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Facelift surgery addresses sagging and loose tissues that have fallen due to aging. To a large degree facelifts are a tissue resuspension method which uses some tissue excision (skin and fat) to create the effect. However, a facelift in and of itself, does not change many of the more superficial lines and wrinkles on the overlying skin. Some wrinkle reduction occurs near the incisions in and around the ears due to the pull of the tissues but more central facial wrinkling remains unchanged.

Laser resurfacing is well known to be the best treatment for superficial lines and wrinkles that we currently have. It is an ideal complement to a facelift as it addresses an aging problem that tissue rearrangement will not improve. Historically it has been often done at the time of a facelift around the mouth area…not only because it addresses a facial area that a facelift does not but also because it is safe do as the skin area treated has not been undermined. (partially devascularized)

In the March 2015 issue of Plastic and Reconstructive Surgery, the article entitled ‘Laser Resurfacing at the time of Rhytidectomy’ was published. Over a fourteen year period the authors performed eight-five (85) facelifts with concurrent erbium laser resurfacing.  Some patients were treated just around the mouth while others had full face treatment. No wound healing complications occurred in the perioral resurfacing group. One patient had moderate hyperpigmentation. There was one case of delayed wound healing and prolonged swelling in the group that had their full face resurfaced. No instances of hypopigmentation or flap necrosis occurred. The overall complication rate was just under 4%. There was a statistically significant difference when comparing number of complications between the facial laser resurfacing area with the full face group potentially being significant. (p = 0.037). Though a significant difference in the number of complications between treatment groups existed, the authors were not able to attribute this exclusively solely to the extentof laser resurfacing.

This paper’s experience as well as that of others shows that, for the most part, simultaneous laser resurfacing and a facelift can be safely performed. The key is that the depth of the laser should not be very deep over the undermined lateral facial skin flaps. The more superficial its depth near the ear, there is little risk of skin flap devascularization.

The other issue to consider with laser resurfacing in the facelift patient is its impact on recovery. The laser injury to the skin causes greater swelling and a more difficult first few days after the procedure when done in a full face manner. When done only around the mouth this is less of a concern.

Dr. Barry Eppley

Indianapolis, Indiana

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