American Society of Plastic Surgeons meeting October 25, 2009.

Establishing Laser Settings for Safely Preforming a Facelfit Combined with Intraoperative Fractional CO2 Resurfacing of the Full Face and Neck Skin Flaps.

Abstract

Background: Facelift combined with intraoperative traditional CO2 resurfacing of the entire face including the skin flaps is not advocated due to concerns for skin flap loss. Recently developed fractional CO2 technology resurfaces at a variety of density and energy levels, and this flexibility allows us to resurface skin flaps without flap loss. The author documents the extent of fractional CO2 resurfacing of skin flaps that can be done during a facelift.

Methods: A series of 10 patients underwent an extended supraplatysmal facelift with intraoperative Fraxel Re:pair fractional CO2 resurfacing of the entire face including the elevated skin flaps of the face and neck. Skin flap dissection extended to the nasolabial fold and neck midline (Figure 1). The skin flaps were treated at 20mJ with 20% skin coverage. Resurfaced skin resected during the facelift was sent to pathology to document the depth of lesion penetration into the skin flap.

Results: All 10 patients healed without any areas of skin loss or delayed healing. Histology showed that the lesions penetrated 444 microns into the skin flap, which represents 30% of the entire flap thickness (Table 1). After fractionally resurfacing 20% of the skin flap surface and 30% of the flaps depth, histology showed that the CO2 laser ablated 6% of the entire flap area. All patients were healed and wearing makeup within 10 days.

Conclusion: Facelift skin flaps were elevated and resurfaced using the Fraxel Re:pair laser creating ablative lesions that penetrated 30% of the flaps thickness. All 10 patients healed without complication. These early findings suggest that we can safely resurface facelift skin flaps of the cheek and neck using fractional CO2 technology without flap loss, enabling surgeons to offer the complementary benefits of a facelift and skin resurfacing in a single surgery with one recovery peroid.