April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Volume 143, Number 1 • Perioral Rhytide Correction Assessment

removed as much as possible as the tissue is ablated during surgery; however, a secondary responseof new collagen formation occurs over the next 6 months. The visible signs of new collagen construction are the appearance of vascularity (erythema) bringing the construction materials for this new collagen forma- tion. Such an explanation to patients is most helpful in their understanding and a true explanation of the erythema seen. Such an explanation also includes a very clear statement that every patient has a differ- ent collagen response that affects final results. The patient cannot control that inflammatory response, nor can the treating physician. The surgeon can con- trol only depth of injury and postoperative care inso- far as the patient follows such instruction. All procedures were performed at an accred- ited ambulatory surgery center with either a gen- eral anesthetic or intravenous sedation and local anesthesia. All appropriate safety precautions were taken. The endotracheal tube and operative field were draped with wet towels. In combination cases, the rhytidectomy is per- formed before laser resurfacing and is performed in combination only when the rhytidectomy tech- nique is a high–superficial musculoaponeurotic system approach, because of a better blood supply and thicker skin flap. The Contour TRL (Sciton, Palo Alto, Calif.) device was used. For the treatment of perioral rhytides, two passes of 150 μ m (37.5 J) each are made around the perioral region, with 5-mm repeating square pattern and the scanner set at 50 percent over- lap. ( See Video, Supplemental Digital Content 1 , which demonstrates the perioral rhytide

clinical assessment and evaluation, available in the “Related Videos” section of the full-text article on PRSJournal.com or, for Ovid users, available at http://links.lww.com/PRS/D146 . See Video, Sup- plemental Digital Content 2 , which demonstrates the initial laser settings and technique for perioral rejuvenation, available in the “Related Videos” section of the full-text article on PRSJournal.com or, for Ovid users, available at http://links.lww.com/ PRS/D147 .) The scanning handpiece is then set to manual and a single spot size of 4 mm is used with a depth of 30 μ m, 7.5 J per pass. ( See Video, Supplemental Digital Content 3 , which demon- strates the focused laser ablation of deep perioral

Video 2. Supplemental Digital Content 2 demonstrates the initial laser settings and technique for perioral rejuvenation, available in the “Related Videos” section of the full-text article on PRSJournal. comor, for Ovidusers, available at http://links.lww.com/PRS/D147 .

Video 1. Supplemental Digital Content 1 demonstrates the peri- oral rhytide clinical assessment and evaluation, available in the “Related Videos”section of the full-text article on PRSJournal.com or, for Ovid users, available at http://links.lww.com/PRS/D146 .

Video 3. Supplemental Digital Content 3 demonstrates the focused laser ablation of deep perioral rhytides, available in the “Related Videos”section of the full-text article on PRSJournal.com or, for Ovid users, available at http://links.lww.com/PRS/D148 .

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