Skip to main content
Top
Published in: Aesthetic Plastic Surgery 6/2015

01-12-2015 | Original Article

Objective Assessment of Facial Rejuvenation After Massive Weight Loss

Authors: Rafael A. Couto, Joshua T. Waltzman, Kashyap K. Tadisina, Steven Rueda, Bryson G. Richards, William F. Schleicher, Esteban Marten, Jeffrey D. Larson, S. Cristina Rotemberg, James E. Zins

Published in: Aesthetic Plastic Surgery | Issue 6/2015

Login to get access

Abstract

Background

While the literature is replete with articles about body contouring after bariatric surgery, little information exists regarding the outcomes of facelift following massive weight loss (MWL). A case report and a technique article are the only sources available addressing this issue. This pilot study objectively examines the effects of MWL in the cervicofacial region and results after facelift.

Methods

A retrospective review of seven patients who underwent facelift after MWL (>100 pounds) was performed. Patient’s change in appearance was objectively evaluated using an apparent age model. Forty blinded reviewers assessed pre- and postoperative photographs of seven MWL and eleven non-MWL female patients. The reviewers estimated the apparent age for each subject. Reduction in apparent age was calculated by comparing patient’s apparent age against actual age.

Results

The preoperative apparent age of MWL patients was 5.1 years older than their actual age (p < 0.02) compared to the increased preoperative apparent age of 1.2 years in non-MWL subjects (p > 0.05); suggesting MWL patients appear older than their actual age. Post-operatively, the apparent age reduction in MWL patients was 6.0 years; and their apparent age after surgery was 0.9 year less than their actual age (p > 0.05). In contrast, the control group exhibited an apparent age reduction of 5.4 years and a postoperative apparent age 4.2 years younger than their actual age (p < 0.01). Apparent age reduction was not significantly different for the two groups (p > 0.05). Age, BMI, and follow-up were similar between groups (p > 0.05).

