Evaluation of Face Lift Skin Perfusion and Epinephrine Effect Using Laser Fluorescence Imaging

Face lift dissections are believed to compromise skin flap circulation, possibly leading to wound healing complications. To reduce blood loss, plastic surgeons commonly inject a solution of local anesthetic that contains epinephrine. However, the effect of surgery on skin perfusion and the degree of vasoconstriction caused by the epinephrine have not been quantitated. Little information is available to guide the selection of epinephrine concentration.

Nine consecutive patients undergoing a deep-plane face lift were asked to participate in this prospective study. All patients consented (inclusion rate, 100%). The SPY Elite Intraoperative Perfusion System was used to quantitate perfusion. Measurements were made at 5 sites on both sides of the face and the neck. A nondissected temple site served as a reference. Three patients received no epinephrine in their local anesthetic solution, 3 patients received 1:800,000 epinephrine, and 3 patients were injected with 1:300,000 epinephrine.

All 9 patients were female nonsmokers. There was no reduction in skin perfusion measurements after surgery. In patients treated with 1:800,000 and 1:300,000 epinephrine, 4 sites showed significantly (P < 0.05) decreased perfusion compared with the no-epinephrine group. Combined perfusion data were almost 50% reduced, but the difference was nonsignificant, likely because of the small sample sizes. One patient developed a hematoma. Two of the 3 patients who received no epinephrine developed extensive bruising.

A deep-plane face lift dissection does not impair skin flap perfusion. Both 1:300,000 epinephrine and 1:800,000 epinephrine concentrations are effective in producing intraoperative vasoconstriction.