Cervicofacial Rhytidectomy Research Articles

Techniques for Creating Inconspicuous Facelift Scars: An Update.

Importance: Patients seeking rhytidectomy desire an improved neckline, jawline, and midface, but rarely at the cost of visible incision lines that divulge a facelift. Objective: To describe an update to our facelift incision planning and specific surgical maneuvers to create inconspicuous scars. Design: Surgical pearls-description of novel surgical technique. Setting: A private practice. Participants: Patients who underwent cervicofacial rhytidectomy.

Parotid Surgery With Concurrent Bilateral Rhytidectomy

Facial reconstruction after parotid surgery can present an aesthetic challenge. This case series describes an asymmetric cervicofacial rhytidectomy technique at the time of parotid surgery to achieve defect closure as well as volume augmentation of the postablative deformity. While unilateral superficial musculoaponeurotic system (SMAS) flaps after parotid tumor extirpation have been described many times, this is the first reported case series of parotid tumor resection with concurrent bilateral cervicofacial rhytidectomy. This series consists of two adult females with unilateral facial swelling who also desired facial rejuvenation surgery. They separately presented to the University of Texas Southwestern Maxillofacial Surgery team and proceeded to have unilateral parotid tumor removal with concurrent bilateral cervicofacial rhytidectomy. To give context to this case series, the authors also searched the PubMed, Scopus, and Google Scholar databases to look for previously reported similar cases. The authors were able to address the patients’ functional as well as aesthetic concerns with a single surgery in a safe manner. Ipsilateral to the tumor resection, there was a sizeable loss in volume in both cases. Therefore, a vascularized SMAS flap was imbricated to provide volume, while a selective SMAS removal and plication was used on the contralateral side to achieve symmetric volume bilaterally. A comprehensive literature search demonstrated one previous report of concurrent bilateral cervicofacial rhytidectomy with parotid tumor extirpation. Despite the prevalence of utilizing a rhytidectomy incision for parotid surgery, there is a dearth of literature describing concurrent bilateral cervicofacial rhytidectomy with parotid tumor extirpation. Functionally, it has been shown to decrease the incidence of gustatory sweating on the side of reconstruction. Aesthetically, the surgeon is not only re-establishing the volume by augmenting the ablative defect, but also creating a symmetrical postoperative appearance by performing a reductive rhytidectomy on the contralateral side. Utilizing an asymmetric bilateral cervicofacial rhytidectomy at the time of parotid surgery can be an efficient technique for aesthetically reconstructing a patient with a parotid mass. It should be considered in patients with benign parotid disease who have the desire for facial rejuvenation surgery.

The Effects of Using Tranexamic Acid in Tumescent Solution During Rhytidectomy Surgery

Introduction: Tranexamic acid (TXA) is a common adjunct to assist in hemostasis in a wide variety of applications. Although TXA has gained more popularity in facial cosmetic surgery, there are limited studies evaluating the effects of TXA in rhytidectomy patients, especially when used in tumescent solution. Purpose: The purpose of this study was to evaluate the effects of TXA on surgical time, postoperative ecchymosis, and need for aspiration when used in tumescent solution during cervicofacial rhytidectomy procedures. Materials and Methods: The authors designed a retrospective cohort study from an eligible population of all patients treated with cervicofacial rhytidectomy using tumescent solution at Williamson Cosmetic Center in Baton Rouge, LA, from January 1, 2019, to December 31, 2019. The outcome variables were surgical time, need for postoperative aspiration, and the duration of bruising postoperatively. The primary predictor variable was the use of TXA in the tumescent solution. Statistical analysis was performed using t tests and chi-square analyses. Results: Overall, 70 patients were included in the study with a mean age of 61.4 ± 7.2 years and 90% were female. Forty-five patients were in the TXA group and 25 in the non-TXA group. The use of TXA in tumescent solution was statistically significant for reducing ecchymosis ( p < .001). The majority of patients in the TXA group (60%) had bruising cleared by day 7, whereas the majority of patients in the non-TXA group (52%) had bruising cleared by day 28. There was a statically significant reduction in frequency of postoperative aspiration in the TXA group (8.9% in TXA group vs 40.0% in the non-TXA group, P = .002). The study did not demonstrate a significant difference in surgical time between the two groups. Discussion: Although there is a lack of recognition of the potential benefits of TXA, there has been an increased off-label use by numerous surgical specialties. Routes of administration include topical, oral, intravenous, local infiltrative, and by tumescent anesthesia. Improvements in intraoperative hemostasis and postoperative ecchymosis are some of the main benefits of TXA. Conclusions: Utilizing TXA in tumescent solution in patients undergoing cervicofacial rhytidectomy procedures is associated with an improvement in postoperative ecchymosis duration and a decreased need for postoperative aspiration compared with the non-TXA group.

