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A Case Series and Meta-analysis

Brenton B. Koch, MD; Stephen W. Perkins, MD

Arch Facial Plast Surg. 2002;4:227-233.

Background  The combination of facial rhytidectomy and full-face carbon dioxide laser resurfacing would theoretically provide for superior aesthetic rejuvenation of the face, but some reports have advised against this combination (particularly using chemical peel). However, significant differences exist between previous studies of combination therapy.

Objective  To evaluate these differences and determine protocol for care and carbon dioxide laser settings for resurfacing when done in combination with full-face rhytidectomy.

Design  (1) A case series of 30 patients treated in a private practice over 26 months with simultaneous rhytidectomy and full-face laser resurfacing; (2) a meta-analysis of 3 years of literature reporting the same combination procedure (453 patients). Variables evaluated include rhytidectomy technique, laser type and settings, postoperative care, complications, and outcome analyses.

Outcome Measures  Rate of postoperative complications, premorbidity, previous surgery, concurrent procedures, postoperative dressings, and follow-up status.

Selection  Referred sample patients were determined by the single operating surgeon who performed all procedures. For literature meta-analysis, only peer-reviewed studies of simultaneous rhytidectomy and full-face laser resurfacing from January 1997 through May 2000 were included.

Results  Among the 30 patients treated over our 26-month case series accession period, there was no evidence of flap loss, skin slough, infection (viral or cellulitic), or hypopigmentation. Settings for laser resurfacing were determined. Of the 453 patients included in our meta-analysis, 1 (a smoker) sustained a 2-cm full-thickness flap necrosis, and 4 sustained varying degrees of skin slough in the postauricular area without full-thickness necrosis. The complication rate did not differ from that of rhytidectomy alone.

Conclusion  Simultaneous rhytidectomy and full-face carbon dioxide laser resurfacing can safely provide a dual cosmetic benefit option for aesthetic rejuvenation of the face.

From Carithers and Koch Facial Plastic Surgery, Des Moines, Iowa (Dr Koch), and Perkins Hamilton Facial Plastic Surgery, Indianapolis, Ind (Dr Perkins).

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