Massive weight loss is considered a loss of a minimum of 100 pounds or 40% of your current body weight. In our practice, we usually consider anything over 50 pounds a post-bariatric reconstructive patient. Prolonged obesity creates many changes in the skin components of the body. Not only is the skin stretched way beyond its capacity – this prolonged obesity changes the collagen and protein relationships in the dermis.
Once the excess weight is eliminated – either through a specific type of bariatric surgery – or diet and exercise the skin will sag. Therefore, the post-bariatric patient may require significant skin reduction surgery. The areas may include arms, legs, abdomen, breasts, face, and neck. So, therefore, the answer to the question is most likely yes.
Not only will the skin sag but the muscle of the neck and cheeks will be stretched out and will manifest itself in the neck by vertical bands – commonly referred to as the turkey wattle. Age does not limit the formation of skin laxity after massive weight loss. Therefore, even in the younger age group a saggy neck may occur and may result in the need for a surgical facelift.
Facelift
The best way to achieve maximum tightening of the cheeks and neck is to have a full formal mid and lower facelift. If done properly the skin muscle and fat are addressed systematically during the operation and incised, excised, and tightened in its totality. Remember the neck sac is usually made up of skin muscle and fat. Sometimes there may also be fat under the muscle, which may need treatment.
Stimulation of collagen formation – which is essentially scar tissue – by nonsurgical methods in my opinion has not fully been investigated adequately to determine its impact on a surgical facelift. Theoretically, these nonsurgical techniques are supposed to stimulate collagen which therefore tightens laxity. Personally, I’m skeptical of this.
In my opinion, if you have significant laxity of the cheeks and neck, especially after massive weight loss, where we now know that damage to the existing skin has occurred, a surgical facelift is a treatment of choice. Then in my opinion and only then would be appropriate to discuss nonsurgical adjunctive therapy. Also, this may include laser resurfacing because this method seems to be the best for improving the texture of the skin. Remember daily cleansing and moisture station are essential.
THOMAS TREVISANI, MD
BOARD-CERTIFIED PLASTIC SURGEON
MEMBER OF THE AMERICAN SOCIETY OF AESTHETIC PLASTIC SURGERY
