Concurrent structural fat grafting and carbon dioxide laser resurfacing for perioral and lower face rejuvenation

Abstract

Objective: To quantitatively evaluate a dual-modality treatment that combines autologous structural fat grafting and carbon dioxide (CO2) laser resurfacing for perioral and lower face rejuvenation. Method: Retrospective review of patients undergoing rejuvenation by a single surgeon between 2005 and 2009. A blinded expert rated photographs on three scales, each with a range of 1 (no abnormality) to 5 (severe abnormality): (i) perioral fine rhytids; (ii) deep folds; and (iii) pigmentary or cutaneous abnormalities. Within-subject comparisons were generated. Results were correlated with skin type (Fitzpatrick) and baseline photodamage (Glogau). A test for effect of adjunctive procedures was performed. Results: Seventeen patients were included (all female, mean age 61 years). Significant postoperative improvement was noted for perioral fine rhytids (3.1 to 1.7, p < 0.0001); deep folds (3.4 to 2.0, p < 0.00001); and pigmentation (2.5 to 1.9, p = 0.02). Fitzpatrick skin type was inversely correlated with improvement in pigmentation scores (r = −0.78), while the Glogau score correlated with improvement of fine rhytids (r = 0.76). No significant effect of adjunctive procedures was found. No complications occurred, though fat grafts resorbed in one patient. Conclusions: Concurrent structural fat grafting and CO2 resurfacing result in quantifiable improvement of perioral and lower face aesthetics in relation to baseline characteristics and independent of adjunctive surgical procedures.