Adjunct Perioral Phenol-Croton Oil Peel Shortens Philtral Length in Patients Undergoing Primary Facelift

Goals/Purpose: Formal facelift is the most powerful tool for midface, lower face, jawline, and neck rejuvenation. The central face, however, is largely unaffected by isolated facelift procedures. Other treatment options such as chemical peeling, energy-based skin tightening devices, microneedling, micro-coring, fat grafting, fillers, neurotoxin injections, and surgical lip lifts are often utilized for perioral rejuvenation. Recent studies have reported objective shortening of philtral length in patients undergoing facelift with perioral micro-coring. Anecdotally, this appears to be the case with perioral chemical peeling as well, but the literature does not show equivalent results. The current study aims to determine the effect of perioral phenol-croton oil peeling on philtral length in patients undergoing primary facelift procedures.

Methods/Technique: A retrospective cohort study was performed on Caucasian female patients with Fitzpatrick Type I and II skin undergoing primary facelift under general anesthesia with perioral heavy formula phenol-croton oil peels (33% phenol, 1.1% croton oil). Septisol was utilized as the peel surfactant before 1/1/2021, while Johnson and Johnson baby shampoo was utilized after 1/1/2021. Propensity matching was performed by body mass index (BMI) and age for appropriate comparison to control patients undergoing facelift without adjunct perioral chemical peel. Patients undergoing secondary facelift, tertiary facelifts, perioral laser, or lip lifts were specifically excluded. Medial intercanthal distance was calibrated to 30mm for retrospective standardization using Mirror Medical Imaging Software (Canfield Scientific, Parsippany, New Jersey, USA). Estimated pre- and post-operative philtral length based on this calibration was measured for each patient from the nadir of cupid’s bow to subnasale at their first follow up appointment at least three months postoperatively. Mann Whitney and independent t-tests were used as appropriate to compare percent change in post-operative philtral height amongst and between cohorts.

Results/Complications: A total of 100 primary facelift patients were included in this study (50 with perioral peel, 50 without perioral peel). Mean age was 67.0 years (± 4.5, range 46.9 – 78.1), mean BMI was 24.6 kg/m² (± 3.7, range 17.0 -33.8), and mean follow up for first appointment at least three months after surgery was 6.4 months (± 3.3, range 3.0 –16.1). Septisol was used for 37 patients (74%), and Johnson and Johnson baby shampoo for 13 patients (26%). Peel patients had significantly shorter philtral lengths postoperatively, with average decrease of 9.3% (± 4.6%, p <0.001). Control patients had no difference in philtral length postoperatively (p > 0.05). Two peel patients experienced prolonged erythema and mild perioral hypertrophic scarring that resolved with serial steroid injections.

Conclusion: Phenol-croton oil peeling is an underappreciated and powerful tool for tightening skin and softening rhytides in the perioral region. Prior studies have demonstrated high patient satisfaction and subjective improvement in both apparent age and perioral wrinkle severity with perioral phenol-croton oil peels in patients undergoing facelift. This study demonstrates an additional, previously-unreported benefit of objective philtral length shortening that is comparable to results reported in a similar micro-coring study (9.3 vs. 6.2%, respectively). These findings are largely welcomed, as philtral lengthening is a classic finding in the aging face. While the effect cannot compare to direct skin excision achieved with formal lip lift procedures, it is certainly a beneficial, non-invasive, and scarless alternative that should be strongly considered for facelift patients seeking perioral rejuvenation as well.