Self-esteem in post-bariatric patients submitted to rhytidoplasty with and without SMAS plicature

Introduction: Bariatric surgery has become an increasingly popular procedure for the treatment of morbid obesity and its associated comorbidities. Although the large weight loss provides a significant reduction in body fat, it also entails a redundancy of skin that can be physically and psychologically debilitating. Post-bariatric patients present a particularity in relation to other candidate patients for face surgery, which is the predominance of excess skin in the lower third of the face being its main aging stigma associated with loss of self-esteem. In the literature there are few studies related to cervicofacial deformities and ritidoplasty results in post-bariatric patients. Objective: To evaluate the self-esteem of post-bariatric patients submitted to ritidoplasty with and without plicature of SMAS, considering the operative time of each procedure.

Methods: This is a primary, clinical, prospective, analytical, interventional, randomized, controlled, and single-center study. From June 2018 to March 2019, rhytidoplasty surgeries were performed to treat facial flaccidity and rhytidosis in 28 post bariatric patients, divided into two groups. The experimental group was submitted to classical rhytidoplasty with SMAS plicature, and the control group was submitted to classical rhytidoplasty without plicature. A self-esteem questionnaire (Rosenberg self-esteem questionnaire) was applied pre-surgery and after 6 months.

Results: Through the Kolmogorov-Smirnov test and after after analyzing the data, it was observed that long-term self-esteem was better in the patients of the control group, who were submitted to rhytidoplasty without SMAS plicature.

Discussion/Conclusion: Post-bariatric patients present a damaged healing process, so they may present early recurrence associated with plicature of SMAS.  Thus, although the immediate result of the experimental group was more satisfactory, the loss of long-term results was more significant in this group when compared to the control group, leading to greater flaccidity, lower satisfaction and self-esteem after 6 months of surgery. Considerable part of the control group satisfaction may be associated to the shorter surgical time to which they were exposed, which reduced the risk of infections and any other undesirable outcomes linked to long-term surgeries. Previous studies had already evaluated self-esteem in patients submitted to rhytidoplasty, but none of them had considered the specific group of post bariatric patients. From this study, it was observed that there is no need to perform plicature of SMAS in post-bariatric patients submitted to ritidoplasty, since this procedure increases the operative time and, consequently, the associated morbidity and its outcomes, reflecting on self-esteem.

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