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Objective Assessment of Facial Rejuvenation in the Massive Weight Loss Population
Rafael A. Couto, MD, Kashyap Tadisina, BS, Josh Waltzman, MD, MBA, Steven Rueda, MD, Bryson Richards, MD, William F. Schleicher, MD, James E. Zins, MD.
Cleveland Clinic Foundation, Cleveland, OH, USA.

PURPOSE:While the literature is replete with articles about body contouring after bariatric surgery, there are no papers in the plastic surgery literature regarding the outcomes of rhytidectomy following massive weight loss (MWL). There is only a single case report in facial plastic literature addressing this issue. This pilot study objectively examines the effects of MWL in the cervicofacial region and outcomes after rhytidectomy.
METHODS:A retrospective review of seven patients who underwent rhytidectomy after MWL (>100 pounds) was performed. Patient’s change in appearance was objectively evaluated using an apparent-age model. Forty blinded reviewers assessed pre- and post-operative photographs of seven MWL and eleven non-MWL patients. The reviewers estimated an apparent-age for each subject. Reduction in apparent-age was calculated by comparing patient’s apparent-age against actual-age.
RESULTS:The pre-operative apparent-age of MWL patients was 5.0 years greater than their actual-age (p<0.02), compared to the increased pre-operative apparent-age of 1.2 years in non-MWL subjects (p<0.77); suggesting MWL patients appear older than their actual-age. Post-operatively, the apparent-age reduction in MWL patients was 6.0 years; however, their apparent-age after surgery was 1.0 year less than their actual-age (p<0.25). In contrast, the control group exhibited an apparent-age reduction of 5.4 years and a post-operative apparent-age 4.2 years younger than their actual-age (p<0.01). Age, BMI, and follow-up were similar between groups (p<0.12).
CONCLUSION:MWL may accelerate apparent cervicofacial aging. This is the first report to objectively examine the effects of rhytidectomy in the MWL population, hopefully stimulating further interest in the study of facial aesthetics in this increasing population.


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