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    Dallas Surgeon Dr. Jejurikar: Ozempic Explained



    Dr. Sal Pacella: Good morning, everyone. It’s Doctor Sal Pacella from San Diego, California. Hope everyone’s well and joined today. Of course, my colleague, Doctor Sam Rhee, from Paramus, New Jersey. He’s at Bergen Cosmetic and Doctor Sam Jejerikar from Dallas, Texas. He’s at Sam Jejerikar. I am at San Diego Plastic Surgeon. How are you guys? 

    Dr. Sam Jejurikar: Doing great. 

    Dr.Sam Rhee: Doing amazing. 

    Dr. Sal Pacella: We have had a hiatus from our usual podcast, 3 Plastic Surgeons and a Microphone, and we’re happy to pick things back up here and talk about an awesome new topic. Alright. So, today’s topic, we’re going to talk about what’s hot in the media, Ozempic face, okay? So, these are a new class of weight drugs that a lot of doctors have been prescribing recently, and they’ve had some interesting side effects. So, we’re going to talk about those today, but first, before we do that, we’re going to give a little disclaimer, our usual disclaimer. This show is not a substitute for professional medical advice, diagnosis, or treatment. The show is for informational purposes only. Treatment and results may vary based on the circumstances. 

    So, the situation and medical judgment after appropriate discussion. Always seek the advice of your surgeon or qualified health provider with any questions you may have regarding medical care. Never disregard professional medical advice or delay seeking advice because of something in the show. Alright, gents. Well, so I’m going to hand it over to Doctor Jejurikar. He’s going to take the lead here and tell us a bit about Ozempic Face

    Does Ozempic help with Type 2 Diabetes?

    Dr. Sam Jejurikar: Perfect. Yeah. So much like you guys, over the last two weeks, my social media feed has been sort of dumb by this #Ozempicface. I have saw sort articles in the New York Times. I’ve seen other plastic surgeons talking about it on social media feeds, so I thought this would be a timely topic for us to talk about. So, first of all, what are these medications? Ozempic and Wegovy were the first medications that were sort of released. They’re both the same medication, semi-glide, and Ozempic was released for treating type 2 diabetes. Wegovy was a high dose of semi-glutide that was approved for the treatment of obesity. A few months later, in June of 2022, Manjiro was FDA approved for the treatment of type 2 diabetes. But interestingly enough, as the clinical trials were done, even though Manjiro is technically for type two diabetes, the clinical trials actually show that weight loss with this medication could be twice as much as you might see with these other meds. 

    So, in a lot of cities, Dallas is one of them. I know New York City; I’m sure you guys do as well; you’re seeing it a lot. A lot of patients started getting this prescribed to the doctors for the treatment of weight loss, and there’s just tons of chatter. It’s almost like it’s magic that’s out there and there; again, Ozempic was sort of the first one that was talked about a lot. Now Manjiro seems to be the most effective. Before we get any further, I want our patients to know; we’re not necessarily promoting the use of these medications. There are side effects, as there could be with any other medication. The reported ones that they’ve seen thyroid cancer and rodents with all of these medications, pancreatitis could be a side effect of these medications. So, we are not trying to push these medications, but in the New York Times article that I read earlier this week and they actually said that on Twitter, the #Ozempicface had actually already been referenced 2.3 million times. So, a lot of people are actually talking about this. 

    So, how do these medications work? Manjiro, I’m going to talk about that as well as Ozempic. So, Manjiro and Ozempic both work through something called GLP-1 receptors. Which are glucagon-like peptide receptors, and they do a few things. The first thing they do is sort of increase the effects of insulin in your body. So, as we get older or when people have diabetes, they get more resistance to insulin, meaning that their ability to just sort of break down glucose and process it gets worse. So, they’re more likely to start seeing diabetes; they’re more likely to start gaining weight and storing that glucose. So, these medications increase the sensitivity of your body to insulin. The second thing they both do is reduce gastric emptying, meaning you eat a little bit and you get full a lot quicker. And then, they both reduce glucan levels, which means you’re less likely to mobilize glucose in your bloodstream. So, all of those medications, an Ozempic, Wegovy and Manjiro do this. 

