Facelift necessary after weight loss? (Photo)

Question

Male, nearly 48 yrs old, 6' tall, 175 lbs. I lost 65 lbs at a rate of 1.3 lbs/wk after many years of being overweight. My weight has been stable using tirzepatide for 3-4 months, and I do not anticipate being impacted by drug shortages, so I am interested in restoring my appearance. What would be required to compensate for the loss of volume and excess skin shown in the photos? Do I need a facelift, or would fillers be an option? For either of those, what types would be my best options?

John Michael Thomassen, MD · Answer

I would recommend a facelift after significant weight loss.  Fillers would not be effective in effacing your nasolabial folds, but a facelift would be very effective.  If possible fat grafting to the cheeks can help add lost volume at the same time.

Alan Gonzalez, MD, FACS · Answer

Hello @Hypersonic, thank you for your question. Based on the photos, and considering the results you want, I recommend a facelift for the second and third thirds of your face. This includes the first third of the neck. This would be part of your surgical plan for you to obtain better results. During this type of procedure, it is important to develop a surgical plan that considers the relationship between the areas to be treated and the other areas of the face to achieve a balanced, harmonious and long-lasting result. When considering a facelift a consultation is vital to establishing a surgical plan that meets your needs, meets your expectations, and takes into account what is realistically possible. Best wishes!

Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Alan Gonzalez MD, FACS. International Federation for Adipose Therapeutics and Science”  Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

Gurkan Kayabasoglu, MD · Answer

Hi dear, filler definitely cant be an option for you. Please even dont think. Run away from anyone who offers such an offer. All you need is a deep plan face and neck lift. Please contact us for more detailed information and consultation

Ryan Rebowe, MD · Answer

A facelift will typically be necessary following significant weight loss due to sagging skin. Often times, facial fat grafting will be added to help restore lost volume.

Ali Riza Öreroglu, MD · Answer

I generally prefer to conduct a physical examination first, but from what I can gather from your photos, the weight fluctuations have caused sagging in your face. Instead of using fillers , I would prefer to address this with a more permanent solution like a facelift. With a mid-facelift, it is possible to rejuvenate the nasolabial area for a more youthful appearance. I cannot see the neck area but I presume you may also need a Necklift to remove excess skin and achieve  a contoured jawline. You may also be recommended a facial fat grafting to compensate some areas where loss of volume is evident, howecver your photos do not completely show your face so this is an approximate guess. It is important to have a one-on-one discussion with the patient and conduct a detailed evaluation to determine a precise treatment plan.

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photographs. In terms of features that can restore volume in the face, SCULPTRA is a typical product that does not get significantly impacted by weight loss or low body fat in general. Fat transfer can also restore volume in the mid-face, and a facelift tends to redistribute the volume, creating the impression of softer mid-face contours.

If you want to understand the impact of a facelift intervention, lying down completely flat without a pillow generally gives a reasonable understanding of what facelift surgery can produce as an end result. For restoring volume close to the appearance of the mid-face before weight loss, fat transfer or SCULPTRA are probably the most effective options.

Ahmad N. Saad, MD, FACS · Answer

Fillers fill, facelifts lift sagging skin. One of the most common errors practitioners do is try to lift by filling. In your case, in order to improve the nasolabial folds, you might need very large volume of fillers and still it will not look good. Definitely recommend a facelift, and specifically a deep plane facelift.
Hope that was helpful

Salvador Medina, MD · Answer

Hello Hypersonic.

After massive weight loss, the skin looses it elasticity, looses its support because of the fat loss. This will afect all our body, In the face we have loose and excess skin and an important volume loss.
The ideal procedure is to reposition the muscle layer and skin to its original position and replace the volume loss with fat transfer to many areas in the face. This will rejuvenate your appearance and make you look great. Using only fillers usually doesn´t achieve good results because of the lax skin.
Let me know if you would like more information.

Dr. Medina

Jacob Tower, MD · Answer

Hello, hope you are well. Congratulations on your weight loss journey. I see this all the time in my practice. The short answer is that a deep plane facelift is the best approach to treat the skin/soft tissue envelope laxity--especially in the midface and the nasolabial folds. Further midface augmentation can be incorporated as well. Many will tell you to do fat grafting, but cheek implants are a superior alternative in my opinion. Fillers come in a distant third place for cheek augmentation.

Best,
Dr. Tower

Best,
Dr. Tower

John Reilly, MD, FACS · Answer

Hello, 
Fat transfers to the face can be very powerful in restoring volume and shape when it has been lost especially due to massive weight loss. I routinely perform facial grafting during facelifts as that is part of the aging process, i.e, facial fat thins and  descends. In an effort to restore a youthful appearance we must treat all of the factors that have given the appearance of age: excess/loose skin, loss of facial skeletal bone which causes a deepening of the area between the nose and upper lip and lower lip and chin. Tightening the skin by removing the excess and facial fat grafting to the areas of loss can make profound changes.

Based on your photos I believe a very reasonable approach would be to consider facial fat grafting as an isolated procedure. This can restore some fullness and curve to the cheek region and re-inflate some of the loose skin that is causing a crease along the side of nose and lips ("nasolabial fold"). This can be an in-office procedure for those who perform it often and can also provide a very nice change with minimal scarring, discomfort and recovery time. Good luck.

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