Facelift (Rhytidectomy)

Even the face is affected after massive weight loss. Plastic surgeons used to think that the human face ages because of the prolonged effects of gravity and loss of skin elasticity. However, plastic surgeons now believe that the face ages because of loss of fat. Plastic surgeons believe that a more youthful face is round and fuller, similar to a baby’s face. Nowhere is this more true than in the faces of patients after massive weight loss. Just as in other areas of the body like the breasts and buttocks, with weight loss, the face losses fat. The resulting appearance may be sunken orbits, atrophy of the cheeks, deepening nasolabial folds, sagging jowls, and neck with significant excess skin. After massive weight loss, the result is a dramatically “older” looking face.

Correction of the aging face after massive weight loss usually requires correcting two issues. First, volume to the face must be restored. This can be achieved with fillers. Fillers range from absorbable to permanent material. Absorbable filler include fat, Restylane, Rejuvaderm, and Sculptra, among others. Typically, these fillers can be injected throughout the face, including the nasolabial folds, cheeks, and mouth. Permanent implants work well for augmentation of the cheek (malar implants), chin, and lips.

The second issue that must be addressed in the massive weight loss face is eliminating excess skin and tightening the face. This is achieved with a facelift. Dr. Katzen believes in restoring a natural look to the face, and not the wind-blown look of a face pulled too tightly from a facelift.

Consultation visit

When you meet with Dr. Katzen, please tell him exactly what bothers you. You and Dr. Katzen will analyze your face and determine which areas need to be augmented and which fillers would be most appropriate for you. Then you and Dr. Katzen will discuss where the incisions are placed and the anticipated look of your face. Typically, the facelift incision is hidden behind the ears and in the hairline. There is a small portion of the incision that is carefully placed in the anterior ear creases. Medical insurance does not cover the facelift procedure.

The Procedure

Typically, a facelift takes 3 to 4 hours depending what other procedures are being preformed such as chin augmentation, cheek augmentation, lip augmentation, etc.. Dr. Katzen always uses a board certified anesthesiologist for the facelift procedure. Before your surgery, you and Dr. Katzen will review your face and plan the incisions. Once you are asleep, the surgery begins. An incision is made around your ear and the facial skin is raised. The supportive layer of the face is identified; this is called the superficial muscular aponeurotic system (SMAS) layer. This layer is then tightened with sutures. The SMAS tightening pulls the deep facial system up and back. Dr. Katzen believes that tightening the SMAS is essential to achieving excellent results with facelifts in massive weight loss patients. The skin is redraped over the face, trimmed of any excess and closed in several layers in a tension free fashion. A big bulky dressing is placed and you are awakened from anesthesia. Typically, you will spend 1 to 2 hours in the recovery room. Usually, after the recovery room, you will be allowed to go home the same day. Dr. Katzen will see you several days later and the bandages will be changed. After surgery, your face will feel tight and swollen. Usually, the facial swelling subsides after several days. Most patients are able to return to work approximately 7 to 10 after a facelift.