    Manjiro actually does something else. It actually works through other receptors as well, which are called GIP receptors or glucose-dependent insulinotropic polypeptide receptors. So, what it also does, is it also works on your brain. You’re not hungry, and it increases the sensitivity even more so to insulin. So, it’s sort of speculated because it’s got this dual mechanism of action. That’s why it’s more effective than an Ozempic. So, my personal story is this. I come from a family that has a strong history of type 2 diabetes. About a year ago when I checked my hemoglobin A1C level, which is a marker of diabetes. It came back elevated at 5.6, which is the beginning of pre-diabetes. So, with my doctor, we came up with a regimen of changes to my diet where basically, I had fewer carbs. I actually started doing intermittent fasting, all in an attempt to control the levels of my glucose levels and to try to control my, you know, propensity for type two diabetes. 

    So, a year goes by; I actually lose about 12 pounds doing this. I checked my Hemoglobin A1C again. It’s gone up to 5.9. And so now my doctor is telling me, well, you probably need to start some medication for this. He actually ran Commended that I start a different medication, a different pill, but because I’ve seen so many of my patients on Manjiro, I actually asked, can I try Manjiro for a few months? I wouldn’t mind losing another 15 or 20 pounds and then transitioning to this, which he agreed to. So, I started on Manjiro about five weeks ago, and what happened is in these past five weeks, I have actually lost 15 pounds, and it just so turns out that about a year ago, I’d actually taken some photos before I was getting a laser treatment it, and so I got another set of photos to see whether I had gotten Ozempic face. So, gentlemen, what do you think? Do I have Ozempic face? 

    Dr. Sam Rhee: I think you look chiseled. 

    Dr.Sal Pacella: I think you look like the rock. 

    Dr.Sam Jejurikar: Yes. Well, so. 

    Dr. Sal Pacella: Yes, I do. 

    Dr. Sam Jejurikar: Yeah, it’s interesting, right? It’s interesting. So, when we look from these views, I mean, I definitely think I look better, but I also think that the weight loss in my face is disproportionate to a 15-pound weight loss. I think there’s a lot, yes.

    Dr. Sal Pacella: Well, so let me say, we see in cancer reconstruction that I do very frequently. We have the benefit of the kind of seeing patients over and over several months and over a year, two years, etcetera. We sometimes take pictures of their face, etcetera, and there is some yo-yo-ing that sometimes occurs with weight. I was that even 5 to 10 pounds of weight loss; you can actually see it in the face, I’m going to say. So, it’s actually not surprising to me, with just 15 pounds, that we’re seeing some subtle changes in your face. The big thing that jumps out of me the most is that I think your jaw looks great to go to the oblique for a second here. I mean, your jaw definitely looks more chiseled; look at the submental area. You don’t have any additional fat underneath your chin area. So, you look great. 

    The only thing I see here that I would say may be a little bit treatable is the temporal area right here above, right in between your ears and your eyebrow. That is notoriously a place where I see patients kind of lose weight to sort of have issues related to weight loss. So, we got some treatments for that, my friend. 

    Dr. Sam Rhee: The other comment I would make is I agree with Sal 100%. The only others place I would see any sort of maybe more overt signs of aging is under your eyes a little bit. There’s a little bit of hollowing there that, honestly, though, for your age and for your weight loss, is pretty good. What I’m impressed with is when I see a lot of people who’ve lost this kind of weight, their nasolabial folds get pretty deep, and I don’t see that in you, and I don’t know if that’s genes or you just never really had that, to begin with. I’m not sure, but honestly, for 15 pounds at your age, your face is holding up pretty well there. 

    Dr. Sal Pacella: Yeah, it looks great. 

