Narasimhan Kailash, Ramanadham Smita, Rohrich Rod J
Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2015 Feb;135(2):397-405. doi: 10.1097/PRS.0000000000000881.
The authors evaluated their experience with facial rejuvenation in the massive weight loss patient.
A retrospective chart review of the senior author's (R.J.R) face-lift patients was conducted. Data on patient age and body mass index, surgical techniques used (when available), and intraoperative and postoperative complications were collected.
Of the senior author's 25-year database of 1089 patients, 22 were identified (15 women and seven men). Nineteen patients had primary face lifts performed; three patients were secondary cases. Average age at face lift was 52.7 years (range, 41.0 to 67.0 years). Body mass index at the time of surgery was 26.0. There were no intraoperative complications. Postoperative complications included one hematoma that responded to drainage. Nineteen patients (86 percent) had volume loss in the midface and nasolabial groove regions. Thirteen patients (59 percent) had perioral volume loss, all had skin excess and redundancy in the jowl and submental region, and 18 (82 percent) had documented platysmal bands. The superficial musculoaponeurotic system (SMAS) was addressed in 20 patients (91 percent) with a SMASectomy. Fat augmentation was performed in all patients. On average, almost twice as much fat was used (22 ml versus 12 ml in non-massive weight loss patients).
In the massive weight loss population, there are common techniques that can enhance results. (1) Individualized components analysis can be used; (2) to treat laxity of skin and deflation of fat compartments, twice as much fat augmentation is needed; (3) SMASectomy is used for redundant skin; and (4) SMAS neck suspension sutures are used in thicker-skinned patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
作者评估了他们在大量减重患者中进行面部年轻化治疗的经验。
对资深作者（R.J.R）的面部提升手术患者进行回顾性病历审查。收集患者年龄、体重指数、所采用的手术技术（如有）以及术中及术后并发症的数据。
在资深作者25年的1089例患者数据库中，识别出22例（15名女性和7名男性）。19例患者接受了初次面部提升手术；3例为二次手术病例。面部提升的平均年龄为52.7岁（范围41.0至67.0岁）。手术时的体重指数为26.0。无术中并发症。术后并发症包括1例经引流处理的血肿。19例患者（86%）在中面部和鼻唇沟区域出现容量缺失。13例患者（59%）口周出现容量缺失，所有患者在颌下和颏下区域均有皮肤多余和松弛，18例（82%）有颈阔肌条索记录。20例患者（91%）进行了表浅肌肉腱膜系统（SMAS）切除术。所有患者均进行了脂肪填充。平均而言，使用的脂肪量几乎是非大量减重患者的两倍（22毫升对12毫升）。
在大量减重人群中，有一些可提高效果的常用技术。（1）可采用个体化成分分析；（2）为治疗皮肤松弛和脂肪间隙萎缩，需要两倍的脂肪填充量；（3）使用SMAS切除术处理多余皮肤；（4）对于皮肤较厚的患者，使用SMAS颈部悬吊缝线。
临床问题/证据级别：治疗性，IV级。
