Short flap rhytidectomy and fractional CO2 laser rejuvenation of the aging face

A novel technique for treating atrophic facial scars in Asians using ultra-pulse CO2 laser

BACKGROUND AND AIMS

Fractional lasers have become increasingly popular for treating atrophic scars, but their effectiveness is limited for deeper scars. We developed a novel technique (manual fractional thermal contraction technology, MFTCT) using an ultra-pulse CO₂ laser and evaluated its efficacy and safety for treating atrophic facial scars.

METHODS

A total of 44 patients with atrophic facial scars were treated with MFTCT every 8 weeks for 1-4 times. Overall scar improvement was assessed by photographs taken at baseline and 3 months after the last treatment according to the 4-point global assessment scale (GAS) and ECCA grading scale. Improvements in color, distortion, and texture were assessed by the modified Manchester Scar Scale and scored individually from 1 to 4. Pain degrees and adverse reactions during and after treatment were recorded.

RESULTS

A total of 44 patients completed the treatment and follow-ups; of them, 89% reported at least 50% overall improvement after the last treatment. The mean ECCA scores fell from 67.50 ± 23.98 to 45.68 ± 18.57 (a 32% improvement), and the change was significant (P = .000). The average score for overall improvement was 3.48. The average scores for color, distortion, and texture were 3.07 ± 0.62, 3.27 ± 0.50, and 3.52 ± 0.51, respectively. Mean pain degree score was 4.27 ± 1.04, and mean erythema duration was 28.43 ± 6.58 days. Some patients developed pigmentation for a few months that resolved with topical treatment.

CONCLUSION

Manual fractional thermal contraction technology has definite clinical efficacy in the treatment of atrophic facial scars with fewer adverse reactions and is worth using in the clinical setting.

The combination of rhytidoplasty and fractional CO2 laser therapy in the treatment of facial aging

BACKGROUND

Facial aging is a natural biological process with symptoms such as sagging tissue, accentuated lines, furrows, wrinkles, dyschromias, and loss of facial volume. Rhytidectomy alone often fails to achieve a patient's expected goals, which is why there is a high demand for adjunct laser skin treatment.

METHODS

From January 2007 to February 2013, a total of 80 patients with skin types Fitzpatrick I-IV underwent large undermined cutaneous flap rhytidectomy and superficial muscular aponeurotic system (SMAS) plicature plus hyaluronic acid injection on the nasolabial folds and lips and concomitant Lumenis UltraPulse CO2 Active FX total ablation mode resurfacing of nonundermined skin. The undermined skin was treated with a fractional laser using different energies depending on the type of skin. Patients were evaluated at 5, 10, 15, 30, 60, and 90 days after the operation. At the last evaluation patients completed a specific questionnaire about satisfaction.

RESULTS

Complications included expansive hematomas (5 %), partial necrosis (1.25 %), bacterial infection (1.25 %), herpetic infection (1.25 %), hypertrophic scar (1.25 %), and spot hyperchromia (1.25 %). 95 % of patients were extremely satisfied, 3.75 % were satisfied, and only 1.25 % were unsatisfied.

CONCLUSION

The combination of subcutaneous flap rhytidectomy and SMAS plicature with fractional laser resurfacing plus hyaluronic acid injection is a safe procedure with low incidence of major complications and improves patient satisfaction.