CO₂ Laser Therapy as an Effective Solution for Stubborn Perioral Wrinkling in Smokers

Studies have shown an association between cigarette smoking and premature aging. The objective is to compare severity of facial wrinkling in smokers and nonsmokers after rhytidectomy with concurrent procedures. Patients who underwent rhytidectomy at a single academic institution between 2009 and 2020 were identified. The main outcome measure was the Merz wrinkle scale for preoperative and postoperative photos at 3 and 12 months. Of the 155 patients included, 66 (43%) patients had a smoking history: 7 current and 59 former smokers. Average packs per day was 0.70 and pack-years was 16. All patients showed significant improvement in midface wrinkles postoperatively ( P < .001). At baseline and 3 months, smokers had significantly worse lip wrinkle scores ( P < .01). All patients who received CO2 laser at time of rhytidectomy (with and without fat transfer) showed significantly greater improvement in lip wrinkle scores at both 3 and 12 months postop ( P < .02). Severity of facial wrinkling is greater in smokers, especially around the lips. Concurrent use of CO2 laser significantly improved perioral wrinkling, and the greatest results were seen when combined with fat transfer.