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Other factors, such as sun exposure, genes, and lifestyle can also contribute to a loss of facial volume and sagging skin

This could cause a relative biotin deficiency and have an influence on the skin

Food and Drug Administration: Glucophage (Metformin Hydrochloride) Tablets Label JCEM Case Reports : Metformin-Associated Vitamin B12 Deficiency: An Underrecognized Complication Clinical Diabetes : Increasing Vitamin B12 Screening Among Patients With Type 2 Diabetes on Long-Term Metformin Therapy Harvard Health Publishing: Vitamin B12 Deficiency Can Be Sneaky and Harmful Johns Hopkins Medicine: Vitamin B12 Deficiency Anemia Yale Medicine: Are You Getting Enough Vitamin B12

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