Total Face Rejuvenation: Simultaneous 3-Plane Surgical Approach Combined with Ablative Laser Resurfacing

Abstract

Introduction: Among the public, the gold standard in facial rejuvenation surgery is often thought of as face-lift surgery or rhytidectomy; however, a lifting and tightening procedure more optimally treats the jawline and neck by smoothing the jowls and addressing the submental waddle. In the middle third of the face, a lifting or tightening procedure may result in widening and flattening of the mid-face, producing an unnatural, pulled appearance. Volume restoration in the mid-face region often creates a more natural-appearing rejuvenation by reversing the deflation of the facial middle third that has occurred over time. While rhytidectomy and volume restoration create excellent results, the aging of the facial skin through extrinsic factors such as sun exposure or tobacco use remains untreated. Consequently, for a more complete facial rejuvenation, ablative laser resurfacing may be added to address fine facial lines and pigment irregularities to smooth the overlying skin texture. More complete facial rejuvenation may be achieved through combined rhytidectomy, mid-face volume restoration, and full-face ablative laser resurfacing performed concomitantly. Although there seem to be inherent risks of simultaneous laser resurfacing and rhytidectomy, previous studies have demonstrated the safety in these combined procedures. To achieve a more complete facial rejuvenation, a third plane of surgical dissection may be performed to restore mid-face volume through a subperiosteal approach; however, the inherent risks of laser resurfacing in patients undergoing a triplanar procedure, including subcutaneous, sub–superficial musculoaponeurotic system (SMAS), and subperiosteal dissection have not been previously established in the literature. The objective is to evaluate the safety of combined extended-SMAS rhytidectomy, mid-face implant placement, and full-face erbium:YAG resurfacing. Materials and Methods: A retrospective review of patients undergoing combined extended-SMAS rhytidectomy, mid-face augmentation, and full-face erbium:YAG laser resurfacing by a single surgeon was conducted. Demographic data, surgical complications, and associated factors were recorded. Results: Twenty-one patients were identified. All were female and aged from 58 to 71 years. There were no cases of flap necrosis or slough. There was 1 case of hematoma that resolved with conservative management. One patient with a history of Roux-en-Y gastric bypass had an implant infection. She was found to have malabsorption of her antibiotics, which immediately resolved once her antibiotics were crushed. Epithelization occurred within 10 days, and all patients were able to wear makeup after 10 days. It is important to note that none of these complications are felt to be the result of combining the procedures. Conclusions: Simultaneous extended-SMAS rhytidectomy, mid-face augmentation, and full-face erbium:YAG resurfacing is a safe and effective strategy in providing facial rejuvenation.