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Facial Rejuvenation in the Weight Loss Patient

                                 Facial Rejuvenation in the Weight Loss Patient


Massive weight loss (MWL) is defined as 50% or greater loss of the excess weight. While massive weight loss construes many positive benefits in one’s heath, lifestyle, and well being; there are also problematic excesses of skin that are left behind. One such area is the face and neck, which can appear deflated with an exaggerated gravitational aging effect. The face is also problematic in that it cannot be hidden in clothing making these changes more concerning for weight loss patients.


A youthful face is not only defined by its skin elasticity but also by anatomically correct distribution of facial fat. Facial fat has been extensively studies and is distributed in discrete compartments. As a patient ages, the facial fat diminishes and succumbs to the effect of gravity. Older faces will appear thin and gaunt. Replacing facial fat using a facial fat transfer can rejuvenate the face by recreating the fullness of youth.


In addition to the loss and displacement of facial fat, gravity ages the face by pulling the soft tissue down over the body skeleton in well-defined ways. In the upper third of the face the forehead skin becomes looser causing the brows to sit lower. The lateral brow position, which is ideally elevated in females, drops causing hooding of the upper eyelids. Other telltale signs include deepening of the nasolabial folds and marionette lines, jowling, and the loss of a sharp neck contour.


Goals of facial rejuvenation are thus twofold: excising redundant skin with tightening of the internal layer and adding volume using fat grafting. Redundant skin is generally far more excessive than in non-weight loss patients. In addition, addressing the deeper connective tissue layer called the Submuscular Aponeurotic System (SMAS layer) is paramount to an ideal and longer lasting result. With weight loss patient, the SMAS layer can be redundant. Removing part of the SMAS layer, SMASectomy, can be done as part of the tightening technique. In the neck, liposuction can be used to remove excess fat. Similar to SMAS tightening, the neck muscle, platysma, can be tightened in a technique known as corset platysmaplasty.


Fat grafting/fat transfer in the massive weight loss patient typically requires a larger volume than a typical facelift patient. Common areas for fat transfer are the temples, midface, and around the mouth (nasolabial folds and marionette lines). Replacing volume with facial fat transfer fills the face in ways that improves facial shape, lifts by filling, and smooths sharp lines of demarcation such as seen in the lower eyelid and cheek junction.


In the weight loss patient, aging is characterized by both laxity and redundancy of skin and soft tissue as well as the loss of facial volume. Techniques address to address these unique issues are as follows:

  • Adequate excess skin excision
  • Aggressive tightening and excision of internal connective tissue (SMAS)
  • Replacement of volume using fat transfer in the temple, midface, and perioral areas
  • Neck contouring utilizing liposuction to remove excess fat, skin removal, and platysmal muscle tightening.


Following these well proven guidelines in the weight loss patient can restore facial appearance so that the face matches the much thinner body.