Thomas L. Roberts

CO2 Laser Resurfacing: Recognizing and Minimizing Complications

The new generation of high-energy CO2 lasers is finding wide application in aesthetic plastic surgery. [1][1],[2][2] The vaporizational mode of these lasers is currently used to minimize wrinkles and tighten facial skin. We report our experience with complications in more than 1000 laser skin resurfacing procedures. [1]: #ref-1 [2]: #ref-2

Aesthetic CO2 Laser Surgery: Evaluation of 907 Patients

Resurfacing the skin to improve skin quality is an important concept in aesthetic plasticsurgery. Although time-honored methods (e.g., dermabrasion and chemical peel) are available for this purpose, they have several disadvantages. A newer method with a highenergy pulsed carbon dioxide laser provides a more controllable and more predictable method of resurfacing facial skin. In our study of 907 patients, monitored up to 2 years 868 laser resurfacing procedures were done for facial wrinkles. Eight hundred two of 868 (92.4%) achieved very good to excellent results (>75% removal of wrinkles in 92.4% of cases). Forty-six of 61 (75.4%) patients with acne scars also obtained very good to excellent results. Most patients with selected skin lesions (rhinophyma, actinic cheilitis, epidermal nevi, seborrheic keratoses, syringomas, xanthelasmas, and postsurgical scars) achieved good to excellent results, although these are admittedly more difficult to quantify. Major complications were uncommon. One hundred one of 907 (11.1%) patients had development of temporary hyperpigmentation, which resolved in an average of 2.6 weeks. Thirty-four of 907 (3.8%) patients had development of mild permanent hypopigmentation. Eight of 908 (0.9%) patients had development of some induration that resolved with use of intralesional steroids. Most of these (5 of 8) were in the perioral area. Three of 907 (0.3%) patients had development of a small persistent scar. Seven of 316 (2%) patients undergoing periorbital resurfacing had development of some mild scleral show. Early in our experience one patient developed ectropion that required surgical correction. We conclude that the new generation high-energy pulsed carbon dioxide laser is safe andeffective for resurfacing facial skin. However, this procedure is very technique dependent and requires a combination of didactic and hands-on training, conservative surgical judgment, and diligent patient follow-up to obtain optimal results with minimal complications.

Minimally Invasive Facial Rejuvenation Endolaser Mid-Face Lift

Abstract. Endolaser mid-face lift was performed on patients in a multi-center study over a 36-month period (Feb. 1998 to Feb. 2001). It permits significant facial rejuvenation through small incisions. This technique achieves aesthetic results and wider rejuvenation while being less traumatic and creating minimal morbidity. Combined with other procedures, it rejuvenates the face by three strategic methods: soft tissue suspension, reversal of photo aging, and correction of the depletion of volume. To achieve this triple result, the mid-face lift is performed by endoscopic approach, and in every case is combined with the endoscopic lift of the frontal area. Laser resurfacing was used to reverse skin photo damage. The Ultrapulse CO2 laser and/or the Ultrafine Erbium YAG(Coherent, Inc, Palo Alto, CA) were used. The third combined procedure was the introduction of fat graft to compensate the atrophy/ptosis of fat and the depletion of bone mass (other filling materials besides fat may be used, depending on the preference of the surgeon). Our method of fixation using the Casagrande Needle (an evolution of Reverdin Needle) makes the mechanical purchase on the tissues to be suspended much easier, permitting the intra-oral and/or infra-orbital incisions to be eliminated. The present study of the technical evolution of the endolaser mid-face lift method allows us to conclude that a very satisfactory outcome has been reached, offering patients a minimally invasive procedure, which can be performed under local anesthesia, with low morbidity, imperceptible incisions, and an excellent long-term result.

Cosmetic Surgery of the Buttocks Region

Thomas L. Roberts III, MD Jose Abel de la Pena, MD Juan Carlos Cardenas, MD Joseph P. Hunstad, MD Luiz S. Toledo, MD Dr. Roberts: The first patient is a 20-year-old college student who wants more fullness in the entire buttocks (Figure 1). Dr. Cardenas, would she be a good candidate for buttock implants? Figure 1 This 20-year-old woman would like more shape and fullness to her buttock area. Dr. Cardenas: She is a good candidate for buttock implants, but my first choice would be autologous fat injection. I think she would benefit greatly from lipoplasty of her waist or abdominal region and fat injection to the buttocks. A minimum of 400 mL injected into each side would give her an excellent appearance. Dr. Roberts: Ten years ago, if you were using an implant, would you have used a solid silicone or a gel implant? And what would have been your choice of incision? Dr. Cardenas: I am not an expert in gluteal silicone implants, but I would have used oval silicone-gel implants, and I would have made a 5-cm incision between the buttocks. Dr. Roberts: What would have been your choice of implant placement 10 years ago, below the muscle or above the muscle? Would you have used drains? Dr. Cardenas: I would have placed the implant beneath the muscle. I never use drains in that region. I prefer excellent hemostasis and avoid any contact between the interior and the exterior. Dr. Roberts: Has your implant technique changed since then? Dr. Cardenas: I still use silicone-gel implants with the same incision and usually in the submuscular plane, although, in some patients, I use intramuscular or subfascial placement. Dr. Roberts: Dr. de la Pena, what type of implant and implant position would you have used 10 years ago, and how have you …