Goals/Purpose: Facelift surgery combined with perioral phenol-croton oil peeling is a powerful and under-recognized tool for lower face rejuvenation. This approach results in significant central face skin tightening as well as wrinkle ablation. In this study we reviewed our experience with these simultaneous procedures using a variety of outcomes measures.
Methods/Technique: A retrospective review of 47 consecutive patients who underwent simultaneous facelift and perioral peel was performed. The extended SMAS approach was the most common facelift procedure combined with perioral resurfacing. Phenol-croton oil peel solution used consisted of 33% phenol, 1.1% croton oil, septisol and purified water. The solution was applied to the perioral region until a dense white frosting was observed. In none of the cases was undermined flaps peeled. The objective measures used to evaluate appearance change included: (1) patient satisfaction questionnaire, (2) evaluation of apparent age by 6 observers, (3) evaluation of perioral wrinkles by 2 independent plastic surgeons.
The validated patient satisfaction questionnaire consisted of 14 items designed to measure satisfaction after treatment.1 The items questioned overall satisfaction, improvement in appearance and improvement in facial lines.
Assesment of apparent age was calculated as follows: Pre and post operative photographs were randomly mixed and were shown to 6 independent reviewers who were asked to estimate the patient`s age. The apparent age was then compared to patient`s actual age. Additionally, reduction in apparent age was calculated by the formula [Postoperative Apparent Age-Actual Age] – [Preoperative Apparent Age-Actual Age]. 2
Improvement in perioral rhytids was evaluated by 2 independent plastic surgeons using pre and postoperative perioral photographs. Objective wrinkle assessment was made using the Glogau (1-4) scale. All reviewers were blinded to the patient`s operative status.
Results/Complications: The average patient age was 63±5.6. Mean follow up was 23.2 months. The extended SMAS was the most common type of facelift performed (n=39, 83%). In 37 (78.7%) of 47 patients submental lipectomy and platsymaplasty was also done. During their follow up period, 6 (12.8%) patients had re-peeling of perioral region. Average time to re-peeling was 12 months.
The response rate to the patient questionnaire was 57.4%. Overall satisfaction was rated as 6.5 on a 1 to 7 scale, with higher scores indicating greater satisfaction. The highest satisfaction score was 6.6 for the item which questioned “no sign of a procedure”. All the items in the questionnaire had a mean score above 5 indicating “satisfied” or “very satisfied”.
Preoperative apparent age assessment was quite accurate. There was no statistical significant difference between the patient`s real age and the preoperative apparent age. (p>0.05). However, when postoperative photographs were assessed significant differences were found between real age and apparent age (p=0.0002). Patients` postoperative apparent age estimate was 8.2 years younger than their real age.
The mean Glogau score as evaluated by two plastic surgeons was 3.5 and 3.2 prior to the combined procedure and was 2.3 and 2.1 postoperatively. The 95% confidence interval of the reduction was 0.87 - 1.53 (p<0.0001) for surgeon one and 0.79 - 1.42 (p<0.0001) for surgeon two.
Figures 1-4 demonstrate patients` representetive frontal views before and 10 to 13 months postoperatively. Profile views will be included in the presentation.
Conclusion: Outcomes measurements including patient satisfaction, objective evaluation of wrinkle improvement and significant reduction in apparent age document the power of this technique.
References
1. Cox SE, Finn JC, Stetler L, et al. Development of the Facial Lines Treatment Satisfaction Questionnaire and initial results for botulinum toxin type A-treated patients. Dermatol Surg 2003; 29: 444-9; discussion 449
2. Swanson E. Objective assessment of change in apparent age after facial rejuvenation surgery. J Plast Reconstr Aesthet Surg 2011; 64: 1124-31
Figures
Figure 1. Preoperative pictures of a 59 year old patient (A).She underwent extended SMAS facelift combined
with perioral phenol-croton oil peel, platsymaplasty and lipofilling. The patient is seen 12 months postoperatively (B).
Figure 2. A 64 year old patient presenting for facial rejuvenation (A). She is seen 11 months postop
following extended SMAS facelift combined with perioral phenol-croton oil peel, platsymaplasty and lipofilling (B).
Figure 3. A 68 year old patient is seen prior to surgery (A).She had extended SMAS facelift combined
with perioral phenol-croton oil peel and platsymaplasty. She is seen 10 months postoperatively (B).
Figure 4. A 63 year old patient presenting for facial rejuvenation (A). She is seen 13 months after extended
SMAS facelift combined with perioral phenol-croton oil peel,platsymaplasty and lipofilling (B).