Conclusions

MWL may accelerate apparent cervicofacial aging. Facelift following MWL enhances cervicofacial appearance and significantly reduces apparent age. We hope this study stimulates further interest in the study of facial esthetics in this increasing population.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
go back to reference Trus TL, Pope GD, Finlayson SR (2005) National trends in utilization and outcomes of bariatric surgery. Surg Endosc 19(5):616–620CrossRefPubMed Trus TL, Pope GD, Finlayson SR (2005) National trends in utilization and outcomes of bariatric surgery. Surg Endosc 19(5):616–620CrossRefPubMed
2.
go back to reference Rosenberg PH, Henderson KE, Grilo CM (2006) Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: a cross-sectional study using structured interview-based diagnosis. J Clin Psychiatry 67(7):1080–1085CrossRef Rosenberg PH, Henderson KE, Grilo CM (2006) Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: a cross-sectional study using structured interview-based diagnosis. J Clin Psychiatry 67(7):1080–1085CrossRef
3.
go back to reference Kalarchian MA, Marcus MD, Levine MD et al (2007) Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry 164(2):328–334CrossRefPubMed Kalarchian MA, Marcus MD, Levine MD et al (2007) Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry 164(2):328–334CrossRefPubMed
4.
go back to reference Poyatos JV, Balibrea JM, Sales BO et al (2014) Post-bariatric surgery body contouring treatment in the public health system: cost study and perception by patients. Plast Recon Surg 134(3):448–454CrossRef Poyatos JV, Balibrea JM, Sales BO et al (2014) Post-bariatric surgery body contouring treatment in the public health system: cost study and perception by patients. Plast Recon Surg 134(3):448–454CrossRef
5.
7.
go back to reference Kitzinger HB, Abayev S, Pittermann A et al (2012) After massive weight loss: patients’ expectations of body contouring surgery. Obes Surg 22:544–548CrossRefPubMed Kitzinger HB, Abayev S, Pittermann A et al (2012) After massive weight loss: patients’ expectations of body contouring surgery. Obes Surg 22:544–548CrossRefPubMed
9.
go back to reference Sclafani AP (2005) Restoration of the jawline and neck after bariatric surgery. Facial Plast Surg 21(1):28–32CrossRefPubMed Sclafani AP (2005) Restoration of the jawline and neck after bariatric surgery. Facial Plast Surg 21(1):28–32CrossRefPubMed
10.
go back to reference Narasimhan K, Ramanadham S, Rohrich RJ (2015) Facelifting in the massive weight loss patient: modifications of our technique for this population. Plast Recon Surg 135(2):397–405CrossRef Narasimhan K, Ramanadham S, Rohrich RJ (2015) Facelifting in the massive weight loss patient: modifications of our technique for this population. Plast Recon Surg 135(2):397–405CrossRef
11.
go back to reference Marten E, Langevin CJ, Kaswan S et al (2011) The safety of rhytidectomy in the elderly. Plast Recons Surg. 127(6):2455–2463CrossRef Marten E, Langevin CJ, Kaswan S et al (2011) The safety of rhytidectomy in the elderly. Plast Recons Surg. 127(6):2455–2463CrossRef
12.
go back to reference Swanson E (2011) Objective assessment of change in apparent age after facial rejuvenation surgery. J Plast Reconstr Aesthet Surg 64(9):1124–1131CrossRefPubMed Swanson E (2011) Objective assessment of change in apparent age after facial rejuvenation surgery. J Plast Reconstr Aesthet Surg 64(9):1124–1131CrossRefPubMed
13.
go back to reference Ozturck CE, Huettner F, Ozturck et al (2013) Outcomes assesment of combination face lift and perioral phenol-croton oil peel. Plast Reconstr Surg 132(5):743e–758eCrossRef Ozturck CE, Huettner F, Ozturck et al (2013) Outcomes assesment of combination face lift and perioral phenol-croton oil peel. Plast Reconstr Surg 132(5):743e–758eCrossRef
14.
go back to reference Aly AS, Cram AE, Heddens C (2004) Truncal body contouring surgery in the massive weight loss patient. Clin Plast Surg 31:611–624CrossRefPubMed Aly AS, Cram AE, Heddens C (2004) Truncal body contouring surgery in the massive weight loss patient. Clin Plast Surg 31:611–624CrossRefPubMed
15.
