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printer-friendly version| Facial Rejuvenation after Bariatric Surgery by Jay Calvert, MD, FACS - January 2007 Do not forget your face! Your post bariatric face is an important part of your overall transformation, yet the face and neck are often neglected after massive weight loss, since the surgical focus is on the excess skin of the abdomen, arms and legs. Your face and neck are what everyone sees before and after bariatric surgery. Weight loss occurs in these areas as much as anywhere else on the body. The face is frequently left with excess skin, extra folds and wrinkles, and an overall drawn and hollowed out look. This is not the look of health, nor is it the look of youth. You have worked so hard to lose the weight and take a stand for your health, it seems a shame to forget the most visible part of your body that also shows your success. But because the dollars spent on post-bariatric plastic surgery are precious and mostly scarce, the face does not seem to get its fair share. I believe the face needs to be addressed in the overall plan for post-bariatric reconstruction, using techniques that offer the best results. The face and neck have many layers. Starting from the outside and working in toward the bones, there is the skin, the fat, the thick suspension layer of the face called the SMAS, the facial muscles, and the lining over the bones called the periosteum. These layers work in harmony to perform the functions of the face and neck, but each layer is affected in a different manner by massive weight loss. The skin thins and often becomes a bit dehydrated. The layer of fat beneath the skin is usually the layer most affected by massive weight loss with extreme thinning and loss of the extracellular matrix, the protein and collagen around the cells, that keeps the skin looking plump and youthful. This really hits the neck hard as the fat around the muscles of the neck decrease in volume and cause the skin to hang. This causes platysmal bands. The muscles of the face even become a bit lax since they too have lost volume due to the operation. This results in sad-looking eyes, a down turned mouth and droopy cheeks. Finally, the tight tissue over the bones, the periosteum, is more or less unaffected. The best approach to the problem of face and neck volume loss after bariatric surgery is multifactorial. The most crucial part of the process is repositioning of the facial structures to create the look of youth. The first thing to consider is whether or not a full face and neck lift are warranted. The way I choose the right operation for the patients in my practice is through a thorough physical examination. With the patient looking in a mirror, I use my hands to position the structures of the face where I know the operations will place them. I am able to simulate the operations for the patient and they can see if they like what it will look like after a facelift. I do this with the brow, the eyes, the cheek, the jowls, and the neck. Then, they can tell me how they like what they see. If they like what I do with their face and neck, we are off to the operating room! And what I do there reflects the specific needs of the patient who has lost massive quantities of weight. First off, I tell them that they may need the neck operated on twice. Usually, there is so much skin on the neck that it just cannot all be taken out in one operation. I show them why this is, and how elastic their skin is, and they accept that the operation is limited and that they may be back in one year. Second, I find the sub-periosteal techniques quite valuable in lifting not only the cheek, but also the jowl. Traditional facelifts are done by pulling back on the skin of the face, but I find that look to be unattractive and dated. The sub-periosteal face lift is one that creates a youthful look since the direction of lift is vertical (toward the upper face) instead of back toward the ears. No more windblown-looking facelifts! This is especially key in the post-bariatric population, because the skin can be quite elastic, accentuating that windblown look. Third, I try to make sure to lift the brow, operate on the upper and lower eyelids and perform the midfacelift, lower facelift, and neck lift all at the same time. This preserves facial harmony. I find that the face looks unbalanced when the upper face is lifted but the neck and jowls have not been touched. Facial harmony is the key to getting a great result, and rejuvenating all parts of the face at the same time is the way to make this happen. Whatever choice you make for facial rejuvenation, it is important to be certain that your surgeon is board certified and that they specialize in performing procedures for the post bariatric population. The medical and surgical problems associated with post-bariatric existence need to be understood in order to create beautiful outcomes.  For more information about post-bariatric facial rejuvenation, visit Dr. Calvert?s Website at www.JayCalvertMD.com or see his center?s Website at www.RoxburySurgeryOnline.com. Jay Calvert, MD, FACS, is a board certified plastic surgeon who has offices in Beverly Hills and Newport Beach, California. He is known as a surgical pioneer, patented inventor and surgical educator. He appears regularly on television as an expert and is well known for his pioneering work in post-bariatric face and body rejuvenation. |
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