Pyoderma Gangrenosum After Facelift and Otoplasty Surgery: Case Presentations and Literature Review

Pyoderma gangrenosum (PG) is an uncommon autoimmune, neutrophilic, ulcerative skin condition of uncertain etiology believed to result from dysregulation of the immune system. Although this entity is well recognized by dermatologists, other specialists are less familiar with diagnosis and treatment. This report describes a severe PG reaction to an elective cosmetic facelift, which is believed to be the second reported case of PG after facelift surgery. A second case after otoplasty surgery is described. An unusual presentation of PG after cervicofacial rhytidectomy (facelift) is presented and discussed with a review of the literature. The present case was a rare complication after facelift surgery and followed the natural progression of PG. Delayed diagnosis and treatment extended the disease process. PG can mimic other surgical complications and delay diagnosis and treatment. This case is believed to represent the second reported incidence of PG after elective facelift surgery.

Redefining the Neck: A Retrospective Review Utilizing Hyoid Suspension

Neck contouring is one of the most frequent reasons patients seek cervicofacial rhytidectomy. But what makes for aesthetically pleasing youthful neck? Ellenbogen and Karlin described 5 criteria in their 1980 landmark publication, including having a cervicomental angle between 105° and 120° and a visible subhyoid depression. Recent advances in neck anatomy have revealed the existence of ligamentous like structures attaching the skin and platysma to the hyoid. These have been termed the hyoplatysmal ligament (HPL) and cervicomental suspensory angle ligament by different authors. This study was undertaken to determine whether surgically reestablishing the above structures utilizing a hyoid suspension technique resulted in statistically significant changes in cervicomental contour. A retrospective chart review was performed from January 2014 to present. After December 2016, the second author began utilizing a hyoid suspension technique where the inter- and subplatysmal fat was resected and the HPL was reestablished surgically (hyoid suspension). Cases before this date served as controls if a similar neck manipulation was performed without reestablishing the HPL. In total, 104 charts were queried, of which, 21 charts fit inclusion criteria to serve as controls and 20 as the experimental group. Before and after profile pictures were then compared for differences in cervicomental angle utilizing commercially available imaging software (Canfield Mirror, Parsippany, New Jersey). An unpaired Student t test was then performed to determine whether this 2 groups differed significantly utilizing a P value of .05 to denote statistical significance. The mean difference between pre- and postoperative cervicomental angle for the control group was 17.38° with a standard deviation of 8.05°. The mean difference between pre and postoperative cervicomental angle for the experimental group was 28.75° with a standard deviation of 15.52°. The resulting 11.37° difference in cervicomental angle between the 2 groups was found to be statistically significant with a P value of .0051. Our cosmetic surgical and anatomical knowledge continues to progress. Brant first described a ligamentous structure that attaches the platysma to the hyoid. Through biomechanical testing, he noted this ligament to be one of the weakest in the face and neck. Thereafter, in 2016 Yousif et al and Le Lourn separately described similar procedures to attach the platysma to the hyoid, in effect reestablishing this ligament. Utilizing one simple surgical maneuver, the hyoid suspension reestablishes the HPL. This surgically creates an acute cervicomental angle, resulting in less platysmal displacement postoperatively, with virtually no addition to surgical time or morbidity.

Neck rejuvenation by direct anterior medial cervicoplasty: the modified zigzag-plasty according to Tschopp.

Conventional cervicofacial rhytidectomy has become the standard treatment of skin excess of the ageing neck. However, some patients want to avoid an extensive surgical procedure, especially if the anterior neck is the predominant problem zone. To report on the efficacy and safety of a zigzag-shaped skin excision combined with platysma plication. We present a retrospective case review series of six female patients. Skin excess was marked preoperatively using the skin pinching technique, then transferred to a zigzag-shaped area and finally excised using the method according to Tschopp, which is described. Patients were followed up for at least 1year. All patients (age: 55-82years, median: 65years) were very satisfied with the results. On an overall patient satisfaction scale of 1-10 (1 being the best), the scars were graded on average 1.85 (median: 2) 1year after surgery. No scar hypertrophy, functional impairment, nerve damage or other serious complications were observed. In selected patients, the direct anterior zigzag-shaped excision poses an effective, safe and easy surgical option for both skin excess and fat excess and platysma banding. The technique is easily reproducible, with low morbidity and high patient satisfaction.

