Effects of Agonists on Skin Quality: A Comprehensive Literature Review.

INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), particularly semaglutide and liraglutide, have revolutionized the treatment of type 2 diabetes and obesity due to their potent effects on weight loss and glycemic control. However, emerging evidence has highlighted dermatologic side effects associated with the rapid reduction of subcutaneous adipose tissue, particularly in the context of aesthetic skin integrity. This systematic review aims to comprehensively evaluate the current evidence on the effects of GLP-1 RAs on skin quality, including dermal structure alterations, adipose compartment loss, and skin elasticity changes. METHODS: A systematic literature search was performed in PubMed (MEDLINE) using predefined keywords including "semaglutide," "liraglutide," "GLP-1 receptor agonists," "skin quality," "adipose tissue loss," and "elasticity." Studies published up to May 2025 were considered. Inclusion criteria involved human studies documenting dermatologic alterations associated with GLP-1 RA use. Forty studies were selected based on PRISMA guidelines, encompassing clinical trials, case reports, and observational studies. RESULTS: The data revealed that GLP-1 RA-induced weight loss frequently results in visible changes to skin morphology. Key findings included facial volume loss ("Ozempic face"), dermal thinning, loss of collagen and elastin fibers, and decreased skin elasticity. Patients exhibited localized fat loss in multiple anatomical regions, leading to redundant skin folds and accelerated signs of aging. Risk factors for more severe dermatological outcomes included advanced age, prolonged obesity history, rapid weight loss, poor hydration, and insufficient protein intake. CONCLUSION: While GLP-1 RAs offer substantial benefits for weight and metabolic health, their dermatologic side effects represent an important clinical consideration. Proactive measures such as gradual weight loss, nutritional optimization, hydration, and early dermatologic intervention are recommended. Future prospective studies are warranted to better define the pathophysiology and management of GLP-1 RA-associated skin changes. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.