Background: Simultaneous facelift and full face laser resurfacing is attractive to both patients and surgeons.  The author documents the extent of fractional CO2 resurfacing of elevated skin flaps of the face and neck that can be safely done during a facelift without impairing wound healing.

Methods:  Simultaneous facelift and Fractional CO2 resurfacing of the entire face and neck  including the  skin flaps were preformed on 10 patients. Undermining of the cheek skin extended to the nasolabial fold and the neck midline (fig. 1). The Fraxel Re:pair laser was used to laser the entire face, neck and chest during the facelift after the incisions were closed. The skin flaps of the face and neck were treated at 20 mJ with 20% flap coverage.  Forehead, nose and perioral skin was treated at 40 Joules with 40% coverage. 

                                                                         Fig. 1

 Resurfaced preauricular skin was sent to pathology to document the depth of ablative lesions found in the elevated skin flap.

Results:  All 10 patients experienced no delayed healing or pigmentary skin changes from the combined resurfacing and facelift procedure.  Five days post operatively flexan was removed and skin was still healing from resurfacing (fig. 2)  Ten days postoperatively all sutures were removed, and the resurfaced skin was healed and patients were able to conceal erythema with makeup, and 14 days postop patients all returned to normal activity with normal levels of post op swelling wearing makeup (fig. 3)

                                    Fig. 2                                                               Fig. 3

   Histological examination of the resected skin flap showed that at 20 mJ the  lesions penetrated 444.94 microns deep with a width of 224.23 microns (fig. 4 and Table 1). Sections also showed the average skin flap thickness to be 1.5mm, therefore the lesions penetrated 444 microns into a 1.5mm skin flap or  30% of the entire depth of the skin flap.

Table 1

            EXTENT OF SKIN FLAP ABLATION

      Lesion depth                      444.94 microns

     Ablation depth                     334.23 microns              

     Coagulation depth                  110.71 microns

      Lesion width                      234.14 microns                    

      Ablative width                    160.75 microns

     Average flap thickness              1,500 microns

     Percentage of flap depth ablated         30%

     Percentage of flap surface ablated       20%

                                                                                                            Fig. 4

                                                                        Fig. 5                    

                                                                        Fig. 6

                                                                         Fig. 7

Conclusion:  All 10 facelift patients having simultaneous facelift and fractional CO2 resurfacing of the entire face and neck treated at 20% coverage and 20mj healed without complication. Histology showed that at 20mj and 20% coverage the Fraxel RE:pair fractional CO2 laser created lesions that extended 444.95 microns the face lift flap or 30% of the flaps entire thickness.   When combining these procedures these settings should be respected.  If one were to increase the power to 40mj the laser would penetrate to over 1mm which could result in full thickness skin flap penetration.  The settings of 20mj and 20% coverage do not impair healing and yield happy patients who get two procedures in one setting.