Neck Contouring Without Rhytidectomy in the Presence of Excess Skin.

Patients with severe neck skin laxity due to excess submental adipose tissue have required either standard rhytidectomy or direct excision of neck skin with Z-plasty and submental lipectomy. Our recent experiences with four patients who declined cervicofacial rhytidectomy demonstrate that submental lipectomy and platysmarrhaphy appear to obtain sufficient improvement. The submental area, submandibular area, and lateral neck are injected with local anesthetic. An incision is made in the submental area anterior to the existing crease, and the incision is taken through the subcutaneous tissue to the underlying fat. The skin is undermined in the deep subcutaneous plane. The lateral fat that cannot be visualized directly is suctioned using a number 2 cannula. Supra-platysmal and subplatysmal excess fat are excised under direct vision. The anterior bellies of the digastric muscle are excised partially or completely to obtain a flat contour if necessary. The submaxillary gland is partially or totally removed as indicated. The platysmarrhaphy is performed, and a TLS drain is placed in position and brought out through the left post-auricular sulcus using the attached trocar. The submental incision is then closed without skin excision. Non-excisional surgical neck rejuvenation was performed on four patients with significant skin laxity. There was adequate improvement in the cervicomental angle and neck profile contour in all patients, indicating that significant improvement may be achieved without skin excision. Patients with excess skin can achieve acceptable results with submental lipectomy and platysmarrhaphy without rhytidectomy or direct excision of neck skin. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anatomical Differences in Ethnic Facial Aging – Clinical Implications

INTRODUCTION: Projections to the year 2050 estimate a non-Caucasian ethnic majority in the United States. As per American Society of Plastic Surgeons Statistic Reports from 2005 to 2014, there has been an 111% increase in cosmetic procedures performed on non-Caucasians.1 Since the face is the most immediately discernible sign of aging, we attempt to summarize current available literature pertaining to ethnic facial aging and its impact on current anti-aging therapies. METHODS: A literature search was performed in the PubMed/Medline database for studies linking facial aging and ethnicity using MeSH headings including ‘ethnic’, ‘aging’, ‘face’, ‘African’, ‘African American’, ‘Caucasian’, ‘Asian’, ‘Indian’, ‘Hispanic’, and ‘Middle Eastern’. A total of 23 electronic publications were selected with subsequent manual bibliographic searches. Data on anatomical differences and variations were noted and recorded. Treatment recommendations, in an algorithmic form, were compiled. RESULTS: The majority of available literature compares ethnic groups to a Caucasian standard. Asian skin has thinner stratum corneum and higher levels of melanin that confer a greater risk of post-inflammatory hyperpigmentation. Overall, the combination of thick skin, heavier malar fat pads, and weaker skeletal support of the Asian face makes laxity more severe with aging and greater gains can be achieved with more comprehensive surgical techniques such as cervico-facial rhytidectomy. Less data is available for the Hispanic group, however prominent midface structure and yellow skin coloration create the need for focused techniques targeting prominent nasolabial folds yet minimally invasive to avoid hyperpigmentation and prominent scarring. Africans and African Americans have possibly the highest intervariability of facial dimensions but a thicker skin envelope and superficial melanin granules confer photoprotection but also a higher propensity to form keloids and pigment changes. A hypoplastic midface results in localized periorbital and midface aging in contrast to greater periocular changes and cervicomental blunting. Age-related prevention and treatment is therefore preferentially targeted to those areas using a careful selection of minimally invasive procedures and careful use of chemical and nonalabative laser resurfacing. CONCLUSION: Although limited, current literature strongly suggests discernible and predictable differences in facial aging across ethnic groups. Given the increasing availability and acceptance of aesthetic plastic surgery by various ethnic groups, understanding ethnic anatomical variability and its effect with aging will allow the surgeon to better understand and tailor a safe and effective care plan for each individual patient.

Clinical studies of the relationship between the complication of cervicofacial rhytidectomy postoperative nausea and vomiting and different rhytidectomy sites.

