Adjunct Perioral Phenol–Croton Oil Peel Shortens Philtrum Length in Patients Undergoing Primary Facelift

Abstract Background Plastic surgeons have a variety of treatment options for perioral rejuvenation, including chemical peels, energy-based skin-tightening devices, microneedling, microcoring, fat grafting, fillers, neuromodulators, and surgical lip lifts. Objectives The aim of the current study was to determine the effect of perioral phenol–croton oil peeling on philtrum length in patients undergoing primary facelift. Methods A retrospective cohort study was performed on Caucasian females undergoing primary facelift with perioral heavy formula phenol–croton oil peels (33% phenol, 1.1% croton oil). Propensity matching was performed with BMI and age for comparison to control patients undergoing facelift without adjunct peel. Mirror Medical Imaging Software was used to estimate pre- and postoperative philtrum length for each patient from the nadir of the cupid's bow to the subnasale. Mann-Whitney and independent t-tests were used to compare the percentage change in philtrum height amongst and between cohorts. Results The study cohort consisted of 100 female primary facelift patients (50 with perioral peel, 50 without perioral peel). The patients had a mean age of 67.0 years and a mean BMI of 24.6 kg/m2, and the mean [standard deviation] follow-up for first appointment at least 3 months postoperatively was 6.4 [3.3] months (range, 3.0-16.1 months). Peel patients had significantly shorter philtrum lengths postoperatively, with a mean shortening of 9.3% [4.6%] (P < .001). Control patients had no difference in philtrum length postoperatively (P > .05). Conclusions Phenol–croton oil peeling is a powerful tool for tightening skin and softening rhytides in the perioral region. This study demonstrated an additional, previously unreported benefit of average philtrum length shortening of nearly 10%. These findings are gratifying because philtrum lengthening is a classic finding in the aging face. Level of Evidence: 3 (Therapeutic)