What GLP-1-assisted weight loss means for skin quality

As more patients achieve significant weight loss with GLP-1 medication, clinics are seeing a corresponding rise in concerns about laxity, softness and loss of firmness. But what is actually happening within the skin, how strong is the evidence for altered fibroblast activity, and where can ultrasound-based collagen stimulation realistically fit into treatment planning? We talk to Dr Galyna Selezneva and Dr Aggie Zatonska to find out more.

GLP-1 receptor agonists have changed the weight-loss landscape, and aesthetic practitioners are now seeing the effects in clinic. Patients may be pleased with the change in their weight and health, yet find that the skin of the face or body feels softer, looser or less supported than it did before.

Dr Galyna Selezneva says this has become an increasingly familiar consultation.

“Absolutely. As GLP-1 medications have become more widely used, I've seen a noticeable increase in patients who are delighted with their weight-loss results but are concerned about the changes they've noticed in their skin. While losing weight has significant health benefits, rapid fat loss can leave the skin looking less firm, particularly in the face and neck where volume loss is often most apparent. Many patients tell me they feel healthier than ever, but don't feel their skin reflects how vibrant they feel. Increasingly, they're looking for treatments that restore firmness without adding volume or changing their natural facial features, which is where Sofwave fits beautifully.”

Dr Aggie Zatonska has seen the same shift.

“Yes, we see a growing number of patients using GLP-1 receptor agonists. Those patients often lose a significant amount of body fat, which has considerable health benefits, but rapid weight loss can also lead to increased skin laxity.”

Why rapid weight loss shows up in the skin

Some of what patients are seeing can be explained mechanically. Fat provides support beneath the skin. When a substantial amount disappears, particularly over a short period, there is less tissue underneath the skin envelope. Whether that skin contracts sufficiently depends partly on its existing condition. Age, previous weight gain, sun exposure and the amount and speed of weight loss can all affect how well it adapts.

There are changes within the dermis too. Studies of people who have undergone major weight loss have found altered collagen architecture and damage or fragmentation within the elastic fibre network. One 2024 prospective study found reduced collagen fibres, reduced elastic fibres and fewer adipocytes following massive weight loss after bariatric surgery. Other studies have similarly found disorganisation of collagen after substantial weight loss. This matters because collagen provides much of the skin's tensile strength, while elastin allows it to stretch and recoil. Fibroblasts in the dermis are responsible for producing these structural proteins.

Selezneva explains:

“Our skin relies on a strong collagen and elastin framework to remain firm, resilient and supported. When weight is lost quickly, the skin doesn't always have enough time to adapt to its new contours. If collagen and elastin levels have already declined through ageing, as they naturally do from our mid-to-late twenties onwards, the skin may struggle to retract fully. Fibroblasts, the cells responsible for producing new collagen and elastin, also become less active with age, meaning the skin's repair processes slow down. The result can be loose, crepey or softer-looking skin, even when someone has reached a healthy weight.”

Zatonska sees these changes most clearly where facial fat previously provided structural support.

“This is particularly noticeable in the mid-face, lower face and submental area (under the chin), where the loss of fat reduces the skin’s underlying support. If the weight loss happens quickly, the skin may not be able to adapt at the same pace.

“Collagen and elastin, which give the skin its firmness and elasticity, are produced by fibroblasts in the dermis. Their activity naturally declines with age, so the skin’s ability to remodel is already reduced. Rapid fat loss can further challenge this process.

“There is also emerging evidence suggesting that GLP-1-induced rapid fat loss may reduce the number of adipose-derived stem cells, which are thought to support fibroblast activity and tissue regeneration. While these early findings appear to align with clinical observations, the evidence remains preliminary and is not yet conclusive.

“What we do consistently see in clinical practice is that patients, particularly those on higher-dose GLP-1 therapies who lose weight quickly, often develop more noticeable skin laxity in the face, neck, abdomen, inner thighs and arms. That’s why supporting skin quality and collagen remodelling alongside the weight-loss journey can be an important part of achieving the best overall outcome.”

What do we actually know about GLP-1s and fibroblasts?

There is good evidence that major weight loss can alter the structure of the skin. Researchers are now asking whether GLP-1 receptor agonists could have additional effects on the cells involved in maintaining it.

A human study published in 2026 provides an interesting early finding. Researchers compared abdominal adipose tissue from people taking GLP-1 receptor agonists with untreated controls. They found around a four-fold reduction in adipose-derived stem-cell counts in the GLP-1 group. The fibroblast populations themselves, however, were not significantly different between the two groups.

Adipose-derived stem cells are relevant because they participate in tissue maintenance and communicate with other cells in the local environment, including fibroblasts. A reduced population could therefore offer one possible explanation for changes in tissue quality beyond the physical effects of losing fat. It’s important to caveat that the study involved only 10 adipose tissue samples at baseline, and it does not show that GLP-1 medication directly switches off fibroblasts or prevents collagen production.

What is clear from the study, however, is that rapid and substantial weight loss changes the support beneath the skin, that major weight loss has been associated with changes in collagen and elastin, and that early research is examining whether GLP-1 treatment may have additional effects on the regenerative cells found within adipose tissue.

The face is only part of the picture

The lower face and neck attract much of the attention around so-called “GLP-1 face”, but post-weight-loss laxity is not confined to these areas.

Zatonska says:

“While the face and neck are the most frequently discussed areas, we also see laxity affecting the inner arms, abdomen and inner thighs. These areas are particularly vulnerable because the skin is naturally thinner and has relatively little underlying subcutaneous fat to provide structural support. When fat is lost rapidly, the skin may not be able to contract sufficiently, making laxity more apparent.”

