After significant weight loss, there is loss of fat throughout the face.  In addition, facial fat stretches the supporting ligaments and these ligaments fail to recoil.  This loss of fat and ligamentous recoil failure results in significant sag throughout the face.  This is most evident in the forehead, temple region, eyebrows, eye sockets, cheeks, jaw line and neck. 

To rejuvenate the face, two key elements need to be corrected.  First, sagging structures need to be re-suspended.  Second, volume needs to be reestablished.  It is felt that facial fat and volume makes one’s face look younger – just look at a baby’s face.  In fact, many patients have volume fillers (like fat, Radiance, collagen and implants) placed into the face to reestablish a more youthful appearance.

FOREHEAD:  With weight loss, there is usually loss of fat in the temporal region.  In addition, there is wrinkling of the forehead and sagging of the upper eyebrows.  To surgically correct this area, the brow needs to be elevated and re-suspended.  This is either done through several small incisions made in the hairline or an open incision which heals very well in the hairline.  Thus the eyebrow is thus raised and forehead wrinkles are eliminated.  To reestablish loss of volume and tissue in the temporal area, Dr. Katzen uses grafting techniques to fill in this area with your own live skin and/or fat from other areas.

MIDFACE:  Usually with weight loss, there is loss of fat in the cheekbones and descent of the remaining excess skin.  This makes the line from your nose to the lateral corner of your mouth seem deeper and gives the face a significantly older appearance.  To rejuvenate the mid-face,  usually a cheek lift is required.  This is achieved through a small hidden facelift incision in front of the ear.  Some patients may require cheek implants due to the significant loss of fat in their face.  To further correct the deep groove between the nose and the lateral corner of the mouth, fat and/or skin may be required to be injected in this area.

LOWER FACE AND JOWLS:  With aging and loss of facial fat, there is drooping of skin and fat along the bottom portion of the jaw directly below the corner of the mouth.  This is called jowling.  The jowls can be lifted through the same incision as the mid-face.  Through these incisions, Dr. Katzen is able to get down to the bottom of the jaw and re-suspend the jowls and re-establish a more youthful jaw line.

NECK:  Sagging of the neck skin and the underlying muscles may be more evident with weight loss.  The muscles appear as vertical bands that are sometimes visible without even grimacing.  Through the previously mentioned face lift incision, Dr. Katzen is able to lift the neck and eliminate the excess skin in the central portion of the neck.  In addition, Dr. Katzen will reconstruct the neck by sewing the muscle together.  This results in a much cleaner well-defined neck line.  Typically, the mid-face, the lower face, and neck lift surgery lasts 5 hours.  It is usually performed under general anesthesia.  Typically, the patients are presentable 3-4 weeks after the surgery when most of the swelling has subsided.

A forehead, cheek implant, face lift, neck lift, and lip augmentation can dramatically improve your face.  The scars resulting are considered minimal considering the benefit obtained.  Different patients have different priorities and the facial reconstruction can be done anytime throughout your total body reconstruction.  For some patients, the face needs to be done first before the body lift, medial thighs, breast and/or arms.  Ask Dr. Katzen about any and all the things he can do for your face.