Post-bariatric surgery body contouring has become a cottage industry in recent years due to both the success and popularity of weight loss surgery. Similar to body procedures following weight loss surgery, post-bariatric surgery facelifting also requires a special skill set and techniques to address excess skin and other aesthetic concerns in this patient population.
“In the facial area, excess skin causes cosmetic problems, like a ‘droopy’ face and a ‘turkey’ neck. Patients are particularly displeased with their post-bariatric face and neck because they cannot camouflage this area with clothing,” write study authors led by Kailash Narasimhan, MD, chief plastic surgery resident and colleagues of University of Texas Southwestern Medical Center in Dallas. The team reports their experience and techniques in the February issue of Plastic and Reconstructive Surgery®.
From a database of nearly 1,100 facelift patients, the researchers identified 22 patients who underwent facelift surgery after major weight loss. The patients were 15 women and seven men, average age 53 years. In patients with available data, average weight loss was 145 pounds. All patients had been at a stable weight for at least 6 months before surgery. Most patients had loss of volume in the midface and around the mouth, and all had excess skin in the cheeks (jowls) and neck.
Compared to the typical facelift patient, patients with massive weight loss needed a larger volume of fat augmentation, increased tightening of the cheek and neck skin, and more extensive elevation of the underlying muscle and other facial tissues. Most patients underwent other procedures—such as eyelid surgery, forehead lift procedures, forehead left, or facial resurfacing—at the same time.
Patients achieved significant improvement in facial fullness and shape, with no major complications. The improvements were well maintained over 2 years’ follow-up, similar to the results achieved in other facelift patients. Narasimhan and colleagues believe that their modified techniques can help address the unique characteristics of patients seeking facelift surgery after massive weight loss.
“These strategies help achieve the goals we all strive for in all of our facial rejuvenation patients,” the study authors conclude.