Koch Brenton B, Perkins Stephen W
Carithers and Koch Facial Plastic Surgery, 535 40th St, Des Moines, IA 50312, USA.
Arch Facial Plast Surg. 2002 Oct-Dec;4(4):227-33. doi: 10.1001/archfaci.4.4.227.
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.
To evaluate these differences and determine protocol for care and carbon dioxide laser settings for resurfacing when done in combination with full-face rhytidectomy.
(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 and 1/2 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.
Rate of postoperative complications, premorbidity, previous surgery, concurrent procedures, postoperative dressings, and follow-up status.
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.
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.
Simultaneous rhytidectomy and full-face carbon dioxide laser resurfacing can safely provide a dual cosmetic benefit option for aesthetic rejuvenation of the face.
理论上，面部除皱术与全脸二氧化碳激光换肤术相结合可实现更卓越的面部美容年轻化效果，但一些报告不建议采用这种联合方式（尤其是联合化学剥脱术）。然而，以往联合治疗的研究存在显著差异。
评估这些差异，并确定与全脸除皱术联合进行换肤时的护理方案及二氧化碳激光设置。
（1）一项病例系列研究，对在私人诊所接受治疗的30例患者进行了为期26个月的同期除皱术和全脸激光换肤术；（2）对3年半的文献进行荟萃分析，这些文献报道了相同的联合手术（453例患者）。评估的变量包括除皱术技术、激光类型及设置、术后护理、并发症和疗效分析。
术后并发症发生率、术前疾病情况、既往手术史、同期手术、术后敷料及随访情况。
由实施所有手术的单一外科医生确定转诊样本患者。对于文献荟萃分析，仅纳入了1997年1月至2000年5月间关于同期除皱术和全脸激光换肤术的同行评审研究。
在我们为期26个月的病例系列研究纳入的30例患者中，未发现皮瓣丢失、皮肤脱落、感染（病毒感染或蜂窝织炎）或色素减退的迹象。确定了激光换肤的设置。在我们的荟萃分析纳入的453例患者中，1例（吸烟者）出现了2厘米的全层皮瓣坏死，4例在耳后区域出现了不同程度的皮肤脱落，但无全层坏死。并发症发生率与单纯除皱术无异。
同期除皱术和全脸二氧化碳激光换肤术可为面部美容年轻化安全地提供双重美容益处选择。
