Facial rejuvenation poses special challenges in massive weight loss (MWL) patients who routinely have a more deflated face and lax superficial musculoaponeurotic system (SMAS) than the average facelift patient.
Seeking insights into the best techniques for this population, surgeons at the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, conducted a retrospective chart review of MWL facelift patients going back 25 years, the results of which have been published in the February issue of Plastic and Reconstructive Surgery.
Study authors Kailash Narasimhan, M.D., Smita Ramanadham, M.D., and Rod J. Rohrich, M.D., identified 22 patients who had facelifts after massive weight loss. Prior to surgery, 86 percent of patients exhibited volume loss in the midface and nasolabial groove regions, and 59 percent had perioral volume loss. All patients had skin excess and redundancy in the jowl and submental region; 82 percent had platysmal banding. Average patient age was 52.7 with a body mass index of 26.0 at the time of surgery.
Counseling the MWL patient for corrective surgery
Nineteen patients underwent primary facelifts, while three had secondary facelifts. Patients with primary facelifts underwent SMAS stacking placation or SMASectomy. All patients had fat grafting to shape and fill the face, and on average, twice as much fat was used in these patients compared with non-MWL patients. There were no major complications during or after surgery. One patient experienced postsurgical hematoma, which responded to drainage.
Based on the authors' findings, they outline several techniques that may improve facelifting results in the MWL patient population, including an individiualized component analysis, SMASectomy to treat redundant skin, SMAS neck suspension sutures in thicker-skinned patients and the use of double the amount of fat for fat augmentation.
While the study authors note that these techniques offer the MWL patient enhanced results, they also point out, “Although our strategy appears effective to the massive weight loss patient, only a prospective study comparing results from massive weight loss and non-massive weight loss patients would verify the effectiveness of our individualized strategy.”