The face is the most visible determinant of an individual’s perceived age. A youthful midface is characterised by smooth midfacial skin without wrinkles or pigmentary changes, a smooth transition from the lower eyelid to the lower face, and when viewed from the side, well-projected cheekbones. The lower face is characterized by a sharp, well-defined lower jaw contour, with no loose or overhanging skin.
An aesthetic neck is characterized by taut, well-contoured skin, good muscle tone, and a well-defined angle between the chin and neck when viewed from the side. A youthful and aesthetic face and neck projects the image of confidence, vitality, and happiness.
The hallmarks of the post-weight loss face and neck include:
Individuals with these changes are often described as looking aged, angry or tired. They may have diminished self-confidence and social functioning.
Facial aging is a complex multi-factorial process including loosening of the skin, loss of facial fat volume, laxity of the facial muscle (SMAS) layer, and overall loss of the facial bone skeleton. The two predominant mechanisms of aging in individuals with significant weight loss are shrinkage of the superficial and deep fat compartments and laxity of the facial SMAS layer.
Previous obesity leads to increase in volume of the superficial and deep fat compartments, causing partial irreversible expansion of the skin and SMAS (muscle) layer. Weight loss results in loss of subcutaneous volume and a relative excess of skin and SMAS, and areas that are not supported by the facial ligaments will droop and form bulges.
Facial and neck drooping resulting from weight loss have moderate to severe laxity of skin and SMAS and are less likely to successfully respond to non-surgical techniques. Such cases require significant SMAS tightening, structural fat grafting and significant skin resection to achieve good outcomes. Non-surgical techniques such as lasers, fillers, and thread lifts do not address the anatomical causes of facial drooping and are likely to deliver suboptimal results.
We frequently see or hear of people who look unnatural following aesthetic treatments. This is often due to practitioners who attempt to reverse all the signs of aging by using revolumization techniques alone, resulting in an overfilled “pillow face”, and excessive administration of botulinum toxin may result in an expressionless, “frozen” face.
Filler injection does not reverse skin and muscle laxity or ligament lengthening. Choice of the incorrect filler type will also result in irregularities that become more prominent when an individual animates the face. The key to effective and natural-looking rejuvenation in men is tightening of the SMAS (muscle) layer, which is difficult to achieve with non-surgical treatments. Attaining bespoke and natural-looking results that retain an individual’s expressivity is frequently possible and requires accurate assessment, appropriate procedure choice, precise execution by an experienced practitioner.
The face and neck lift (rhytidectomy) is the most comprehensive method of rejuvenation of the midface, lower face and neck. It addresses the multiple causes of facial aging and produces effective, elegant and long-lasting results. The scars are well-concealed at the junction between the face and the ear, and between the posterior hairline and neck. Rhytidectomy corrects many of the aging changes that cannot be effectively achieved by non-surgical methods because of its ability to tighten the SMAS (muscle) layer and to excise loose and redundant skin. There is often more significant improvement and long-term expenditure reduction with rhytidectomy as compared with recurrent treatment with non-surgical therapies. It is performed as an ambulatory procedure under intravenous sedation and local anesthesia.
The following individuals may consider post weight loss rhytidectomy:
The face lift tightens and elevates the cheek, lower face and neck, reduces unsightly droopy bulges and effaces the facial grooves, i.e. the tear troughs, midcheek grooves, laugh lines, jowls and marionette lines. The cheeks are elevated and revolumized, recreating the gentle concave contours seen in youthful face. There is improvement to the contour of the lower face and neck. Excess loose skin is excised to create a crisp and smooth skin contour and the scars are inconspicuous when healed. The result is elegant, comprehensive and harmonious improvement of the individual’s facial and neck appearance and reduction of the perceived age. Successful outcomes help to improve body image, self-esteem and social functioning.
Individuals are advised to stop herbal supplements and traditional medicine, and start special medications 7 days prior to surgery to minimize bruising and swelling. Hypertension, if present, should be well-controlled, and smoking needs to be stopped for at least 2 to 4 weeks prior to surgery to minimize the occurrence of complications.
The face lift is performed through well-sited incisions in the hairline, between the ear and the face, and between the neck and posterior hairline. This gives maximal visibility of the SMAS (muscle) layer and permits application of proprietary SMAS tightening techniques that deliver enhanced results whilst minimizing recovery time. SMAS tightening eliminates the facial bulges and grooves and restores a smooth contour in the midface and lower face. In the lower face, SMAS tightening effaces the marionette lines and improves the lower jaw definition. SMAS tightening is the critical step in face lift surgery and delivers effective, long-lasting and natural-looking results. Face lift surgery is a fine art and strikes a balance between effective facial elevation and tightening whilst avoidance of an overly-tightened and unnatural appearance.
Structural fat grafting is often performed to reverse the age-related fat loss in the superficial and deep fat compartments. Finally, the excess skin is excised and wounds are meticulously closed for optimal postoperative outcome. In men with sideburns, special modifications are performed to prevent advancement of the sideburn hair onto the ear tragus.
Stitches are removed on the 5th postoperative day. Mild swelling and bruising is expected, and will mostly resolve by the 10th postoperative day. Most individuals are able to return to work following removal of stitches.
Neck swelling is improved by lying supine on a neck pillow only (without a head pillow) when sleeping at night for the first 2 to 3 days. Gentle face washing is possible from the second postoperative day onwards. Swelling is reduced by remaining upright during the daytime, and elevating the head of the bed when asleep at night. Strenuous activity should be avoided for the first two weeks to minimize bruising.
Post-weight loss facial rejuvenation is a niche and emerging field within plastic surgery. At Picasso Plastic Surgery, we are pleased to have embraced this subspecialty very early on in Singapore. Dr Yeo is privileged to have visited and learnt from some of the foremost overseas experts in this field in the past.
Dr Yeo is passionate about facial rejuvenation with rhytidectomy, and he delivers lectures in the Asia Pacific region on this topic. He applies proprietary SMAS modification techniques that are the key to delivering enhanced results, while keeping postoperative recovery time to a short duration. He is regularly invited to speak on post weight loss contouring at plastic surgery conferences in the Asia Pacific region.
Complementary procedures enhance the result of the facelift, and often may be performed at the same sitting if desired. These include: