The Impact of Glucagon-Like Peptide-1 Receptor Agonist-Induced Nutritional Deficiencies on Skin Health: A Narrative Review With a Proposed Framework for the Aesthetic Practitioner.

Abstract

Semaglutide and tirzepatide have reshaped obesity care, and aesthetic practitioners increasingly encounter patients with rapid-weight-loss-associated facial volume loss and skin changes. Nutritional deficiency may be an underrecognized contributor to impaired dermal repair during glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy. The authors reviewed and synthesized evidence across metabolic pharmacology, facial anatomy and aesthetics, dermatologic histology, and clinical nutrition. PubMed, Embase, and the Cochrane Library were searched from January 2019 to March 2026, supplemented by foundational studies in collagen biology and post-weight-loss skin histology. GLP-1RA-mediated caloric restriction can reduce intake of micronutrient cofactors required for collagen biosynthesis and wound repair. Vitamin D deficiency reaches 13.6% at 12 months, and ∼22.4% of patients have at least one documented deficiency within 1 year. Deficiencies in vitamin D, iron, vitamin B12, folate, zinc, copper, and protein may plausibly compound rapid fat-compartment depletion and collagen remodeling. Direct GLP-1RA effects on dermal cells remain preclinical and should be interpreted cautiously. In summary, GLP-1RA-associated facial aging changes are multifactorial. The authors propose a risk-stratified framework for aesthetic practitioners emphasizing dietary optimization, selective supplementation, targeted laboratory assessment in at-risk patients, coordination with prescribing clinicians, and procedural timing when nutritional status is optimized. Prospective studies are needed to determine whether correcting deficiencies improves aesthetic or surgical outcomes. Level of Evidence: 5 (Therapeutic) For image description, please refer to the figure legend and surrounding text.