Plastic Surgery Forum

Facial Rejuvenation for Bariatric Patients

by Bernard A Shuster, MD, FACS - July 2006

Weight loss can lead to premature signs of facial aging due to the laxity that develops in the face and neck. While losing weight is of the utmost importance, sagging skin may be a consequence, and it is often quite noticeable in the face. Much of the literature about plastic surgery for bariatric patients focuses on body contouring procedures, but facial procedures are also becoming increasingly popular among bariatric patients. These facial rejuvenation procedures are help reverse the premature sagging that has followed dramatic weight loss.

The facial areas that are often affected by weight loss are the neck, jaw line, and cheeks. Patients develop loose skin hanging under the chin, jowls obscuring the definition of the jaw line, and deepened lines from the nose to upper lip (nasolabial folds). There may also be excesses in the tissue of the upper and lower eyelids. The eyebrows may sag, leading to a tired appearance. While these types of loose skin are a normal part of the aging process, they often show up earlier in the bariatric patient.

Procedures for facial rejuvenation include a wide variety of techniques which provide plastic surgeons with the means of restoring a youthful appearance, including facelifts, eyelid surgery and brow lifts. Less invasive procedures, such as Botox, Restylane, and thread lifts can sometimes help without surgery. This wide repertoire of methods means that patients today should receive a very individualized approach to their unique areas of concern.

A facelift, or rhytidectomy, is a procedure to restore the appearance of the lower half of the face and neck. A well-performed facelift leads to a completely natural appearance with a smooth jaw line and a smooth, clean contour to the neck. Facelifts are now accomplished with very inconspicuous incisions and, in addition to removing the excess skin, allow for the deeper layers of the face and neck, such as the muscle layer, to be tightened. This multi-layer approach to the face is the key to results that are more natural and longer lasting.

Facelifts can range from the less invasive mini-lift to the more involved composite lift. Each person has varying degrees of skin laxity, so lift procedures reflect those degrees of laxity. Some people may consult with a plastic surgeon earlier or with only slight laxity of the jowls and neck. Such patients are appropriate candidates for mini-lift procedures. Others may present with considerably more sagging. These patients will require a more thorough procedure in order to obtain a satisfactory result. 

As plastic surgeons, we strive to match the appropriate procedure to the right patient. There is no single technique that works for every patient. It is important for patients to have realistic expectations and understand that mini procedures cannot always produce maximum results.

Bariatric surgery can have a different effect on men than it has on women. Males have a tendency to develop a rather dramatic sagging of the soft tissues under the chin extending down the neck. Some call it a ?turkey neck.? Further, men often wear their hair quite short, making it difficult to place face lift incisions inconspicuously.  For these reasons, some men will be good candidates for an isolated neck lift. This procedure is ideal for addressing the hanging tissue under the chin. It involves directly removing the excess tissue while strategically placing the incisions where they will be least visible.

Patients who are having a facelift will often have other upper facial procedures, such as eyelid surgery and brow lifts, performed at the same time. Descent of the eye brows is an early and often unrecognized sign of facial aging. It creates a heavy, tired appearance to the upper eyelids and is often mistaken for excess eyelid skin. Sagging brows respond very well to a brow lift. A brow lift elevates the tissues creating a more open and youthful appearance. While the results of this surgery are subtle, for the appropriate candidate the benefits are unmistakable. A patient can look straight into a mirror, raise their eyebrows with their hands to take the weight off of their upper eyelids, and determine if this is a procedure they are interested in.

Most brow lifts are performed endoscopically. The surgery utilizes a fine camera, just an eighth of an inch in diameter, and the same technology as used in laparoscopy. Employing this method, a brow lift can be performed via three small incisions behind the hairline. Traditionally, brow lifts were performed by removing skin across the top of the head. The endoscopic technique avoids the lengthy incision, making this a much less invasive procedure with fewer complications and a shorter recovery.



Paula is in her mid 50?s and is 5 years out from her bariatric procedure. She has reached her target weight and literally rides her bike over 100 miles on the weekends, rain or shine. Yet there were still areas Paula wished to change, including the loose skin on her body and the sagging appearance of her face. When she decided on plastic surgery, she certainly did not feel, or act, as old as she looked. She decided to have her facial procedures first. She said, ?I did not lose 120 lbs to look like an old woman. I wanted my face to look as good as I felt.?

Looking back at having these procedures, Paula recalls, ?Plastic surgery is the perfect follow-up to bariatric surgery. I worked so hard at losing weight, staying fit ? and yet when I looked in the mirror all I saw was hanging skin on my face and body. Once I had the facelift I felt reborn. I looked and felt so much better. Looking young was never my goal when I went for the consultation, but it sure is a very nice secondary benefit.?

Her advice to other bariatric patients who have similar concerns is to ?be sure to do your research. The surgeon?s training and experience will make all the differences in your results. Once you are confident in your choice of surgeon, then go for it! Reward yourself for a job well done.?

Paula?s experience is common amongst bariatric patients. She shows that bariatric patients who have reached their target weights are often candidates for excellent results from facial rejuvenation procedures such as facelifts, eyelid surgery, and brow lifts. While the results have a natural appearance they can be just as dramatic as the incredible changes resulting from body contouring procedures.

Bernard A. Shuster, MD, FACS is a Diplomate of the American Board of Plastic Surgery specializing in aesthetic procedures, including restorative plastic surgery following weight loss. Dr. Shuster has presented his work and also lectures in the areas of Facial Rejuvenation, Safety in Liposuction, Rhinoplasty, Advances in Aesthetic Plastic Surgery, Breast Surgery and Reconstruction of Pediatric Deformities at international, national, regional, local and academic meetings. Dr. Schuster is a third generation plastic surgeon and has had exposure to both the artistic and medical aspects of the field since an early age.