Loose Skin and Facelifts After Bariatric Surgery

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Bariatric Surgery

Gastric bypass and other weight-loss surgeries, known collectively as bariatric surgery, involve changing your digestive system to help you lose weight. Bariatric surgery is done when diet and exercise haven't worked or when you have serious health problems because of your weight. Some procedures limit how much you can eat. Other methods work by reducing the body's ability to absorb nutrients. Some procedures do both. Long-term weight loss through the standard of care procedures is primarily achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.

Main Digest

The unique challenges of facelift surgery in this group of patients - and practical techniques for addressing them - are 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 the 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 body contouring procedures to remove excess skin folds in the 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 of 53 years. In patients with available data, the average weight loss was 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 lost 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 that the skin condition 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 procedures - such as eyelid surgery, forehead lift procedures, forehead left, or facial resurfacing - simultaneously.

Dr. Narasimhan and colleagues achieved excellent aesthetic outcomes using this approach.

Patients improved significantly in facial fullness and shape, with no major complications. Given the additional challenges in massive weight loss patients, the authors were pleased to note that the improvements were well maintained over two years' follow-up, similar to the results achieved in other facelift patients.

While emphasizing the need for an individualized approach in every case, Dr. Narasimhan and coauthors believe that their modified techniques can help address the unique characteristics of patients seeking facelift surgery after massive weight loss. They conclude:

"These strategies help achieve the goals we all strive for in all of our facial rejuvenation patients."

Reference:

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health. "Face Lifting in the Massive Weight Loss Patient: Modifications of Our Technique for This Population." Article: "Face Lifting in the Massive Weight Loss Patient: Modifications of Our Technique for This Population" (DOI: 10.1097/PRS.0000000000000881)

Attribution/Source(s):

This quality-reviewed article relating to our Cosmetic Surgery Information section was selected for publishing by the editors of Disabled World due to its likely interest to our disability community readers. Though the content may have been edited for style, clarity, or length, the article "Loose Skin and Facelifts After Bariatric Surgery" was originally written by Wolters Kluwer Health, and published by Disabled-World.com on 2015/02/01 (Updated: 2022/06/17). Should you require further information or clarification, Wolters Kluwer Health can be contacted at lww.com. Disabled World makes no warranties or representations in connection therewith.

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