title: Objective Assessment of Facial Rejuvenation After Massive Weight Loss.
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.
  
  
  METHODS
  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.
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: Rafael A
authors: RA
authors: Couto
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: Joshua T
authors: JT
authors: Waltzman
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: Kashyap K
authors: KK
authors: Tadisina
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: Steven
authors: S
authors: Rueda
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: Bryson G
authors: BG
authors: Richards
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: William F
authors: WF
authors: Schleicher
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: Esteban
authors: E
authors: Marten
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: Jeffrey D
authors: JD
authors: Larson
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors: S Cristina
authors: SC
authors: Rotemberg
authors: Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. zinsj@ccf.org.
authors: James E
authors: JE
authors: Zins
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D012060:Rejuvenation; D012189:Retrospective Studies; D015361:Rhytidoplasty; D015431:Weight Loss
keywords: Apparent age; Facelift; Facial aging; Massive weight loss; Rhytidectomy