Complex protocols for correction of age-related changes caused by drug-induced loss of subcutaneous fat tissue of the face and body using a PLA-based preparation

With the increasing popularity of glucagon-like peptide-1 receptor agonists (GLP-1RA), the public and the cosmetic and plastic surgery community have coined new terminology to characterize some of the unintended effects of these drugs. Terms such as “Ozempic® face” and “Ozempic® body” have come into common usage to describe the loss of tissue volume resulting from semaglutide therapy. A Google Trends search was conducted to clarify public perceptions of GLP-1 receptor agonists and their relationship to the morphologic changes observed with drug-induced weight loss. There is some evidence to suggest that GLP-1RA may also accelerate skin aging by targeting cells in the adipose tissue layer and suppressing their proliferation and metabolic activity. GLP-1RA affects dermal white adipose tissue (DWAT) and adipose-derived stem cells (ADSCs), and possibly hormonal regulation and facial muscles. A wide range of hardware and injection methods are used to correct changes associated with the risk of a sharp increase in the skin flap and loss of tissue volume. A special place is occupied by injectable collagen stimulators based on polylactic acid (PLA). After administration, PLA fillers cause differentiation of macrophages into the M2 subtype, which is known to induce collagen production by increasing the expression of TGF-β in fibroblasts and is a biocompatible material that is hydrolyzed to water and carbon dioxide. After administration, PDLLA microspheres remain localized in the tissues, promoting the attraction of myofibroblasts and ADSCs, which is important in patients with drug-induced loss of subcutaneous fat. This review presents the main correction methods and options for combined protocols, and provides clinical cases.