April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Plastic and Reconstructive Surgery • January 2019

Table 1. Patient Demographics Characteristic

When evaluating our series, there were zero complications at 6 months. There were no cases of hypopigmentation at the 6-month postoperative visit and no perioral scarring (Figs. 3 through 6). DISCUSSION Lasers have been used for facial resurfacing for decades. However, the role of erbium in facial rejuvenation has not been assessed long term. This is the first long-term assessment of peri- oral rhytides following erbium laser resurfacing. There was no statistically significant difference in perioral rhytide scores in patients who underwent perioral erbium laser with concomitant face-lift procedures and those who underwent erbium laser treatment alone. In addition, there were no differences in perioral rhytide scores between nonphysicians and plastic surgeons. This dem- onstrates the important role erbium has in facial rejuvenation and proves no judgment bias within the study. Even the best comprehensive surgical facial rejuvenation falls short when perioral rhytides are not addressed. Unfortunately, the current surgi- cal treatments for facial aging do not effectively address the perioral rhytides. This has led to the development of numerous adjunctive procedures, ranging from dermabrasion and fillers to lasers and peels. 10 Our current study showed no statis- tically significant difference in perioral rhytide improvement in the face-lift cohort compared with isolated erbium treatment. This confirms our belief that erbium laser treatment to the perioral area is the reason for improvement in perioral appearance and not simply the face-lift procedure. The results of this study show that erbium laser is useful and safe for treating perioral rhyt- ides, both in isolation and when combined with other surgical procedures to improve long-term appearance. Isolated perioral resurfacing can be carried out with any face-lift technique because of the rich vascular supply; however, full-face Percentage rhytide improvement 66.1 ± 20.4 61.1 ± 15.0 *Significant changes from preoperative to postoperative scores are group dependent. †Statistically significant ( p < 0.05). Table 3. Isolated Erbium Laser Resurfacing Scores and Percentage Improvement for Both Nonphysicians and Surgeons* Nonsurgeon Surgeon Preoperative rhytide score 4.1 ± 1.7 4.2 ± 1.6 Postoperative rhytide score 2.2 ± 1.4† 2.4 ± 1.0† Absolute rhytide improvement 1.9 ± 0.9 1.8 ± 0.8

Value (%)

Age, yr

 Mean

60.4

 Range

46–77

Total no. of patients

45

 Erbium

14 (31) 31 (69)

 Face lift and erbium

Fitzpatrick skin type  1

6

 2  3

32

7

 Average Follow-up, mo  Mean Rhytide severity  Preoperatively  Mean  Range

2.02

13

6–26

4.6

  Range

2.0–8.0

 Postoperatively  Mean

2.4

 Range

1.0–5.1

 Score improvement  Mean

2.2

 Range

0.40–5.2

who underwent concurrent face lift at the time of erbium treatment had an absolute score improve- ment of 2.3 and had a 60.9 percent improvement ( p < 0.05). When surgeons evaluated the patients, there was a statistically significant absolute score improvement of 2.0 and a 56.1 percent improve- ment ( p < 0.05) (Table 2). Patients who underwent erbium treatment alone saw an absolute improvement of 1.9 ( p < 0.05) and a 66.1 percentage improvement of peri- oral rhytides as evaluated by the nonphysicians. In the surgeon cohort, there was a significant improvement of 1.8 and a 61.1 percent improve- ment ( p < 0.05) (Table 3). When comparing the absolute and percent improvement between erbium and erbium with face-lift groups, there was no statistically significant difference between either group. Likewise, when comparing absolute and percentage improvement between the sur- geon and nonphysician scores, there were no sta- tistically significant differences. Table 2. Erbium Laser Resurfacing with Concomitant Face-Lift Scores and Percentage Improvement for Both Nonphysicians and Surgeons* Nonsurgeon Surgeon Preoperative rhytide score 4.8 ± 1.1 4.6 ± 1.3 Postoperative rhytide score 2.5 ± 0.6† 2.6 ± 0.9† Absolute rhytide improvement 2.3 ± 1.0 2.0 ± 0.9 Percentage rhytide improvement 60.9 ± 16.9 56.1 ± 16.9 *Significant changes from preoperatively to postoperatively are group dependent. †Statistically significant ( p < 0.05).

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