Facelift Surgery after Massive Weight Loss Poses Challenges, Reports Plastic and Reconstructive Surgery

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Newswise January 29, 2015 Patients undergoing bariatric surgery for severe obesity are often left with excess, sagging skin affecting all areas of the bodyincluding the face. The unique challenges of facelift surgery in this group of patientsand effective techniques for addressing themare presented in a paper in the February issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Kailash Narasimhan, MD, and colleagues of University of Texas Southwestern Medical Center, Dallas, outline their approach to facelift surgery in patients who have lost 100 pounds or more after bariatric surgery. "In the massive weight loss population there are common techniques which we feel can enhance results in these patients," the researchers write. Rod J. Rohrich, MD, Editor-in-Chief of Plastic and Reconstructive Surgery, is a co-author of the new study.

Unique Challenges of Facelift Surgery after Massive Weight Loss "Massive weight loss surgery patients in general have a large amount of redundant skin and soft tissue," according to Dr. Narasimhan and colleagues. Such patients commonly undergo procedures called body contouring to remove excessive skinfolds in upper and lower body.

In the facial area, excess skin causes cosmetic problems like a "droopy" face and "turkey" neck. The researchers note, "Patients are particularly displeased with their post bariatric face and neck because they cannot camouflage this area with clothing."

From a database of nearly 1,100 facelift patients, Dr. Narasimhan and coauthors 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 145 pounds. All patients had been at a stable weight for at least six months before surgery.

The researchers outline their technical approach, targeting the unique characteristics of patients with massive weight loss. Most patients had loss of volume in the midface and around the mouth, and all had excess skin in the cheeks (jowls) and neck.

Recommended Techniques Address 'Deflation and Skin Laxity' Dr. Narasimhan and colleagues chose plastic surgery techniques that address the increased skin laxity and facial "deflation" in this group of patients. The researchers note the condition of the skin after massive weight loss is similar to aging skin, with loss of underlying fat and decreased skin thickness.

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 proceduressuch as eyelid surgery, forehead lift procedures, forehead left, or facial resurfacingat the same time.

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Facelift Surgery after Massive Weight Loss Poses Challenges, Reports Plastic and Reconstructive Surgery