It was demonstrated that there are many complications following cervicofacial rhytidectomy, such as hematoma, edema, seromas, ecchymosis, nerve injury, hypertrophic scarring, contour irregularities, infection, nausea, vomiting, and so on. Accordingly, there is a lot of reports about the treatment of complications following rhytidectomy; nonetheless, we find that there is a trifle of research about the complication of postoperative nausea and vomiting. Thus, this study analyzes the cause of postoperative nausea and vomiting and the relationship between it and different sites. From 2004 to 2008, 108 patients with a mean age of 52 years (range, 30-74 years) underwent cervicofacial rhytidectomy.The approach of operation is local subcutaneous undermining and superficial musculoaponeurotic system double-plication or suture. All data were recorded such as the time when postoperative nausea and vomiting occurred, the duration of the symptom, the frequency of nausea and vomiting, and the antiemetic medicine taken. All cases were grouped according to the different sites of operation. We divided the patients into group A1 and group A2 based on whether forehead rhytidectomy was performed. Meanwhile, we divided the patients into group B1 and group B2 based on whether cervical rhytidectomy was performed. The data of each group were recorded and statistically analyzed. Among 108 patients, postoperative nausea and vomiting occurred in 55 patients. The duration of symptom was about 24 hours. The frequency of vomiting was 1 to 5 times. Besides, nausea and vomiting was characteristic of time limit and the tendency of termination. The ratios of vomiting between groups A1 and A2 were significantly different (P < 0.000 l). The ratios between groups B1 and B2 are of no significant difference (P > 0.05). The occurrence of postoperative nausea and vomiting is significantly related with forehead rhytidectomy; nonetheless, postoperative nausea and vomiting almost do not occur in the mid-inferior face and cervical rhytidectomy.

Erratum to: Reducing the Incidence of Hematomas in Cervicofacial Rhytidectomy: New External Quilting Sutures and Other Ancillary Procedures

Erratum to: Reducing the Incidence of Hematomas in Cervicofacial Rhytidectomy: New External Quilting Sutures and Other Ancillary Procedures

Cervicofacial Rhytidectomy without Notorious Scars: Experience of 29 Years

Presentation and evaluation of results of the surgical technique of cervicofacial rhytidectomy used by the senior author (F.P.), using the classification of facial aging to determine the stage of pre- and postsurgical age. The surgical technique was used in 1,181 patients operated on in the past 29 years, starting in 1983. We analyzed retrospectively 318 patients operated on between the years 2001 and 2008, of whom 71 patients met the selection criteria. Postoperative follow-up period was from 6 months to 5 years. All patients in stage I showed clinically visible rejuvenation postoperatively. Significant improvement in facial rejuvenation in stages II and III of aging was shown, with a postoperative change of stage. The technique of cervicofacial rhytidectomy with short flap, facial superficial musculoaponeurotic system (SMAS) imbrication, cervical SMAS plication, inconspicuous incisions, and postauricular z-plasty allows for successful and sustainable results over time, with short recovery time and minimal complications. The classification of facial aging pre- and postsurgery has been useful for the assessment of surgical results.

Submental Area Rejuvenation by Digastric Corset: Anatomical Study and Clinical Application in 20 Cases

Knowing the difficulties and limitations of surgery for rejuvenating the submental area during a cervicofacial rhytidectomy, we came up with the concept of the digastric corset, which is described in this article along with the surgical importance of the platysma, digastric and mylohyoid muscles based on anatomical dissections. A study of ten cadavers was conducted to describe precisely the limits of the submental area, the mandibular edge between the two Furnas ligaments, and the hyoid bone. Each anatomical item was dissected plane by plane: the skin, platysma, digastrics muscles, and mylohyoid muscle. The sliding of each muscle relative to the others was studied, photographed, and recorded. Feldman's corset technique was tested on two cadavers and a digastric corset was performed on eight cadavers. After suprahyoid fat lipectomy, we suture the digastric retaining ligaments to the mylohyoid muscles using a running suture, like a corset, then the platysma muscles are put aside on the median line followed by lateral platysma suspension. The different steps are presented and the results of 20 patients who underwent this procedure are presented after 1year of follow-up. This study showed that the technique of a digastric corset anchored on the mylohyoid allows for one-step reconstruction of the floor of the mouth and a well-defined anterior cervical angle, a sign of a youthful-looking neck. This technique is indicated for difficult necks, when lateral repositioning of the platysma alone gives insufficient results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reducing the Incidence of Hematomas in Cervicofacial Rhytidectomy: New External Quilting Sutures and Other Ancillary Procedures

