title: Face lifting in the massive weight loss patient: modifications of our technique for this population.
abstract: BACKGROUND
  The authors evaluated their experience with facial rejuvenation in the massive weight loss patient.
  
  
  METHODS
  A retrospective chart review of the senior author's (R.J.R) face-lift patients was conducted. Data on patient age and body mass index, surgical techniques used (when available), and intraoperative and postoperative complications were collected.
  
  
  RESULTS
  Of the senior author's 25-year database of 1089 patients, 22 were identified (15 women and seven men). Nineteen patients had primary face lifts performed; three patients were secondary cases. Average age at face lift was 52.7 years (range, 41.0 to 67.0 years). Body mass index at the time of surgery was 26.0. There were no intraoperative complications. Postoperative complications included one hematoma that responded to drainage. Nineteen patients (86 percent) had volume loss in the midface and nasolabial groove regions. Thirteen patients (59 percent) had perioral volume loss, all had skin excess and redundancy in the jowl and submental region, and 18 (82 percent) had documented platysmal bands. The superficial musculoaponeurotic system (SMAS) was addressed in 20 patients (91 percent) with a SMASectomy. Fat augmentation was performed in all patients. On average, almost twice as much fat was used (22 ml versus 12 ml in non-massive weight loss patients).
  
  
  CONCLUSIONS
  In the massive weight loss population, there are common techniques that can enhance results. (1) Individualized components analysis can be used; (2) to treat laxity of skin and deflation of fat compartments, twice as much fat augmentation is needed; (3) SMASectomy is used for redundant skin; and (4) SMAS neck suspension sutures are used in thicker-skinned patients.
  
  
  METHODS
  Therapeutic, IV.
authors: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors: Kailash
authors: K
authors: Narasimhan
authors: Smita
authors: S
authors: Ramanadham
authors: Rod J
authors: RJ
authors: Rohrich
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015992:Body Mass Index; D044964:Cervicoplasty / Q000379:methods; D004038:Diet, Reducing; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000473:pathology / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D015595:Skin Aging; D013536:Suture Techniques; D014182:Transplantation, Autologous; D015431:Weight Loss
references: Rohrich RJ, Ghavami A, Lemmon JA, Brown SA. The individualized component face lift: Developing a systematic approach to facial rejuvenation. Plast Reconstr Surg. 2009;123:1050–1063
references: Choo S, Marti G, Nastai M, Mallalieu J, Shermak MA. Biomechanical properties of skin in massive weight loss patients. Obes Surg. 2010;20:1422–1428
references: Wulf HC, Sandby-Møller J, Kobayasi T, Gniadecki R. Skin aging and natural photoprotection. Micron. 2004;35:185–191
references: Sclafani AP. Restoration of the jaw and neckline after bariatric surgery. Facial Plast Surg. 2005;21:28–32
references: Yousif NJ, Gosain A, Sanger JR, Larson DL, Matloub HS. The nasolabial fold: A photogrammetric analysis. Plast Reconstr Surg. 1994;93:70––77
references: Narasimhan K, Stuzin JM, Rohrich RJ. Five step neck lift: Integrating anatomy with clinical practice to optimize results. Plast Reconstr Surg. 2013;132:339–350