Laser Resurfacing at the Time of Facelift Surgery: A Systematic Review and Meta-Analysis.

Abstract

Simultaneous rhytidectomy and laser resurfacing has become a common single-stage facial rejuvenation technique. However, concerns remain, particularly with photothermal injury to undermined tissue. This is the first methodologically robust systematic review and meta-analysis to evaluate the safety, satisfaction, and predictors of outcomes for this dual-modality procedure. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a systematic review was conducted through April 2025. Data extracted included patient satisfaction, postoperative complications, and covariates for meta-regression. Seventeen studies comprising 1361 patients were included. The pooled patient satisfaction rate was 98.1%. Complications were rare: full-thickness flap necrosis (0.01%), skin slough (0.21%), secondary superficial infections (0.74%), hypertrophic scarring (0.51%), hematoma (0.35%), ectropion (0.12%), nontransient dyspigmentation (0.35%), contour irregularity (0.04%), and delayed reepithelialization (0.03%). Meta-regression demonstrated that lasering in areas undermined in the facelift dissection at the same energy density as nondissected regions of the face was significantly associated with higher skin slough rates. Superficial musculoaponeurotic system manipulation and biplanar rhytidectomy techniques were more likely to result in nontransient dyspigmentation compared to endoscopic subperiosteal techniques. Additionally, lasering undermined flaps with multiple different techniques was associated with higher rates of nontransient dyspigmentation. Procedures performed by plastic surgeons also were associated with lower rates of hypertrophic scarring when compared to dermatologists. Concomitant rhytidectomy and laser resurfacing appears safe with high patient satisfaction when laser and surgical technique are optimized. Identification of modifiable risk factors provides guidance to reduce complications and improve outcomes. Level of Evidence: 3 (Therapeutic).