A study published in The American Journal of Cosmetic Surgery in September 2014 evaluated the safety of combined extended-SMAS rhytidectomy, mid-face implant placement and full-face erbium:YAG resurfacing performed as a single procedure.

Previous studies have demonstrated the safety of laser resurfacing and rhytidectomy performed together. To achieve a more complete facial rejuvenation, a third plane of surgical dissection may be performed to restore mid-face volume through a subperiosteal approach; however, the inherent risks of laser resurfacing in patients undergoing a triplanar procedure, including subcutaneous, sub– superficial musculoaponeurotic system (SMAS) and subperiosteal dissection have not been previously established in the literature. It has previously been thought that such trauma to the skin and underlying tissues all at once in the one downtime might result in skin loss and other problems.

In a review of 21 women aged 58 to 71 there were no cases of flap necrosis or slough. There was one case of haematoma that resolved with conservative management.

One patient with a history of Roux- en-Y gastric bypass had an implant infection. She was found to have malabsorption of her antibiotics, which immediately resolved once her antibiotics were crushed. Epithelisation occurred within 10 days, and all patients were able to wear makeup after 10 days. It is important to note that none of these complications are felt to be the result of combining the procedures.

“In a quest for a more complete or total facial rejuvenation, we started pushing the envelope a little bit and have found that combining techniques is a really safe approach,” said Dr Achih H Chen, Director of Facial Plastic and Reconstructive Surgery at
the Medical College of Georgia at Georgia Regents University and Director of The Georgia Center for Facial Plastic Surgery in the US. He noted that continued refinement of laser technology and surgical technique enabled the momentum. Total facial rejuvenation looks at
tightening, restoring volume and smoothing the skin surface. “Young faces don’t look tight. They don’t have sagging, so tightening is a component, but just tightening and tightening does not really achieve a more youthful appearance. In fact, too much tightening can make you look very unnatural, and I don’t think most people are looking for that as an end point,” Dr Chen said.

Tightening works well for the neck and jawline, but in the midface tightening can further widen and flatten that area of the face. “The youthful midface is full, so volume restoration also is critical,” he says.

In addition to tightening and adding volume, a smooth and even skin texture is a key hallmark of youth and should also be addressed for a global rejuvenation.

Dr Chen goes on to say that non-ablative lasers as well as other exfoliation methods, which tend to remove just the very top of the skin, have much reduced recovery time and results.

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