Post Massive weight loss.
Facial Fillers OR facelift or both?
Hello I’m 45, female and have been thin for 6 years.
Previous to that, I have lost 490lbs (222 kgs) using diet and exercise only to get to
my goal, and have had all the required reconstruction of skin except my face.
My face is the only thing untouched.
I’m not happy with the way it looks.
I feel the filler is there but in the wrong place!
I have added a pic pulling back and relaxed.
If I were your patient, what would you do and why?
(p.s.
fillers I would prefer the reversible type!
Thank you for your question!
You’re 45 years old and you have a remarkable history in that you have lost an excess of
over 490 pounds and that you remain thin for several years.
You submitted several photos and you’re asking a question about improving your facial
appearance and whether to do volume or whether to do cosmetic surgery.
Now, your situation is becoming more and more common as people have significant weight loss
in this country.
Whether it’s from bariatric surgery, whether or not it’s from gastric banding or various
other procedures, there’s actually a separate specialty of doctors who perform surgery on
the body to restore people’s appearance after all that excess skin remains after all
that weight loss.
Now on the face, there can be various levels of excess skin.
So although it is normal to have a certain amount of facial volume loss and sagging and
descent associated with facial aging, in a case of someone who has significant obesity,
we also have to think of the physical impact on the whole body in terms of the relative
aging it has affected on the body.
It’s no secret that obesity does have aging effects on the body.
This is the basis for so many medical issues in this country whether it’s cardiac disease,
diabetes as well as several osteoarthritis or orthopedic issues.
So essentially, being overweight does accelerate aging.
And so in many ways, your physical aging may reflect that in the appearance may to a degree
reflect that.
But it gets down to the basic principles of dealing with the aging process.
And the thing is you have to decide what is dominating.
Is it volume loss which is bone, muscle, fat and soft tissue?
Or is it descent, sagging of the skin and the supporting structure of the skin?
If the face was very inflated then ligaments and all supporting structures got stretched
and as you lost your weight, depending on the method of how you lost weight, you can
lose a lot of integrity of those structural aspects.
What limits in terms of advice is a physical exam.
When a patient like you comes to my office, the first that I do is do a limited lift to
see if the skin has room to move and we then discuss that option and look at that result.
It is my preference that someone who has facial aging changes, who has significant descent
and sagging that the volume is corrected after restoration of the proper anatomy whether
it’s a facelift, a face and necklift.
Sometimes it’s a combination of facelift with cheek implants but the point is that
the struggle that you have or the part of your question was you have filler but you
don’t like the way it was place or where it was placed.
Well, when you think about it, you have this much skin, a lot more skin and you have this
much filler, it’s going to get lost.
And filler placement is really about strategy and it’s not about absolute volume.
There’s an upper volume of how much volume the skin and soft tissue can take before it
starts to look amorphous.
And all over the city in Long Island where we practice, we see a lot of people with that
pillowy look and commonly referred to as pillow face and the thing is we don’t want that.
We want you to look natural.
So I think that you should start meeting with cosmetic surgeon and discuss these options.
I think a surgeon would have more of an unbiased opinion in that they can offer both the surgery
and the non-surgical options.
You may also, if you don’t have that much of a sagging and descent then volumetric filling
such as the use of a filler like Sculptra can be very good.
A lot of people who have had weight loss will use a filler like Sculptra because this material,
when it’s injected actually stimulates collagen and it is actually very effective as a diffuse
filling in the face.
Sculptra was originally developed to help people with HIV lipodystrophy or people who
are HIV positive who are on medication that results in facial fat volume loss that looked
very hollow and sucked-in.
And so by using Sculptra, this material actually expanded and helped give this diffuse volume.
So that might be worth considering.
A material can last up to a year or longer.
But again, it’s a matter of answering the first question, is there is enough descent
and if so, is it worthwhile in treating with facelift, face and neck lift or etc?
So, there are a lot of different options between lifting and filling so that it really requires
more customized approach based on physical examination.
So I hope that was helpful, I wish you the best of luck and thank you for your question!