title: The combination of rhytidoplasty and fractional CO2 laser therapy in the treatment of facial aging.
abstract: BACKGROUND
  Facial aging is a natural biological process with symptoms such as sagging tissue, accentuated lines, furrows, wrinkles, dyschromias, and loss of facial volume. Rhytidectomy alone often fails to achieve a patient's expected goals, which is why there is a high demand for adjunct laser skin treatment.
  
  
  METHODS
  From January 2007 to February 2013, a total of 80 patients with skin types Fitzpatrick I-IV underwent large undermined cutaneous flap rhytidectomy and superficial muscular aponeurotic system (SMAS) plicature plus hyaluronic acid injection on the nasolabial folds and lips and concomitant Lumenis UltraPulse CO2 Active FX total ablation mode resurfacing of nonundermined skin. The undermined skin was treated with a fractional laser using different energies depending on the type of skin. Patients were evaluated at 5, 10, 15, 30, 60, and 90 days after the operation. At the last evaluation patients completed a specific questionnaire about satisfaction.
  
  
  RESULTS
  Complications included expansive hematomas (5 %), partial necrosis (1.25 %), bacterial infection (1.25 %), herpetic infection (1.25 %), hypertrophic scar (1.25 %), and spot hyperchromia (1.25 %). 95 % of patients were extremely satisfied, 3.75 % were satisfied, and only 1.25 % were unsatisfied.
  
  
  CONCLUSIONS
  The combination of subcutaneous flap rhytidectomy and SMAS plicature with fractional laser resurfacing plus hyaluronic acid injection is a safe procedure with low incidence of major complications and improves patient satisfaction.
authors.affiliation: Institute of Medicine and Dermatology (ISMD), São Paulo, SP, Brazil.
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Moreira
authors.forename: Marcio
authors.initials: M
authors.lastname: Moreira
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Motta
authors.forename: Yasmin C
authors.initials: YC
authors.lastname: Moreira
authors.forename: Ana P
authors.initials: AP
authors.lastname: Bettoni
authors.forename: Heloisa H V O
authors.initials: HH
authors.lastname: Tokunaga
authors.forename: Djalma J
authors.initials: DJ
authors.lastname: Fagundes
mesh_terms: D003357:Cosmetic Techniques; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015361:Rhytidoplasty; D015595:Skin Aging
chemical_list: D006820:Hyaluronic Acid