go back to reference Aly AS, Zahrani Al-, Cram AE (2013) Lower bodylifts. In: Neligan PC, Warren R (eds) Plastic surgery: volume two: aesthetic, 3rd edn. Elsevier, Oxford, pp 568–598 Aly AS, Zahrani Al-, Cram AE (2013) Lower bodylifts. In: Neligan PC, Warren R (eds) Plastic surgery: volume two: aesthetic, 3rd edn. Elsevier, Oxford, pp 568–598
16.
go back to reference Rubin JP, Nguyen V, Schwentker A (2006) Perioperative management of the post-gastric bypass patient presenting for body contouring surgery. Clin Plast Surg 31:601–610CrossRef Rubin JP, Nguyen V, Schwentker A (2006) Perioperative management of the post-gastric bypass patient presenting for body contouring surgery. Clin Plast Surg 31:601–610CrossRef
17.
go back to reference Staalsen T, Olsen MF, Elander A (2012) Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/post pregnancy. J Plast Surg Hand Surg. 46(6):416–420CrossRef Staalsen T, Olsen MF, Elander A (2012) Complications of abdominoplasty after weight loss as a result of bariatric surgery or dieting/post pregnancy. J Plast Surg Hand Surg. 46(6):416–420CrossRef
18.
go back to reference Stuzin JM (2006) Restoring facial shape in face lifting: the role of skeletal support in facial analysis and midface soft-tissue repositioning (Baker Gordon symposium cosmetic series). Plast Reconstr Surg 191:362–377 Stuzin JM (2006) Restoring facial shape in face lifting: the role of skeletal support in facial analysis and midface soft-tissue repositioning (Baker Gordon symposium cosmetic series). Plast Reconstr Surg 191:362–377
19.
go back to reference Rawlani V, Mustoe TA (2012) The staged face lift: addressing the biomechanical limitations of the primary rhytidectomy. Plast Recon Surg. 130(6):1305–1314CrossRef Rawlani V, Mustoe TA (2012) The staged face lift: addressing the biomechanical limitations of the primary rhytidectomy. Plast Recon Surg. 130(6):1305–1314CrossRef
20.
go back to reference Burke JP (1974) Should the subcutaneous tissue be plicated in a face lift? Plast Recosntr Surg. 54(1):1–4CrossRef Burke JP (1974) Should the subcutaneous tissue be plicated in a face lift? Plast Recosntr Surg. 54(1):1–4CrossRef
21.
go back to reference Rees TD, Aston SJ (1977) A clinical evaluation of the results of submusculo-aponeurotic dissection and fixation in face lifts. Plast Recosntr Surg 59(12):851–859CrossRef Rees TD, Aston SJ (1977) A clinical evaluation of the results of submusculo-aponeurotic dissection and fixation in face lifts. Plast Recosntr Surg 59(12):851–859CrossRef
22.
go back to reference Smith RC, Karolow WW, Papsidero MJ et al (1982) Comparison of SMAS plication with SMAS imbrication in face lifting. Laryngoscope 92:901–911PubMed Smith RC, Karolow WW, Papsidero MJ et al (1982) Comparison of SMAS plication with SMAS imbrication in face lifting. Laryngoscope 92:901–911PubMed
23.
go back to reference Prado A, Andrades P, Danilla S et al (2006) A clinical restrospective study comparing two short-scar face lifts: minimal access cranial suspension versus lateral SMASectomy. Plast Recosntr Surg 117(5):1413–1425CrossRef Prado A, Andrades P, Danilla S et al (2006) A clinical restrospective study comparing two short-scar face lifts: minimal access cranial suspension versus lateral SMASectomy. Plast Recosntr Surg 117(5):1413–1425CrossRef
24.
go back to reference Antell DE, Orseck MJ (2007) A comparison of face lifts techniques in eight consecutive sets of identical twins. Plastic Reconstr Surg 120(6):1667–1673CrossRef Antell DE, Orseck MJ (2007) A comparison of face lifts techniques in eight consecutive sets of identical twins. Plastic Reconstr Surg 120(6):1667–1673CrossRef
25.
go back to reference Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Recon Surg 119(7):2219–2227CrossRef Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Recon Surg 119(7):2219–2227CrossRef
26.
go back to reference Carlin GA, Gurdin MM (1978) Ancillary procedures for the aging face and neck. Surg Clin North Am 51:371 Carlin GA, Gurdin MM (1978) Ancillary procedures for the aging face and neck. Surg Clin North Am 51:371
27.
go back to reference Rafaty FM, Cochran J (1978) A technique of nasolabioplasty. Laryngoscope 51(2):371–385 Rafaty FM, Cochran J (1978) A technique of nasolabioplasty. Laryngoscope 51(2):371–385
28.
go back to reference Rees TD (1980) Aesthetic plastic surgery, vol 2. Saunders, Philadelphia, p 703 Rees TD (1980) Aesthetic plastic surgery, vol 2. Saunders, Philadelphia, p 703
