"Take your Facelifts to the next level: Case Series reflecting the Safety and Efficacy of Plasma Resurfacing with Face and Neck Lifts".

[BACKGROUND] Deep facial skin resurfacing with plasma radiofrequency (RF) technology, introduced in the early 2000's, has demonstrated superior correction of superficial and deep rhytids, photodamage, and tissue contraction compared to other deep facial resurfacing techniques. This statement reflects the author's clinical experience over the past eight years (2017-current) using plasma technology, in comparison to her prior eight years (2009-2017) utilizing other resurfacing modalities, including phenol chemical peels, non-ablative erbium (1540 nm), ablative erbium (2940 nm), and C02 laser (10,600 nm). By performing deep plasma skin resurfacing concurrently with a rhytidectomy procedure, patients can achieve enhanced facial rejuvenation with improved skin quality and tissue tightening in a single surgical session and recovery period.

[METHODS] This paper presents a single surgeon's experience from 2017 to the present, involving 96 consecutive patients who underwent a combination of face and neck lifts, full-face fat grafting, and full-face deep plasma skin resurfacing in one session. Patients ranged in age from 48-86, with 93 females and 3 males. Most procedures were performed under IV sedation (94), with 2 under general anesthesia. Rhytidectomy techniques (SMAS plication, SMAS imbrication, or deep plane/sub-SMAS) were selected based on patient facial anatomy. Concurrent neck lift and platysmaplasty were performed, followed by full-face resurfacing using helium plasma RF (84 patients) or nitrogen RF plasma (12 patients). All helium RF plasma treated patients were Fitzpatrick type 1-3, while the nitrogen plasma treated patients ranged from Fitzpatrick type 1-3 (8 patients), and Fitzpatrick 4 (4 patients). The helium plasma RF settings were 40% energy at 4 liters of helium flow. A single pass was completed on the whole face, while a second pass was performed on the chin and peri-oral areas. The nitrogen RF plasma settings were at 3-4 kilojoules (kj) for a single pass for the Fitzpatrick 1-3 patients, and 2.5 kj for the Fitzpatrick 4 patients. Full-face fat grafting was also performed. Follow-up included post-operative visits the day after surgery, weekly, then monthly. Computerized skin analysis using ImageProTM was conducted on a subset of 20 patients (January 2023 - September 2024) pre-operatively and at 90 days post-operatively. The longest follow-up was 6 years.

[RESULTS] Computerized analysis (Image ProTM) of pre- and 90-day post-operative results showed upper cutaneous lip skin contraction (height decrease) ranging from 0.25 mm to 2.47 mm (average 1.26 mm). The corresponding percentage of upper lip shrinkage ranged from 3.9%-21.32% (average 13.85%), a decrease in skin age by 1 to 9 years (average 4.27 years), elasticity improvement by 1 to 20 years (average 9.81 years), rhytid reduction of 1 to 22 years (average 7.36 years), and UV spot reduction by 1 to 9 years (average 4.54 years).There were four complications (4/96, 4.1%), all in the helium RF treated group. One patient developed late-onset forehead cellulitis at 8 weeks post-operatively, which resolved with a one-week course of oral antibiotics. Three patients developed small areas of hypertrophic scarring on the chin, which were successfully treated with light C02 resurfacing and laser-assisted delivery of triamcinolone. No incidents of skin necrosis were observed in the areas of the elevated rhytidectomy or neck lift skin flaps. Aesthetic results demonstrated significant improvements in deep and superficial rhytids, skin elasticity, UV photodamage, and overall quality of the skin.

[CONCLUSIONS] This seven-year case series demonstrates that full-face deep plasma skin resurfacing can be safely and effectively combined with face and neck lifts, along with fat grafting, to achieve comprehensive three-dimensional facial and neck rejuvenation. The single-session approach addresses multiple aspects of facial aging, including sagging tissues, volume loss, and poor skin quality, without increasing the risk of complications such as skin necrosis or compromised wound healing. By eliminating the need for staged procedures, this method offers patients enhanced aesthetic outcomes with reduced downtime, less surgical time and anesthesia exposure, providing a promising and efficient alternative to traditional staged procedures.

[LEVEL OF EVIDENCE] IV.