Facial contouring in the postbariatric surgery patient

Morbid obesity is a rising epidemic with 1.7 billion people considered overweight [1]. Approximately two-thirds of adults in the United States are overweight and half are obese [2]. In 1991, the National Institute of Health established guidelines for what has now become known as bariatric surgery for the morbidly obese patient (BMI > 40 or BMI > 35 with significant comorbidities). According to a recent meta-analysis, patients who undergo bariatric surgery lose 61.6% of their actual excess body weight and a majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experience complete resolution or improvement of these comorbidities [3]. Despite the drastic improvement in health, two-thirds of massive-weight loss patients are unhappy with their appearance secondary to copious sagging skin [4]. According to the American Society of Plastic Surgeons, 47% of these (roughly 150,000) patients underwent body contouring procedures in 2007 after significant postsurgery weight loss [5].