29.
go back to reference Guyuron B, Michelow B (1994) The nasolabial fold: a challenge, a solution. Plast Reconstr Surg 93(3):522–529CrossRefPubMed Guyuron B, Michelow B (1994) The nasolabial fold: a challenge, a solution. Plast Reconstr Surg 93(3):522–529CrossRefPubMed
30.
go back to reference Guyuron B (1995) The armamentarium to the recalcitrant nasolabial fold. Clin Plast Surg 22:253PubMed Guyuron B (1995) The armamentarium to the recalcitrant nasolabial fold. Clin Plast Surg 22:253PubMed
31.
go back to reference Rudkin G, Miller TA (1999) Aging nasolabial fold and treatment by direct excision. Plast Recon Surg 104(5):1502–1505CrossRef Rudkin G, Miller TA (1999) Aging nasolabial fold and treatment by direct excision. Plast Recon Surg 104(5):1502–1505CrossRef
32.
go back to reference Sen C, Cek DI, Reis M (2004) Direct skin excision fat reshaping and repositioning for correction of prominent nasolabial fold. Aesthet Plast Surg 28(5):307–311CrossRef Sen C, Cek DI, Reis M (2004) Direct skin excision fat reshaping and repositioning for correction of prominent nasolabial fold. Aesthet Plast Surg 28(5):307–311CrossRef
33.
go back to reference Talmor M, Hoffman LA, LaTrenta GS (2002) Facial atrophy in HIV-related fat redistribution syndrome: anatomic Evaluation and Surgical Reconstruction. Ann Plast Surg 49(1):11–17CrossRefPubMed Talmor M, Hoffman LA, LaTrenta GS (2002) Facial atrophy in HIV-related fat redistribution syndrome: anatomic Evaluation and Surgical Reconstruction. Ann Plast Surg 49(1):11–17CrossRefPubMed
34.
35.
go back to reference Abood A, Ong J, Withey S et al (2006) Facial atrophy in HIV-related fat redistribution syndrome: a plastic surgical perspective on treatment options and a look to the future. Int J STD AIDS 17:217–220CrossRefPubMed Abood A, Ong J, Withey S et al (2006) Facial atrophy in HIV-related fat redistribution syndrome: a plastic surgical perspective on treatment options and a look to the future. Int J STD AIDS 17:217–220CrossRefPubMed
36.
go back to reference Mori A, Lo Russo G, Agostini T, Pattarino J, Vichi F, Dini M (2006) Treatment of human immunodeficiency virus-associated facial lipoatrophy with lipofilling and submalar silicone implants. J Plast Reconstr Aesthet Surg 59(11):1209–1216CrossRefPubMed Mori A, Lo Russo G, Agostini T, Pattarino J, Vichi F, Dini M (2006) Treatment of human immunodeficiency virus-associated facial lipoatrophy with lipofilling and submalar silicone implants. J Plast Reconstr Aesthet Surg 59(11):1209–1216CrossRefPubMed
37.
go back to reference Zins JE, Morrison CM, Langevin CJ (2013) Neck rejuvenation. In: Neligan PC, Warren R (eds) Plastic surgery: volume two: aesthetic surgery, 3rd edn. Elsevier, London, pp 313–326 Zins JE, Morrison CM, Langevin CJ (2013) Neck rejuvenation. In: Neligan PC, Warren R (eds) Plastic surgery: volume two: aesthetic surgery, 3rd edn. Elsevier, London, pp 313–326
38.
go back to reference Zins JE, Moreira-Gonzalez A (2006) Advances in facial aesthetic surgery: new approaches to old problems and current approaches to new problems. In: Siemionow A (ed) Tissue surgery, vol 1. Springer, London, UK, pp 101–117CrossRef Zins JE, Moreira-Gonzalez A (2006) Advances in facial aesthetic surgery: new approaches to old problems and current approaches to new problems. In: Siemionow A (ed) Tissue surgery, vol 1. Springer, London, UK, pp 101–117CrossRef
39.
go back to reference Pitanguy I, Pamplona D, Weber HI, Leta F, Salgado F, Radwanski HN (1998) Numerical modeling of facial aging. Plast Recon Surg 102(1):200–204CrossRef Pitanguy I, Pamplona D, Weber HI, Leta F, Salgado F, Radwanski HN (1998) Numerical modeling of facial aging. Plast Recon Surg 102(1):200–204CrossRef
Metadata
Title
Objective Assessment of Facial Rejuvenation After Massive Weight Loss
Authors
Rafael A. Couto
Joshua T. Waltzman
Kashyap K. Tadisina
Steven Rueda
Bryson G. Richards
William F. Schleicher
Esteban Marten
Jeffrey D. Larson
S. Cristina Rotemberg
James E. Zins
Publication date
01-12-2015
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 6/2015
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-015-0540-6

Other articles of this Issue 6/2015

Aesthetic Plastic Surgery 6/2015 Go to the issue