Despite the use of many different strategies and techniques and notwithstanding recent advances such as fibrin glue and short scar operations, hematoma remains the most common complication in rhytidectomies. This study analyzed 383 patients who underwent cervicofacial rhytidectomies between September 2006 and March 2012. The patients were distributed into three groups. Group 1 comprised patients who had classic face-lifts with epinephrine in the anesthetic solution used to infiltrate the face and neck. The incidence of hematomas in this group was 12 % (24 of 200 patients). Group 2 comprised patients who underwent face-lifts without epinephrine in the solution used to infiltrate the midface and neck. The incidence of hematomas in this group was reduced to 3.6 % (3 of 83 patients). Group 3 comprised the remaining 100 patients, who underwent rhytidectomies with internal and external quilting sutures used in conjunction with other ancillary procedures listed in this report. The incidence of hematomas in this group was reduced to 0 %. The most important single procedure that reduced hematoma cases to zero in cervicofacial rhytidectomies was the use of quilting sutures in conjunction with other procedures. Furthermore, the use of these sutures did not cause flap ischemia or necrosis, and there was no adverse impact on the quality of the facial rejuvenation.

Isolated Neck-Lifting Procedure: Isolated Stork Lift

Many patients desire cosmetic improvement of neck laxity when consulting with a plastic surgeon about their face. Neck laxity and loss of the cervicomental angle can be due to multiple components of aging such as skin quality/elasticity, loss of platysma muscle tone, and submental fat accumulation. Traditionally, the procedure of choice for patients with an aging lower face and neck is a cervicofacial rhytidectomy. However, occasionally, a patient wishes to have no other facial surgery than an improvement of their excessive skin of the anterior, lateral, and/or posterior neck. In other instances, a patient may present with having had a face/neck-lifting procedure that left objectionable vertical/diagonal lines at the lateral neck. In both these instances, a surgeon should consider an isolated stork lift (ISL) procedure. An ISL procedure avoids and/or corrects problematic vertical/diagonal lateral neck folds by "walking" the excess skin flaps around the posterior inferior occipital hairline bilaterally, bringing the flaps together at the lateral and posterior neck, which sometimes involves a midline posterior dart excision of the dog ear. A patient presenting with excessive skin of the neck (anterior, lateral, and/or posterior) and/or residual vertical/diagonal skin folds is an excellent candidate for the ISL. The ISL procedure was performed on 273 patients over a 2-year period at The Morrow Institute. Patients were included if they had excessive skin of the anterior, lateral, and/or posterior neck and/or diagonal/vertical lateral bands and did not desire a full face-lifting procedure. Patients were excluded from this study if they would not accept having longer hair in order to cover the scar along the posterior inferior occipital hairline or a midline T-flap skin closure scar at the base of the posterior midline neck. Under a combination of local anesthesia and IV sedation, a postauricular face-lift incision was made that was extended in a circumoccipital fashion along the mastoid and posterior hairline to the midline nape of the neck. Long skin flaps were developed by dissecting the anterior neck from the mentum to the anterior clavicles, the lateral neck from the mastoid to the lateral clavicles, and the posterior neck from the hairline to the base of the nape of the neck, all with a combination of sharp and blunt dissection. Suspension sutures of the SMAS were placed at various strategic locations along the lateral neck in a superior posterior vector. The dog ears were walked posteriorly around the hairline, with final trimming at the midline nape using an A-to-T flap closure. The skin closure was affected by a combination of deep and superficial sutures as well as staples. No drains were used on any of the cases. Of the 273 patients (59 males and 214 females) who had the ISL, 240 rated their satisfaction with the results as very high, 21 rated it as high, and 12 rated it as some what satisfied. The average age of the patients was 58.7 years (range=45-79 years). There were two patients who needed a minimal amount of submental liposuction after the procedure. No patients had vertical/diagonal skin folds after this procedure. Five patients reported being slightly bothered by the appearance of the midline posterior scar for the first 6 months. Three of these cases involved hypertrophic scarring and were treated with intralesional triamcinolone suspension 40 mg per cc dilution; doses ranged from 20 to 40 mg per session and no more than two sessions were required. All five cases rated their scar appearance after 6 months to be acceptable. All of the remaining 268 patients reported that the final posterior scar was virtually undetectable. Ten patients needed scar revision for secondary widening of the scar at various locations of the lateral, posterior, and or nape of the neck. There were no other significant complications. Most patients were satisfied with their cosmetic result 2 years after their operation. An ISL procedure provides excellent lifting of the anterior, lateral, and posterior neck without the resulting postoperative sequelae of vertical/diagonal lines, and it is especially indicated for the patient who has markedly excessive skin in those areas and does not want to undergo a lower face-lift procedure at the same time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Management of Post-Rhytidectomy Sialocele

