Facial Rejuvenation in the Massive Weight Loss Patient: Are Traditional Methods Adequate?

Goals/Purpose:

Traditional methods for facial rejuvenation for are inadequate after massive weight loss (MWL).

Methods/Technique:

Eight patients over an eight-year period who underwent rhytidectomy after massive weight loss (>100 lbs) were identified.  Three out of eight (37.5%) patients also underwent supplementary procedures (nasolabial fold excision or submalar implants).  Pre-and post-operative photographs of the eight patients were shuffled with photographs of ten non-MWL facelift patients and were shown in random order to three blinded reviewers independently.  The reviewers were asked to estimate an apparent age for each patient. 

Results/Complications:

The pre-operative apparent age of MWL patients was 4.8 years greater than their actual age.  This was significantly greater than the excess apparent age of 2.3 years in non-MWL patients (p<0.05, two sample T-test).  Rhytidectomy in MWL patients reduced excess apparent age less effectively (3.5 years or 74% of excess apparent age) than it did in non-MWL patients (2.5 years or 110% of excess apparent age), although this was not statistically significant (p=0.28, two sample T-test).  The combination of adjuvant procedures with facelift surgery in MWL patients achieved a greater reduction in excess apparent age (4.2 years or 88% of excess) compared with facelift alone (3.1 years or 65% of excess), although this was not statistically significant (p=0.35, two sample T test).

Conclusion:

Apparent pre-operative age exceeds actual age more significantly in MWL patients when compared to other rhytidectomy patients.  Rhytidectomy combined with other procedures was more effective in reducing excess apparent age than rhytidectomy alone in MWL patients.

MWL patient who underwent facelift, upper blepharoplasty and excision of nasolabial folds.

 SHAPE  \* MERGEFORMAT

MWL patient who underwent rhytidectomy, browlift, excision of nasolabial folds and phenol chemical peel.