Filler Plus Biostimulators Plus Energy Devices: The Three-Step Fix for GLP-1 Faces

Losing 22 pounds can strip up to 7 percent of facial volume — and in GLP-1 patients that loss hits different fat pads than natural aging does. "If you lose 22 pounds, you can lose up to 7 percent of your facial volume," said New York dermatologist Amanda Doyle, MD, citing a 2025 imaging study at NewBeauty's inaugural State of Aesthetics Roundtable in New York.

The roundtable's core message: filler is not the enemy GLP-1 patients assume it is. Placement, technique and patient selection decide the outcome.

Why does the GLP-1 face look different?

Dr. Doyle explained that medication-driven weight loss changes the face in a specific way. With fast weight loss, "it's a more superficial fat pad type of change versus a deeper fat pad loss," she said. Ordinary aging does the reverse. New York dermatologist Marina Peredo, MD said the biggest losses tend to appear in the fat compartments of the temples and cheeks.

That distinction drives injection strategy. "Addressing that specific type of population is really important in knowing how to inject them appropriately with the right type of products," Dr. Doyle said.

Treatment 1: Filler, placed with precision

Austin, TX oculoplastic surgeon Sheila Barbarino, MD said the fear of looking heavier stems from a misunderstanding. "If you place filler in the correct anatomical position, you should always, always, always look like you've lost weight and that you look more sculpted, not that you've gained it," she said. The goal "shouldn't be to augment people, it's to bring out their best features."

Dr. Doyle, who attended the roundtable as a guest of Merz Aesthetics along with New York dermatologist Dendy Engelman, MD, prescribed restraint: smaller amounts, placed carefully and less often. "Not every patient is a filler patient, even if they think they may be," she said. Done well, filler achieves "making it look like something meaningful has been done without being known what's been done." She added: "I think that's really going to turn the tables on aesthetics and make patients more comfortable with filler again over time."

New products support the approach. In September, the FDA approved Belotero Volume (+) for cheek and midface volume and contour, and Belotero Intense (+) for lip fullness, joining Belotero Balance (+). Both use Merz's Cohesive Polydensified Matrix technology, which creates a gel designed to integrate into tissue rather than sit on top of it, preserving expression. Merz reports 95 percent patient satisfaction through 18 months for Belotero Volume (+). "There's some really unique things coming out of Merz with the Belotero Balance and Volume and Intense portfolio that add a unique component to our toolbox," Dr. Doyle said, citing the line's biomimetic design — products that "move naturally with our tissue and integrate really nicely."

Treatment 2: Biostimulators that rebuild collagen

Where filler restores shape, biostimulators prompt the skin to produce its own collagen. Dr. Peredo, a longtime user of Radiesse and Sculptra, said Sculptra is having "a huge comeback" in her practice.

Toronto physician Jennifer Pearlman, MD uses hyperdilute Radiesse, which she said holds a unique place "as it relates to reloading the matrix." She still backs hyaluronic acid: "HAs will always have a place in our aesthetic arsenal if we are thinking about the skin architecturally and we're providing targeted scaffolds."

Data supports pairing the two. Dominic Mazzone, founder and CEO of the physician-led network VOS Collection, said patients who receive regenerative biostimulators without HA filler drop off faster than those who do both.

Treatment 3: Energy treatments for skin quality

The third pillar is the skin itself. Dr. Peredo layers biostimulators with lasers, including a 1550 nm fractional device that spares the skin's surface — safe across ages and skin tones, even in summer. Many practices also offer micro-focused ultrasound, the technology behind Merz Aesthetics' Ultherapy. "We always have our lasers and our light-based treatments," Dr. Pearlman said.

Who should do the injecting?

DJ Sethares, vice president of U.S. marketing for Merz Aesthetics, called the moment an "inflection point of risk because the innovation is outpacing the education." She pushed for shared industry standards, "not to create rigidity, but to create an expectation that we can train towards and that patients can understand and expect."

Dr. Engelman said patient education matters too. "We all have like the attention span of a fruit fly now," she said, and doctors must translate clinical language for consumers. Her first advice to GLP-1 patients is basic: "You need to make sure you're managing your protein and your caloric intake."

Sethares framed the philosophy the roundtable returned to: "I don't believe in starting with product first at all. I believe in starting with the patient first." For GLP-1 patients, that means the most youthful results will come from a tailored mix of all three treatments, matched to where the face lost volume and how fast.