Unique challenges of facelift surgery after massive weight loss

Posted: 02/03/2015

Obese people typically have large round faces and full heavy necks. After bariatric (weight loss) surgery for severe obesity, patients are often left with a large amount of redundant skin and soft tissue on all areas of the body including the face. While there are relatively straightforward procedures such as body contouring available to remove excess skin from the body, the face is a far trickier area to deal with. Facelift surgery for these patients poses unique challenges for surgeons who are constantly seeking the most effective techniques to deal with these. 

Weight loss can exacerbate the ageing process. The skin becomes loose and saggy as fat decreases, heavy lines appear, and the neck skin sags into a “turkey neck”. The appearance of heavy lines around the cheeks and beneath the eyes and jowls creates a “St. Bernard look.” Patients are particularly upset by their post-bariatric face and neck because they cannot camouflage this area with clothing so these dramatic changes in appearance can often have a negative psychological effect on the patient. 

Surgical techniques are aimed at addressing the increased skin laxity and facial “deflation”. Compared to the typical facelift patient, those with massive weight loss tend to need a larger volume of fat augmentation, increased tightening of the cheek and neck skin, and more extensive elevation of the underlying muscle and other facial tissues. Most patients undergo other procedures such as eyelid surgery, forehead lift or facial re-surfacing procedures at the same time. 

The most popular options to treat the effect of weight loss on the face and neck are a face and neck lift, which are typically done at the same time. Due to the large amount of excess skin, the great majority of face and neck lift surgeries will be performed using long incisions hidden at the hairline which are made in front of and around the ear and then down along the hairline behind the ear and into the neck if necessary. There is an extra incision under the chin to repair the neck muscles in the front of the neck. 

Modern techniques also address the underlying structures of the face. Surgeons first rearrange these underlying structures into a more youthful configuration before addressing the superficial layer of the face. Doing so puts less tension on the skin and helps the facelift to last longer. The restoration of a youthful configuration to your face's muscles, fat, and connective tissue is one of the benefits of contemporary facelift procedures. Gone are the days of an unnatural, pulled facial contour after facelift surgery. In addition, a facelift can be combined with facial liposuction to further address jowls, a fleshy neck and other areas. 

Elise Bevan, a solicitor in the cosmetic surgery team at Penningtons Manches LLP, advises: “Skin type and age influence facelift results, so anyone interested in facelift surgery should meet with a qualified cosmetic or plastic surgeon to discuss realistic expectations. Skin will continue to age after the procedure. Patients should also realise that some facelift scarring is unavoidable following the procedure, although the surgeon will strive to make it as inconspicuous as possible. 

“Facelifts are common procedures which are usually successful but, like any surgery, they are not without risks. While facelift surgery can turn back the clock, correct sagging skin, tighten facial muscles and improve your facial contour, it can also cause problems such as infection, bleeding, nerve damage and visible scarring. To make a truly informed decision about whether to undergo face lift surgery, patients must also weigh the benefits against the risks and potential side effects.”

Return to news headlines