    Dr. Sam Jejurikar: So, this is an interesting one for you guys because normally, we’ll look at these pictures, and they’re just some patients you don’t know. So, it’s easier to sort of tear it for you to be a little critical of it. But because it’s you guys and I are nice guys, you are being exceptionally kind. So, I agree. I think I look healthier, having lost weight. I think my faith looks more chiseled. I will say a couple of things about my jawline area. Sam, in terms of your comment, I’m kind of a freak about radiofrequency treatments. I’m a big believer that radio frequency and retinol treatments together at home can be really beneficial for keeping skin tight. So, I think between Morpheus 8 treatments which I’ve sort of done regularly over the last year and a half to two. A home form of radio frequency treatment that I do about once a week and then being very good about retinol treatments. 

    I think that probably explains what we’re seeing with the jawline area a little bit where it hasn’t; I think my jawline actually looks better with weight loss which is more interesting than it did before because you would expect this area along the lower jawline to get more sagging. In terms of the nasolabial folds, which are the lines for patients between the nose and the lips, and the marionette lines, which are the lines between the lips and the jawline. I mean, I think deepening that has actually occurred in this spot. These are very treatable by fillers. I agree that I think that I’ve lost a lot of fat in the orbital region, where if you look at my lower eyelid, that looks substantially more sunken than it did 15 pounds before. I thought the thing which you guys didn’t really mention. I thought I lost a lot of my buckle fat which is another hot topic. 

    A lot of patients will sort of come to us and talk about; do I need my fat buckle pads taken? I want to get more of that chiseled look. And I thought part of the reason why my cheekbones actually look a little bit more defined was I think my buckle fat is gone. I don’t know if that’ll come back if the weight comes back. Because we didn’t mention a lot of patients in these clinical trials, once they stop Manjiro and his Ozempic, they get a portion of this weight back. So, I don’t know if my buckle fat will come back. I don’t know if my orbital fat will come back. I don’t know if my temporal hauling that Doctor Pacella was talking about would come back as well. So, I don’t know, it’s interesting because some of the fat that we lose in our face is just different kinds of fat or fat pads than the typical fat that we might see in our abdomen that wavers. So, I don’t know. 

    Dr. Sal Pacella: Doctor J, one question for you. Do you smell what the rock is cooking? It’s unbelievable. I mean, what you need to do is you need to shave your head and get a flat shoulder, and you are a spinning image of the rock. I mean, it’s amazing. 

    Dr. Sam Jejurikar: If only that were true. 

    Benefits and Limitations of Hyaluronic Acid Fillers for Chiseled Face Appereance

    Dr. Sal Pacella: Alright. So, let’s talk for a second about your mentioned fat transfer. I do a tremendous amount of fat transfer in and around the face in the periorbital region, and the beautiful thing about fat transfer in and around the face is that it is very easy to do, very predictable, and very long-term. This is something you could do right in the office. So, that fat that’s harvested from the abdomen, though, remembers that it’s from the abdomen, right? So, anytime you transfer tissue around, if you gain or lose weight after the fat transfer, you will see it accordingly in those areas. So, as to if you gain weight again, will you see it in your temporal fat pads? My answer to that is probably not. 

    My experience has been that, well, people lose this in this area; it tends to be permanent. Even when people put weight back on, it’s like that’s a combination of aging and or weight loss, but it’s interesting. One of the only places in the body where once you lose the weight, it’s gone, and it doesn’t come back. It’s that area, in my opinion. 

    Dr. Sam Jejurikar: Yeah, I agree with that. I feel like buckle fat, temporal fat, and orbital fat. When they go away, they don’t come back, and I think you’re right. There’s a lot of longevity that comes with a fat transfer, and for patients that don’t wanna do repeated filler treatments, that is a very nice alternative. I am a big fan of doing; know transient filler treatment as well because I find that to be predictable as well, and the thing is, if my weight yo-yos afterward, I’ve definitely seen fat to the temporal region, fat to the cheeks, gain weight afterward once a fat transfer happens, and people’s face look abnormally fat as well. So, my personal approach to me, which I’m going to show you guys in a second, is I’m probably going to do extensive filler treatment in the next few months here to try to overcome some of these changes. Any comments, Sam, before we move on to, like how would you, how if, let’s say, I showed up in your office, and I said I want you to help me with some of these signs of aging? What would your approach to me be? 

