Patients Receiving Radiotherapy Have Increased Risk of Complications in Face Lift Procedures

A retrospective review in JAMA Facial Plastic Surgery suggests that patients who have cervicofacial rhytidectomy (face lift) after radiotherapy are likely to have increased complication rates over patients who have not had radiotherapy.

The findings are important, because almost half of all patients with cancer will have some form of radiotherapy. Patients suffering from early-stage head and neck cancer are often candidates for radiotherapy, and the treatment can lead to scarring and radiation burns, among other side effects. Given that those scars are likely to be visible in many head and neck cancer patients, many seek cervicofacial rhytidectomy as part of post-radiotherapy treatment.

Radiation therapy can cause microvascular changes in the treatment area, which are permanent changes that can adversely impact the outcomes of facelift surgery. The amount of damage can depend on a number of factors, including the penetration level of the radiotherapy and the total dose of radiation.

The article was based on a retrospective review of the medical records of 16 patients who underwent cervicofacial rhytidectomy after completing radiotherapy for head and neck tumors and those of 16 age-matched control participants who did not undergo radiotherapy. Patients underwent treatment from July 2006 through February 2014, with final follow-up in February 2014. Complications after surgery were reviewed and data for surgery type, technique, radiation dose and delivery method, and time to surgery after radiotherapy were analyzed.

The radiotherapy and control group patients were a mean of 62 years old. In the radiotherapy group, 8 of 16 were women; 14 of 16 were women in the control group. Two major complications‑‑1 hematoma and 1 perioperative stroke‑‑occurred in the 16 patients who composed the study cohort. In the control group, there was 1 case of transient facial nerve weakness and 1 case of cellulitis that was successfully treated with antibiotics.

Two patients experienced wound dehiscence, and no incidents of motor or sensory nerve injury occurred. Subcutaneous face-lift (3 of 3 patients [100%] vs. 1 of 13 patients [8%] who underwent superficial musculoaponeurotic system and deep-plane face-lifts; P = .02) and the addition of chemotherapy (4 of 9 patients [44%] vs. 0 of 7 patients who did not receive chemotherapy; P = .04) were associated with increased complications. Notably, neither age nor time from completion of radiotherapy to facial surgery showed any correlation to complications.

According to the researchers, “The incidence of wound dehiscence is elevated in the population undergoing radiotherapy but can be managed conservatively in most cases. Patients who undergo radiotherapy must be counseled on the increased risk for complications before proceeding with cervicofacial rhytidectomy.”