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Outcomes Assessment Of Combination Facelift And Perioral Phenol-Croton Oil Peel
Cemile Nurdan Ozturk, MD1, Franziska Huettner, MD, PhD1, Can Ozturk, MD1, Marisa A. Bartz-Kurycki, BS2, James E. Zins, MD1.
1Cleveland Clinic, Department of Plastic Surgery, Cleveland, OH, USA, 2University of Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
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.
METHODS: 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 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) classification. All reviewers were blinded to the patient`s operative status.
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.
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. 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 class as evaluated by two plastic surgeons was 3.5 and 3.2 preoperatively and was 2.3 and 2.1 postoperatively. (p<0.0001)
Figures demonstrate a patient who underwent the combined procedure. In the second figure she is seen 12 months after surgery.
CONCLUSION: Outcomes measurements including patient satisfaction, objective evaluation of wrinkle improvement and significant reduction in apparent age document the power of this technique.
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