Are results better all the way around if CO2 is done before, during, or after a SMAS procedure? (photos)

Question

My skin is very thin, weathered, and wrinkled. I want to have several procedures done, including SMAS facelift and lip lift. Is it better to have a CO2 laser treatment done before, at the same time, or after? I realize I will have to have it more than once for better results.

Michael Kulick, MD, DDS · Answer

I would recommend the facelift first. There are many types of facelifts and you can view them in the video attached. The benefit is that if you are happy with your facelift then you can avoid the recovery process associated with a laser skin resurfacing. Sometimes patients can benefit from photo rejuvenation after a surgical procedure. It is easier recovery process and helps reduce redness and brown simultaneously. Take a look at case # 3095 who had her sun damaged chest skin improved after undergoing a laser vertical lift. Sincerely,Michael Kulick MDSan Francisco Ca.

Brian K. Machida, MD, FACS · Answer

Most procedures can be done at the same time.  Its best to go for a personal consultation to go over your options.  If you would prefer to separate the procedures, surgery should be done first.  If your skin is weathered and wrinkled, you also might consider Renuvion/J plasma.

Arnold Almonte, DO · Answer

With skin that is thin, you may want to stage your procedures, as in do the resurfacing before or after the surgeries. A personalized consultation is needed to evaluate your skin and facial features. I generally advise to do the surgery first, allow the skin to heal, then move forward with resurfacing. There are other resurfacing options outside of traditional CO2 lasering, including microneedling and Renuvion/Jplasma with or without PRP that render excellent results. See a board certified facial specialist to discuss all your options. Good luck!

Terry Maffi, MD · Answer

The results of CO2 laser resurfacing are the same whether done at the same time as a facelift or after. Ideally, you would undergo laser resurfacing at the same time as your facelift. It would yield the same results and will combine the downtime for both procedures. This is always my suggestion for my patients.

William Portuese, MD · Answer

Laser  resurfacing is probably best  performed after a  SMAS lower face lift procedure.  For  many facelift examples, please see the link and the video below

P. Craig Hobar, MD(retired) · Answer

In many cases I offer CO2 laser at the same time my patients undergo a facelift. This is isolated to areas around the mouth as I am careful not to disrupt the blood supply from the bottom (surgery) and the top (laser) in the same area. You could feasibly have the laser around the mouth, which typically is the area with the most prominent wrinkles. I would then suggest a full face laser after your facelift, once the area is healed and the blood supply is established in order to get the most efficient and best results.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling photos are the best for the evaluation showing the front snd sides of the face.  From the photos, there is evidence of mid cheek grooves (indicate a lack of underlying cheek bone volume allowing tissues ti sag off the cheeks), there is significant excess skin with "jowls) in the lower face and under the chin.   
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. CO2 Laser is a very aggressive skin resurfacing technique...especially in someone with thin skin.  The CO2 Laser is generally considered contraindicated with the more invasive type facelifts described above due to the disruption in blood supply with those facelift techniques.  The Laser would be performed around 1 year after the facelift.  Even with the minimally, invasive SMAS facelift described above, I would limit the skin resurfacing to a full face 30% TCA peel.  This peel has far less risk with a very quick recovery time. As lines and wrinkles flatten out following a facelift with skin removal, it makes sense to have any resurfacing procedure either immediately after the facelift or at the 1 year post op mark when the more invasive facelifts are being considered. 
Hope this helps.

Are results better all the way around if CO2 is done before, during, or after a SMAS procedure? (photos)

Answers (7)

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