    Dr. Sam Rhee: Yeah, my first go-to generally; I mean, Sal’s right fat is an amazing treatment method, and I use it a lot, too, for the face. But I always usually, for a first-time patient, we’ll start with some sort of filler just to make sure that we know what we’re doing in terms of results and whether they like it, and it helps us sort of gauge what a future fat transfer is. So, I will usually start with filler and then bridge to fat if it’s something they really like. 

    Dr. Sam Jejurikar: So, I use some virtual aesthetic software in my practice, which is called Crisalix; the only eerie thing about Crisalix is that it cuts off your hair. It always looks like sort of a weird-looking mask. But I simulated. I started playing around. I’m like, how can I still sort of maintain this look that, hopefully, I’ll maintain most of the weight loss that’s occurred. But how can I reverse some of these signs of aging? And so, Crisalix has a partnership with Allergen, and I do use a lot of allergen filler products in my practice. So, in this, I sort of simulated what I thought two syringes of velour would look like in my nasolabial folds in marionette lines, which is a hyaluronic acid filler. I simulated what two syringes of Volbella would look like in my lower eyelid and kind of spread a little bit into my temple area. That’s a hyaluronic acid filler. 

    I simulated with two syringes of Voluma would look like in my cheeks to try to add a little bit of volume to this lid cheek junction. And I even added a little bit of Voluxe to my jawline, just a little bit, to try to make my jawline even a little bit more rock-like in Doctor Pacella’s analogy. And I thought this would still maintain sort of that chisel look without any substantial downtime. The nice thing about fillers is that I don’t have to have surgery. It’s something that can be done in the office, and I can just regularly get back on my way. And so, I anticipate doing something like this in the next few months, maybe in a peace mail manner. Do you guys have any comments about this? 

    Dr. Sam Rhee: I think it looks great. Yeah. I think it’s amazing how I think I believe this is fairly accurate in terms of simulating what that kind of filler treatment is. What is surprising and yet not surprising is how much filler you had to use to achieve these results in the simulation. How many syringes is that? Is that like eight or ten syringes? Like that’s a lot. 

    Dr. Sam Jejurikar: I was estimating like seven syringes of filler altogether to make this happen. Yeah.

    Dr. Sam Rhee: It’s a lot. 

    Dr. Sam Jejurikar: That’s the thing. Seven altogether is what I was thinking two of Allure, two of Voluma, two of Vobella, and the Voluxe. I don’t really know if I need that one; I just knew, so I wanted to play around with it, jawline filler. 

    Debating the Cost and Benefits of Fillers vs Fat Transfers for Facial Rejuvenation

    Dr. Sal Pacella: So, that’s a good point about the number of syringes, so let’s just say, on average, syringes of the fillers are $400-to-$600, something like that. Would you agree? 

    Dr. Sam Rhee: I mean, the Volumas are way more expensive than that. 

    Dr. Sam Jejurikar: Probably. 

    Dr. Sam Rhee: Yeah. 

    Dr. Sal Pacella: So, let’s just see. 

    Dr. Sam Jejurikar: I’ve seen between $700-to-$1000 a syringe. 

    Dr. Sal Pacella: Okay, so you, let’s just do the math real quick. So, you have 700 bucks for the syringe.

    Dr. Sam Jejurikar: That’s about $5,000. Yeah, let’s just say about $5,000. 

    Dr. Sal Pacella: Okay. 

    Dr. Sam Jejurikar: Yeah 

    Dr. Sal Pacella: So, $5,000. So, fat transfer is relatively inexpensive, can be done in the office setting, takes about an hour, and I would say that it’s well below the cost of that. And so, just to keep this in perspective for patients when they choose a filler. Fillers are temporary and very easy to do; fat transfer takes a little bit of time, a little bit of recovery, and a little bit of lot more swelling. But the fillers are little. bit more reversible, a little bit more subtle, etcetera. So, it is a financial issue many times between them with the cost of fillers for sure. 

