Use of GLP-1 Receptor Agonists is Associated with an Increased Rate of Upper Eyelid Blepharoplasty

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have transformed the management of obesity and type 2 diabetes. Emerging reports describe accelerated facial soft-tissue deflation and periorbital changes among treated patients, often referred to as "Ozempic face." Given the thin skin and minimal subcutaneous tissue of the upper eyelid, rapid weight loss may exacerbate dermatochalasis and increase demand for surgical correction. This study evaluates whether GLP-1 RA therapy is associated with an increased rate of upper eyelid blepharoplasty.

A retrospective cohort study was conducted using the TriNetX Research Network. Female adults aged 18 or older with diabetes mellitus and essential hypertension between January 2015 and January 2020 were identified. Patients prescribed GLP-1 RA comprised the exposure cohort; patients without GLP-1 RA served as controls. Follow-up extended up to five years. The primary outcome was upper eyelid blepharoplasty. Propensity score matching (1:1 nearest neighbor) was performed for age, race, BMI, and comorbidities. Kaplan-Meier survival analysis and Cox proportional hazards modeling were performed. A secondary analysis compared patients achieving weight loss without GLP-1 RA to matched controls with stable BMI.

A total of 821,792 eligible female patients were identified, of whom 28,970 received GLP-1 RA therapy. After propensity score matching, 23,349 patients remained in each cohort. At five-year follow-up, 96 GLP-1 RA users (0.41%) underwent blepharoplasty compared with 36 controls (0.15%). GLP-1 RA use was associated with an increased hazard of blepharoplasty (hazard ratio 2.22; 95% confidence interval 1.51-3.26; p < 0.001). Kaplan-Meier analysis demonstrated shorter time to surgery among GLP-1 RA users. In the secondary analysis, non-GLP-1 RA weight loss was not associated with increased blepharoplasty incidence (hazard ratio 1.31; 95% confidence interval 0.89-1.93; p = 0.56).

GLP-1 receptor agonist use is associated with a significantly increased rate and earlier timing of upper eyelid blepharoplasty compared with matched controls. Weight loss alone did not demonstrate the same association, suggesting a distinct pattern of facial remodeling related to GLP-1 RA therapy. As pharmacologic weight loss expands, plastic surgeons should anticipate increased demand for periorbital rejuvenation and counsel patients accordingly.