Pump Up the Volume for a Youthful Face

A patient visited my office and described how she underwent a stomach reduction procedure for rapid weight loss after struggling unsuccessfully for years with dietary modification and exercise programs.  She was thrilled that she dropped several dress sizes, and her personal life greatly benefitted, but she was still bothered by something.  She stated that, “my waistline and figure looks great, but now my face looks 10 years older- it doesn’t match my body.  I think I looked younger when I was overweight.”  Her perception was accurate.  This was a comment I heard not only often, but with increasing frequency as more and more people undergo weight-reduction surgeries.

The face changes noticeably with significant weight loss (or gain), especially when it is rapid.  Fat cells in the face and neck lose volume such that the overlying skin takes on a “deflated” appearance, and begins to droop downward and toward the mouth.  This creates loose cheeks, deep cheek folds, more pronounced jowls, and sagging skin below the chin (affectionately referred to as a “turkey neck” by some of my patients).  Some patients even notice their eyebrows tend to sit lower.  Natural aging occurs similarly, but with volume loss occurring in the face to a lesser degree and over many years.  So post-weight loss patients often will have the paradox of having their face appear much older than when they were overweight.

This is why it is important to think of the face in three dimensions.  Returning a youthful appearance to the face may not be as simple as pulling loose skin tighter (i.e. facelift).  Sometimes a “spacelift” is needed- adding volume back into the deflated spaces of the face.  Cheek implants do a beautiful job of achieving this, but volume may also be added by fat injections or injectable fillers such as Restylane, Radiesse or collagen.  Often a combination of adding volume, tightening the skin (by facelift), and resurfacing (by chemical or laser) is necessary to achieve the optimal outcome.  By adding volume, we can restore a more full cheek mound and a cherubic appearance similar to a child’s face.  Patients are initially surprised when I recommend treatments such as cheek implants, but then very enlightened to think of the process in three dimensions.  “I never thought of my face that way,” the patient I was describing earlier had mentioned. “I have my younger appearance back now- my face is finally in balance with my body.”