    Dr. Sam Jejurikar: Absolutely, but a couple of things that might take issue with what you said is there’s a lot of downtime with fat grafting to the face or tends to be a prolonged amount of swelling that can happen with it. It’s not a little bit reversible. 

    Dr. Sal Pacella: I mean, that’s what I meant. That’s no, no. 

    Dr. Sam Jejurikar: When you say fillers are a little bit more reversible. It is reversible. And fat is not reversible. 

    Dr. Sal Pacella: Right, I did say that. I did say, wait, wait. I did say the fillers are more reversible, and I said that there’s an extended reversible. 

    Dr. Sam Jejurikar: Yeah, but then the other thing is… 

    Dr. Sal Pacella: Hold on, hold on. Let’s give you some correct information there are ways to treat overfilling of fat, injections of steroids, there’s massage, etcetera. So, that’s I’m just saying the degree of reversibility or change is much more difficult with the fat transfer, I agree, but it’s not a zero-sum, right? 

    Dr. Sam Jejurikar: 100%, but then the other type of cost that I would talk to you about is an opportunity cost, and you know what that is, and Doctor Reed knows what it is. But for people that don’t know what it is. An opportunity cost is that cost from downtime which you’re going to lose out on. So, for me, if I can do filler injection and do it during the course of my day and continue to work and not look abnormal for a couple of weeks or three weeks or four weeks or however long it takes fat to go away or the swelling and breezing to go away. I actually think that that’s less expensive for me in the long term if I’m not looking abnormal for a period of time and I’m seeing patients, and I’m able to continue to operate. 

    So, I agree. I do not hate fat at all. I love fat transfers to the face. I don’t tend to do a lot of it in the office setting for this when I do fat to the temples. When I do fat to the lower eyelids. I do fractionated fat, fracture fat which it just, you know, and so there’s just lots of preparations. I tend to do this in the offering room when I’m doing it. So, there are pros and cons to either approach, but it’s not uncommon for me in my practice to do 4-to-6 syringes on people at a given session. I mean, I probably do that on a weekly basis for people that have needs. So, to me, that’s not an abnormal amount of filler product to use. 

    Dr. Sam Rhee: I love this debate between you two because I think for certain patients, fat is definitely their answer, and for some people, fillers or both sometimes. So, I feel like the fact that we can have a good debate about both shows that there’s utility in both methods of approach, and it’s something that you discuss with your surgeon, and then you sort of figure out what probably would work best for you. 

    Dr. Sam Jejurikar: Yeah, so I think the take on message, at least in my mind, the two questions are is an Ozempic face a real thing? Yeah, I think it is. I think I do think you definitely see signs of facial aging with it. Is it unique to Ozempic, or is it more just related to weight loss? Who knows? But is it treatable? Yes, it’s treatable. They’re great ways to add volume back to the face. So, for me, I’m personally very happy that I’ve been taking Manjiro. I love the fact that over a few weeks, I’ve lost kind of a ridiculous amount of weight, and then I’m motivated to keep it off afterward. We’ll see if I’m actually successful. 

    Dr. Sam Rhee: I think the other key to remember is that you did a lot of non-invasive skin treatments during this time, which can be very helpful. So, people should sort of keep that in mind as well as they’re going through this medication that maybe they should also be focusing on that as well to help themselves. 

    Dr. Sam Jejurikar: Great. 

    Dr. Sal Pacella: Well, that’s a great place to end, I think. I mean, I think that the key here is we’re going to be seeing much more of this in the future as surgeons, and good to know there are a lot of treatments for that. I’m going to leave you with this. “Know your role.” 

    Dr. Sam Jejurikar: Peace out, everyone. 

    Dr. Sal Pacella: Alright.



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