title: Laser Resurfacing at the Time of Rhytidectomy.
abstract: BACKGROUND
  Laser resurfacing with simultaneous rhytidectomy has been used to augment aesthetic results and decrease overall patient recuperative time, yet presents a potential dual insult to the microvasculature supply of facial skin flaps. This study describes the authors' experience with rhytidectomy and simultaneous laser resurfacing.
  
  
  METHODS
  Between May of 1999 and January of 2013, 85 face lifts with concomitant erbium laser resurfacing were reviewed retrospectively. Seven procedures were excluded for incomplete charting. Patient demographics, treatment zone, concomitant procedures, and secondary/tertiary face lifts were analyzed for associations with postoperative complications attributable to laser resurfacing.
  
  
  RESULTS
  No complications were reported in the perioral resurfacing group. There was one instance of delayed wound healing and prolonged erythema in the full face group, and one instance of moderate hyperpigmentation in the central face group. No instances of hypopigmentation or flap necrosis attributable to laser resurfacing were noted. The overall complication rate was 3.8 percent. There was a statistically significant difference when comparing the number of complications between the facial laser resurfacing zones (p = 0.037). When analyzing zone of laser resurfacing as an independent risk factor for complications, no significant association was derived, but full face zone resurfacing approached statistical significance (p = 0.063).
  
  
  CONCLUSIONS
  Although a significant difference in the number of complications between treatment groups existed, the authors were not able to definitively attribute this solely to the extent of laser resurfacing. Simultaneous laser resurfacing and rhytidectomy can be performed safely in select patients using ablative mode only over the undermined flap.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
authors.forename: Jack F
authors.initials: JF
authors.lastname: Scheuer
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Costa
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Dauwe
authors.forename: Smita R
authors.initials: SR
authors.lastname: Ramanadham
authors.forename: Rod J
authors.initials: RJ
authors.lastname: Rohrich
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*
references.citation: Herbig K, Trussler AP, Khosla RK, Rohrich RJ. Combination Jessner’s solution and trichloroacetic acid chemical peel: Technique and outcomes. Plast Reconstr Surg. 2009;124:955–964
references.citation: Khatri KA, Ross V, Grevelink JM, Magro CM, Anderson RR. Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. Arch Dermatol. 1999;135:391–397
references.citation: Sandel HD IV, Perkins SW. CO2 laser resurfacing: Still a good treatment. Aesthet Surg J. 2008;28:456–462
references.citation: Farkas JP, Richardson JA, Burrus CF, Hoopman JE, Brown SA, Kenkel JM. In vivo histopathologic comparison of the acute injury following treatment with five fractional ablative laser devices. Aesthet Surg J. 2010;30:457–464
references.citation: Weiss RA, Harrington AC, Pfau RC, Weiss MA, Marwaha S. Periorbital skin resurfacing using high energy erbium:YAG laser: Results in 50 patients. Lasers Surg Med. 1999;24:81–86
references.citation: Ha RY, Nojima K, Adams WP Jr, Brown SA. Analysis of facial skin thickness: Defining the relative thickness index. Plast Reconstr Surg. 2005;115:1769–1773
references.citation: Rohrich RJ, Ghavami A, Lemmon JA, Brown SA. The individualized component face lift: Developing a systematic approach to facial rejuvenation. Plast Reconstr Surg. 2009;123:1050–1063
references.citation: Guyuron B, Michelow B, Schmelzer R, Thomas T, Ellison MA. Delayed healing of rhytidectomy flap resurfaced with CO2 laser. Plast Reconstr Surg. 1998;101:816–819
references.citation: Guyuron B. Discussion: Combined rhytidectomy and full-face laser resurfacing. Plast Reconstr Surg. 2000;106:1612–1613
references.citation: Park GC, Wiseman JB, Hayes DK. The evaluation of rhytidectomy flap healing after CO2 laser resurfacing in a pig model. Otolaryngol Head Neck Surg. 2001;125:590–592
references.citation: Fulton JE. Simultaneous face lifting and skin resurfacing. Plast Reconstr Surg. 1998;102:2480–2489
references.citation: Graf RM, Bernardes A, Auerswald A, Noronha L. Full-face laser resurfacing and rhytidectomy. Aesthetic Plast Surg. 1999;23:101–106
references.citation: Roberts TL III, Pozner JN, Ritter E. The RSVP facelift: A highly vascular flap permitting safe, simultaneous, comprehensive facial rejuvenation in one operative setting. Aesthetic Plast Surg. 2000;24:313–322
references.citation: Mayl N, Felder DS. CO(2) laser resurfacing over facial flaps. Aesthet Surg J. 1997;17:285–292
references.citation: Koch BB, Perkins SW. Simultaneous rhytidectomy and full-face carbon dioxide laser resurfacing: A case series and meta-analysis. Arch Facial Plast Surg. 2002;4:227–233
references.citation: Carniol PJ. The importance of blood supply in combination rhytidectomy and full-face carbon dioxide laser resurfacing. Arch Facial Plast Surg. 2002;4:234
references.citation: Brackup AB. Combined cervicofacial rhytidectomy and laser skin resurfacing. Ophthal Plast Reconstr Surg. 2002;18:24–39
references.citation: Struck SK. Establishing the safety and efficacy of simultaneous facelift combined with intraoperative full face and neck fractional CO2 resurfacing. Plast Reconstr Surg. 2009;124(Suppl):76
references.citation: Hollmig ST, Struck SK, Hantash BM. Establishing the safety and efficacy of simultaneous face lift and intraoperative full face and neck fractional carbon dioxide resurfacing. Plast Reconstr Surg. 2012;129:737e–739e
references.citation: Weinstein C, Pozner J, Scheflan M, Achauer BM. Combined erbium:YAG laser resurfacing and face lifting. Plast Reconstr Surg. 2001;107:593–594
references.citation: Schwartz RJ, Burns AJ, Rohrich RJ, Barton FE Jr, Byrd HS. Long-term assessment of CO2 facial laser resurfacing: Aesthetic results and complications. Plast Reconstr Surg. 1999;103:592–601
references.citation: Farkas JP, Hoopman JE, Kenkel JM. Five parameters you must understand to master control of your laser/light-based devices. Aesthet Surg J. 2013;33:1059–1064