Selezneva also treats patients concerned about changes to the body.

“The face and neck are certainly the areas I treat most frequently following weight loss. Patients often notice increased laxity around the jawline, lower cheeks and beneath the chin, where reduced structural support can make the skin appear less defined. The neck is another common area, as thinner skin tends to reveal laxity more readily.

“Sofwave is also an excellent option for the body, particularly in areas such as the arms, abdomen and above the knees, where patients may notice mild to moderate skin laxity after losing weight. These are often areas that respond well to collagen stimulation, helping the skin appear firmer without surgery or lengthy downtime.”

The patient's description of “loose skin” also needs unpacking during consultation. Loss of facial fat can change contour and projection without necessarily producing significant dermal laxity. Another patient may retain relatively good volume but have poorer skin recoil. Following very substantial weight loss, there may be enough redundant tissue that a non-surgical tightening treatment cannot produce the change the patient wants.

Those are different problems, even when patients use the same words to describe them.

Can collagen stimulation help?

Collagen-stimulating treatments are attracting interest in this group because they approach skin quality differently from treatments that replace volume.

Sofwave uses high-intensity, high-frequency ultrasound delivered into the dermis. The technology targets tissue at a depth of around 1.5mm, producing controlled thermal injury intended to trigger a healing response and subsequent collagen remodelling.

Selezneva explains why she uses it in patients who have lost weight:

“Sofwave is one of my favourite treatments for this type of patient because it addresses the underlying cause of the concern rather than simply masking it. Using precise ultrasound technology, Sofwave delivers controlled heat into the mid-dermis, where collagen production takes place, while leaving the surface of the skin untouched. This thermal stimulation activates fibroblasts, encouraging the production of new collagen and elastin over the following weeks and months.

“For patients who have experienced rapid weight loss, this can help improve skin firmness, support and elasticity without adding unnecessary volume. The goal isn't to make someone look different; it's to help their skin better adapt to their new shape, creating a naturally firmer, more lifted appearance that continues to improve over time.”

Zatonska describes it similarly:

“Sofwave is a non-invasive treatment that delivers ultrasound energy to the mid-dermis, stimulating collagen production in a controlled way without disrupting the skin’s surface. This triggers natural regeneration with essentially no downtime.

“Patients notice a slightly more taut, firmer appearance, better support in areas like the lower face, and an overall smoother, healthier look as collagen levels increase.”

Ultrasound is a long used method to improve skin quality - a study of 36 participants assessed high-intensity parallel-beam ultrasound delivered at 1.5mm for skin tightening and recorded improvement following treatment. Another prospective trial involving 15 patients found improvement across eyebrow, submental and neck areas after two treatments, with results maintained at six months.

Skin laxity and volume loss require different decisions

GLP-1-related facial changes have generated considerable discussion around filler, but restoring volume is not automatically the answer when the patient's main concern is laxity.

Selezneva says:

“Every patient is different, but for someone whose primary concern is skin laxity following weight loss, I believe Sofwave occupies a unique position. Fillers are designed to restore volume, which isn't always appropriate if the issue is loose skin rather than volume depletion. In fact, adding filler to lax skin can sometimes make the face appear heavier rather than more lifted.

“Surgery remains the gold standard for severe skin laxity, but many patients either aren't ready for surgery or simply don't need it. For mild to moderate laxity, Sofwave offers an effective non-invasive alternative with minimal downtime and clinically proven collagen stimulation.

“Compared with some other energy-based devices, Sofwave's ultrasound technology precisely targets the optimal depth within the dermis to stimulate collagen while protecting the skin's surface. This makes it a comfortable, versatile treatment that delivers gradual, natural-looking improvements in skin firmness, making it particularly well suited to patients who want to refresh and strengthen their skin after significant weight loss without looking overtreated.”

Zatonska takes a skin-first approach before deciding whether volume also needs to be replaced.

“Unlike other energy based treatments Sofwave is typically performed once a year, making it an easy addition to a long-term skin health strategy. With minimal downtime, a strong safety profile for all skin types, and reliable, consistent outcomes it offers a straightforward way to address multiple concerns: skin tightening and overall skin quality improvement in a single treatment.

“Dermal fillers address a different problem. They replace lost volume, but they don’t tighten the skin. In patients who have lost a significant amount of weight, adding too much filler to compensate for laxity can sometimes create an unnatural or heavy appearance. I prefer to improve skin quality first and then use fillers, if needed, very selectively.

“Radiofrequency based devices also stimulate collagen, but they rely on heat. Sofwave delivers a precise ultrasound treatment at the optimal depth for collagen stimulation while bypassing and protecting the epidermis, which gives it an exceptional safety profile across a wide range of skin types.

“For patients with severe skin laxity or significant excess skin following major weight loss, surgery remains the gold standard. No non-surgical device can remove redundant skin. However, for many patients who have mild to moderate laxity or who want to delay or avoid surgery, Sofwave is an excellent evidence-based option and can also complement surgical outcomes by improving overall skin quality.”

This is where assessment becomes more useful than treating “GLP-1 face” as a condition in its own right. A patient may have lost facial volume, developed dermal laxity, or have both. On the body, the difference between mild laxity and genuinely redundant skin is equally relevant. A collagen-stimulating device cannot replace missing facial fat, while filler cannot contract excess skin. Surgery remains the treatment capable of physically removing significant redundant tissue.

The research around GLP-1 medication and the skin is still developing. The newer work on adipose-derived stem cells is particularly interesting because it raises the possibility that some changes may involve more than loss of volume alone, but the data are early. For now, the strongest clinical case is the more familiar one: significant weight loss changes the tissue beneath the skin and can leave an ageing dermis with more contraction and remodelling to do.

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