The image depicts a 67-yr-old man who had significant periorbital skin injury after 5 h of prone spine surgery using a foam headrest with standard taping of eyes. The patient underwent facial laser skin resurfacing 2 months before the event.

Facial pressure ulcers are a serious complication that may lead to pain, additional treatment, longer hospital stays, disfigurement or scarring, increased medical cost, and subsequent lawsuits. Facial pressure ulcer has an incidence of 27% in prone spine surgery lasting more than 3 h and occurs most commonly over the bony prominence of the chin, maxilla, and forehead. Skin damage is due to prolonged and excessive pressure and/or shear that blocks capillary blood flow. Risk factors include operation duration, hyperthermia, hypotension, aggressive fluid replacement, and cervical hyperextension or hyperflexion.1,2 

Patients with recent facial laser skin resurfacing are at greater risk of perioperative facial pressure ulcers...

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