April 2020 HSC Section 4 - Plastic and Reconstructive Problems

Volume 143, Number 1 • Perioral Rhytide Correction Assessment

Fig. 3. Preoperative laser resurfacing patient with average score improvement of her perioral rhytides.

Fig. 4. Postoperative laser resurfacing patient with average score improvement of her perioral rhytides.

resurfacing requires a high–superficial musculo- aponeurotic system or composite technique and a shallower depth of ablation. Erbium laser treatment and the effects on tis- sue collagen are similar to the contracture and collagen deposition following a partial-thick- ness burn, and key to a good treatment result. Castro et al. 11 evaluated the changes that occur in dermal connective tissue and compared this with second-degree burn wounds. Thay found that, histologically, these produced similar results but that laser treatment seemed to target the deep dermal vessels without destroying the surrounding connective tissue, whereas burn wounds led to degradation of all cell types at the reticular dermis level. Further studies by Ross et al. 12 showed that deeper ablative injury to the dermis could heal within a 2-week window, by means of reepithelialization. When evaluating erbium laser resurfacing in deep treatments

into the dermis, the wounds reepithelialized within 7 days. Wounds heal in several ways, but they all involve some form of reepithelialization. 13 This occurs from lateral migration of epithelial cells from the wound edges and from skin appendages. This connection allows for quick epithelialization and watertight closure of the epidermis after an injury to the epidermis. 14,15 Although the deeper layers take longer to heal, epithelialization starts occurring immediately after injury. 16 It would be ideal to stay superficial to the skin appendages; however, the depth of many deep wrinkles is deeper than these appendages. The goal of this technique is to fully ablate the individual perioral wrinkles or to maximally treat them, and to minimize the risk of hypopigmenta- tion and scarring. Our study proves that this strat- egy is predictable, safe, and effective when using the above-mentioned techniques. Assessing the

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