Combination Laser Resurfacing with Facial Plastic Surgery is Superior to Lasers Alone

Abstract

Introduction: This study was designed to demonstrate through validated objective wrinkle scales that the combining of facial plastic surgery with fractionated CO2 lasers in the perioperative setting is superior to CO2 laser only in the treatment of rhytidosis. Materials and Methods: Data were gathered and reviewed from 2 patient groups who were treated with either combined facial plastic surgery with fractionated CO2 lasers or laser-only therapy. Surgeries were performed by the senior author (J.E.B.) at a level 1 trauma center from July 2009 through May 2014. Preoperative and postoperative photographs were gathered for all patients and distributed in random order to a facial plastic surgeon and a dermatologist who objectively rated them. Both raters were blinded to patient data and treatment information. The study included 32 patients (30 females and 2 males). Nineteen patients received adjunctive fractionated CO2 laser resurfacing in the setting of facial plastic surgery; the second group consisting of 13 patients was treated with fractionated CO2 laser only. Surgeries performed included blepharoplasty, deep plane rhytidectomy, forehead rhytidectomy, submental liposuction, and rhinoplasty. Raters used validated scales to objectively assess the 2 patient groups. These included the Glogau, Fitzpatrick, and Modified Fitzpatrick scales. Numerical values were assigned to before and after pictures of patients in the frontal and profile views. Results: Patients treated with the combination of laser plus facial plastic surgery showed a greater decrease in wrinkles than patients treated with laser-only therapy (estimate = −0.78, P = .07) when evaluated with the Glogau scale. In addition, younger patients and patients with darker pigmentation showed a greater reduction in wrinkles compared with their counterparts (estimates negative, P values <.001). Discussion: A combined technique using facial plastic surgery in conjunction with fractional CO2 laser resurfacing is superior in treating rhytidosis in comparison to fractional CO2 laser-only treatment. This technique can be used safely in a wide range of patients and is convenient and cost-effective.