigate nausea and vomiting for some patients. Nutritional counseling was emphasized as essential, not optional, in preventing hair loss, sarcopenia, and exaggerated cutaneous aging.

More serious but rarer concerns including non-arteritic anterior ischemic optic neuropathy and endocrine tumors underscore why these medications require proper medical oversight. Both speakers cautioned against casual dispensing without appropriate monitoring, particularly in aesthetic-only practices.

Looking Ahead

GLP-1 receptor agonists are no longer siloed within endocrinology. They are influencing inflammatory disease trajectories, redefining aesthetic timelines, and challenging dermatologists to think more holistically about metabolism, nutrition, and body composition. As the evidence base grows—particularly around anti-inflammatory effects and combination aesthetic strategies—the dermatology community will need to stay engaged, informed, and patient-centered.

The most consistent message from this session was not about devices or fillers, but perspective: these drugs often make patients feel better than they have in decades. Our role is not to reflexively “fix” every visible change, but to partner with patients, both medically and aesthetically, through a transformation that is as complex as it is powerful.

Reference

1. Lal K, Gold M. Managing complications of GLP-1s. Presented at: South Beach Symposium 2026; February 5-7, 2026; Miami Beach, FL.