Introduction: Inadvertent damage to the parotid gland parenchyma or ductal drainage system is a rare yet devastating complication of cervicofacial rhytidectomy. Here we describe the management of such a case. Materials and Methods: A 66-year-old woman underwent uneventful rhytidectomy and presented postoperatively with a facial sialocele. Pressure dressings, antibiotics, and serial aspirations were the initial measures used. As the leakage was recalcitrant, botulinum toxin A was injected locally and both transdermal and oral anticholinergics were prescribed. Results: After a steady decrease in the volume of fluid that accumulated, the sialocele resolved on postoperative day 44. After rhytidectomy, damage to the parotid gland can lead to leakage of saliva in the form of a sialocele or a salivary fistula. Discussion: Management options include pressure dressings, drain placement, serial aspirations, anticholinergics, chemical denervation, or parotidectomy. As the drainage may persist for a considerable duration, good communication between the patient and the physician is paramount.

A Retrospective Review of the Use of Autologous Platelet Gels for Rhytidectomy

A Retrospective Review of the Use of Autologous Platelet Gels for Rhytidectomy

Cosmetic Facial Surgery

Dermatologic Surgery: September 2011 - Volume 37 - Issue 9 - p 1320 doi: 10.1111/j.1524-4725.2011.02104.x

Lip Augmentation Using Sternocleidomastoid Muscle and Fascia Grafts

To report a new technique for long-term cosmetic lip augmentation and demonstrate that sternocleidomastoid (SCM) muscle and fascia grafts have long-term persistence. Measurements of vermilion show and lip projection were taken from before and after photographs of 25 consecutive patients who underwent SCM muscle and fascia augmentation of the lips with concurrent cervicofacial rhytidectomy and were compared with a control group of 25 cervicofacial rhytidectomy patients who did not undergo lip augmentation. All patients had a minimum follow-up period of 1 year. At a mean follow-up period of 2 years, mean upper and lower lip vermilion show increased 20% to 24% from baseline (P < .001), and mean upper and lower lip projection increased by 0.90 to 0.99 mm from baseline (P < .001). Lip augmentation with SCM muscle and fascia grafts results in long-term enhancement of vermilion show and lip projection. The surgeon must account for some degree of postoperative graft resorption and atrophy when determining the size of the grafts to be transplanted. With careful patient selection and surgical technique, SCM muscle and fascia implantation is a valuable tool when treating the aging lip.

Pulsed-Dye Laser for Treating Ecchymoses After Facial Cosmetic Procedures

To assess the safety and efficacy of a 595-nm pulsed-dye laser in the treatment of ecchymoses after facial cosmetic procedures. Twenty consecutive patients with ecchymoses after facial cosmetic procedures underwent treatment with the pulsed-dye laser. A 10-mm spot size was used, with pulse duration of 6 milliseconds, fluence of 6 J/cm(2), and cryogen spray for 30 milliseconds with a 20-millisecond delay. The ecchymotic area was outlined; the lateral half was treated on postoperative day 5 or 6 and the medial half on postoperative day 7 to 10. Clinical photographs were obtained before and after each treatment. Three blinded independent observers evaluated the photographs and graded the ecchymoses on a scale of 0 to 3, with 3 indicating severe ecchymosis. The most common procedures associated with ecchymoses are cervicofacial rhytidectomy, facial lipocontouring, thread lift, and minimally invasive subperiosteal midface-lift. Pulsed-dye laser treatment resulted in a 63% mean improvement in ecchymosis scores within 48 to 72 hours. The only adverse effects were mild edema and discomfort. Maximal efficacy of the laser treatment was observed when it was performed between 5 and 10 days postoperatively. Patient satisfaction was universally high. Treatment with the pulsed-dye laser is safe and effective for expeditious resolution of postoperative ecchymoses after facial cosmetic procedures. It has the potential for wider application in treating postoperative ecchymoses on other areas of the body and after trauma.

The Efficacy of Surgical Drainage in Cervicofacial Rhytidectomy: A Prospective, Randomized, Controlled Trial

The Efficacy of Surgical Drainage in Cervicofacial Rhytidectomy: A Prospective, Randomized, Controlled Trial