Introduction
The use of cosmetic treatments, such as neuromodulators and fillers, has been on the rise, with many people selecting to pursue minimally invasive facial rejuvenation procedures due to the perception of their facial appearance [ 1 , 2 ]. Compared to younger patients, older patients are more likely to seek soft-tissue fillers and treatments to tighten facial areas with laxity [ 3 ]. Self-described patient motivations for seeking cosmetic treatments include an expectation of improved psychological and personal well-being after treatment [ 4 ].
Despite clinical research into improved quality of life after full facial rejuvenation, few of these studies have been conducted on older patients with multiple medical comorbidities. We present a case report of an elderly patient with multiple medical comorbidities causing excessive weight loss, especially in the face.
Case presentation
A 71-year-old woman presented for facial rejuvenation after losing 40 lbs (33% body weight) over five months due to an array of medical issues and surgical complications. Her past medical history was significant for hyperthyroidism. During that time frame, she also suffered several compression thoracic spine fractures due to her multiple myeloma and osteoporosis. She underwent kyphoplasty to relieve pain but had a hematoma as a surgical complication, which resulted in her being unable to stand up straight, keep food down, or walk and eventually getting pneumonia. She was started on morphine for pain control and placed in a nursing home for five months. The morphine caused severe nausea as well. After five months, her medical comorbidities stabilized, and she was taken off morphine. She returned home with no further medical or surgical treatment plans and noted that her physicians had “lost hope” and advised her to avoid further medical treatments for her multiple myeloma given the recent complications from her surgical treatments.
On examination, the patient had a BMI of 17.4 with a cachectic and gaunt appearance (Figure 1 ).
She maintained that she was actively trying to regain weight but felt distressed by her current appearance. After a thorough discussion about treatment options, the patient opted for volumizing fillers and neuromodulators. We injected calcium hydroxyapatite (CaHA) diluted one-to-one with sodium chloride, for a total of 21 cc (seven syringes of CaHA) over three monthly visits, using a 22 gauge, two-inch cannula. Areas treated included the cheeks, jawline, and nasolabial folds (Figure 2 ).
To assess her quality of life after this full facial multi-modality treatment, the patient filled out baseline and post-treatment FACE-Q aging appraisal, appearance-related psychological distress, and psychological function surveys. Post-treatment surveys were administered three months after the last treatment. All FACE-Q surveys showed improvement post-treatment, with the aging appraisal improving over fivefold (baseline score of 15; three-months post-treatment score of 83), appearance-related psychological distress improving over threefold (baseline score of 31; three-months post-treatment score of 100), and psychological function improving over two and a half-fold (baseline score of 31; three-months post-treatment score of 82).
The patient also shared that both her primary doctor and her orthopedic surgeon were previously only offering palliative care until they saw her improved recent cosmetic appearance. They have now become more optimistic about her chances for recovery and are planning to do an MRI and possibly another kyphoplasty. Her thyroid disease is also under better control since starting medication, and her multiple myeloma is stable. She has gained 8-9 lbs in the last three months.
Discussion
We present a case of a 71-year-old woman who achieved remarkable two-and-a-half-fold to three-fold improvement in her FACE-Q scores after treatment with injectables, specifically CaHA, and neuromodulators. Facial rejuvenation procedures are increasing in popularity, with over $15 billion spent on cosmetic procedures in 2021 [ 5 ].
No studies have evaluated the quality of life in patients with multiple comorbidities that may cause dramatic weight loss or loss of facial volume. Therefore, there are no existing studies or case reports that we can compare with our current results. This population comprising people with active and serious medical illnesses requiring interventions, such as surgery, chemotherapy, or rehabilitation, has not been previously studied.
Our case report showed that facial rejuvenation treatments can dramatically improve quality of life, boost self-esteem, and motivate patients. What is notable about our case study is that, despite her chronic and serious ongoing medical issues, we opted to treat this patient with the goal of improving her quality of life. Compared to previously published studies on quality of life after full facial rejuvenation, our patient had much lower FACE-Q scores at baseline, which is perhaps reflective of the multiple comorbidities and the influence it had on her personal outlook [ 6 - 9 ].
Conclusions
Oftentimes, patients with active cancer or other serious illnesses are excluded from clinical trials or other studies due to their medical history and are, thus, underrepresented in our medical literature. We present a case report of a patient with dramatic weight loss due to medical comorbidities with incredibly low FACE-Q scores reflecting her self-esteem and poor outlook. After full facial rejuvenation with fillers, her FACE-Q scores improved dramatically. This case illustrates how cosmetic treatments can dramatically improve a patient’s quality of life despite dealing with multiple medical comorbidities and limitations.
Author Contributions
Concept and design: Kachiu Lee, Peter Rullan
Acquisition, analysis, or interpretation of data: Kachiu Lee, Peter Rullan
Drafting of the manuscript: Kachiu Lee, Peter Rullan
Critical review of the manuscript for important intellectual content: Kachiu Lee, Peter Rullan
Human Ethics
Consent was obtained or waived by all participants in this study
The authors have declared that no competing interests exist.
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