Rhytidoplasty in the "pseudo-obese" patient: a group with specific characteristics and management

Among candidates for rhytidoplasty there is a group with special features. These patients are called "pseudo-obese" because they look obese since they have flaccid faces. They present deep nasolabial sulcus, a prominent nasogenian region, and large cervicofacial flaccidity, all of which contribute to a look of anxiety or depression. These problems are not resolved by a classic rhytidoplasty alone. The author has applied standard procedures to this group of patients, including: (1) extensive undermining up to the nasogenian sulcus and across the cervical midline; (2) facial liposuction associated with fat injection under the nasogenian and laterobucal sulcus; (3) submentonian and cervical lypectomy performed without visual aid by curettage below the undermined skin; (4) traction on the border of the platisma muscle. Associated procedures were also used, such as treatment of micrognatism, rhinoplasty, perioral chemical peeling, and thickening of the upper lip. Special emphasis is placed on a surgical maneuver of introducing both hands beneath the undermined skin and crossing the fingers over the cervical midline in order to eliminate residual adherences, to verify the symmetry of the undermining on both sides, and to provide rapid trans-surgical skin expansion. Among the 159 patients who underwent rhytidoplasty by the author in 1987 and 1988), 74 (47%) presented "pseudo-obese" features. The author concluded that this group would not present good results if the associated procedures were not applied. This article presents anatomic and technical details, statistical data, and final results of these procedures.