Neck rejuvenation by combining Jessner/TCA peel, dermasanding, and CO2 laser resurfacing

BACKGROUND. One of the greatest challenges facing facial cosmetic surgeons today is the simultaneous rejuvenation of the neck and face. Laser resurfac ing of the face using the carbon dioxide (CO2) laser or the erbium:yttrium- aluminum-garnet (Er:YAG) laser has enjoyed widespread popularity, but the n eck and chest are often avoided. It would be quite helpful to rejuvenate th e neck at the same time the face is being resurfaced. This would diminish l ines of demarcation and help reduce the signs of aging of the neck. There w ould be a better match between the new skin of the neck and face. OBJECTIVE. TO develop a safe and effective method to rejuvenate the neck. METHOD. A step-by-step skin care program was instituted. The patients preco nditioned their face and neck skin with vitamin A/glycolic skin conditionin g lotions for 6-8 weeks prior to surgery. Following this the chest and neck area was treated with the Jessner-trichloroacetic acid (TCA) peel. Then th e middle section of the neck was sanded with 150 grit sandscreen. Finally, the central area was resurfaced with the UltraPulse CO2 laser using reduced power settings. Usually two passes was adequate to shrink the skin of this central section of the neck. A petrolatum-based ointment was applied durin g the initial 7-day postoperative period. After reepithelialization a sunsc reen-moisturizer was used during the day and hydrocortisone moisturizer was applied at night. RESULTS. The neck skin was able to tolerate this step-by-step skin rejuvena tion. The blending from the decollete area to the hairline produced a rejuv enation without a line of demarcation. There were no examples of scarring i n the 12 cases that were evaluated for 6 months. Two cases developed persis tent erythema that responded to silicone gel sheeting. Although no patients complained of hypopigmentation, a decrease in pigment was found using spec ial UV photography. CONCLUSION. It is possible with this gradient, step-by-step method to produ ce a rejuvenation of the neck. An improved texture of the neck developed wi thout visible scarring.