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.

Background: Reconstruction after parotidectomy can include fat grafting, which allows for symmetry, but grafts have demonstrated volume loss over time. Objectives: To provide quantitative evidence for the rate of volume loss of fat grafts. Methods: Patients who received parotidectomy with fat graft reconstruction at a single institution from August 2016 to October 2020 were identified. Relationships between clinical factors and the logarithmic rate of fat graft volume loss were analyzed. Results: Twelve patients received parotidectomy, fat graft reconstruction, and underwent a postoperative magnetic resonance imaging (MRI) scan. Rate of fat graft volume loss was a mean of 1.8% per month (standard deviation [SD]: 2.1% per month). Total parotid fat graft volume loss was a mean of 57.4% (SD: 67.5%). The mean follow-up time was 35.5 months (range: 9–89.8 months). Correlations between body mass index (BMI), history of smoking, and history of alcohol consumption and logarithmic rates of fat graft volume loss were increased but not significantly. Conclusions: Fat grafts have the potential of 60% volume loss at approximately 1 year. If there is clinical suspicion that patients will require adjuvant radiation or have clinical factors such as a smoking or alcohol-use history, volume requirements may be even greater to maintain adequate parotid volume for aesthetic purposes.