Objective Assessment of Facial Rejuvenation After Massive Weight Loss.

BACKGROUND: While the literature is replete with articles about body contouring after bariatric surgery, little information exists regarding the outcomes of facelift following massive weight loss (MWL). A case report and a technique article are the only sources available addressing this issue. This pilot study objectively examines the effects of MWL in the cervicofacial region and results after facelift. METHODS: A retrospective review of seven patients who underwent facelift 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 postoperative photographs of seven MWL and eleven non-MWL female patients. The reviewers estimated the apparent age for each subject. Reduction in apparent age was calculated by comparing patient's apparent age against actual age. RESULTS: The preoperative apparent age of MWL patients was 5.1 years older than their actual age (p < 0.02) compared to the increased preoperative apparent age of 1.2 years in non-MWL subjects (p > 0.05); suggesting MWL patients appear older than their actual age. Post-operatively, the apparent age reduction in MWL patients was 6.0 years; and their apparent age after surgery was 0.9 year less than their actual age (p > 0.05). In contrast, the control group exhibited an apparent age reduction of 5.4 years and a postoperative apparent age 4.2 years younger than their actual age (p < 0.01). Apparent age reduction was not significantly different for the two groups (p > 0.05). Age, BMI, and follow-up were similar between groups (p > 0.05). CONCLUSIONS: MWL may accelerate apparent cervicofacial aging. Facelift following MWL enhances cervicofacial appearance and significantly reduces apparent age. We hope this study stimulates further interest in the study of facial esthetics in this increasing population. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The safety of rhytidectomy in the elderly.

BACKGROUND: The purpose of this study was to evaluate the safety of face-lift surgery in an elderly population. Specifically, is chronologic age an independent risk factor leading to a higher complication rate in the elderly patient undergoing rhytidectomy surgery? METHODS: The authors retrospectively reviewed consecutive face lifts (216 patients) performed by a single surgeon over a 3-year period. Patients were divided into two groups, younger than 65 years (148 patients) and 65 years and older (68 patients). Comorbidities, operative details, and complications were compared using statistical analysis. RESULTS: The average age was 70.0 years in the elderly group and 57.6 years in the younger group. When compared with the patients younger than 65 years, elderly patients were more likely to have a higher American Society of Anesthesiologists score and to have had a prior face lift (41.2 percent versus 17.6 percent, p < 0.001). The elderly had complication rates comparable to those of younger patients (2.9 percent versus 2.0 percent major, p = 0.65; and 5.9 percent versus 6.1 percent minor, p = 0.99). There were no deaths in either group. CONCLUSIONS: In the authors' series of carefully selected elderly patients, face-lift complication rates were not statistically different when compared with those of a younger control group. The authors' data suggest that chronologic age alone was not an independent risk factor for face-lift surgery. Further studies are needed to define whether a chronologic age limit for safe face-lift surgery beyond age 65 exists.