temporal area. This temporal incision is mainly to prevent a “dog ear” when closing the flap. In contrast, in the occipital area, a larger amount of skin can be excised. This allows tightening the skin of the neck. This area can tolerate moderate tension. Absorbable sutures such as 4–0 Vicryl can be used for subcutaneous closure. Closure of the skin in this area can be done with surgical staples. Closure from posterior to anterior direction can minimize the development of “dog ear” deformity. The ear lobe sits approximately 12–15° posterior to the long axis of the ear. Excessive skin removal in this area of the ear lobe can displace it anterior or inferior. If desired, the ear lobe may be secured in position with a single interrupted 6–0 vicryl suture. This suture subcutaneously attaches the most inferomedial portion of the ear lobe to the underlying SMAS tissue.

deformities, and (7) parotid gland pseudocyst. With emerging so-called minimally invasive procedures such as thread lifts, new complications have been reported, including Stensen’s duct laceration and suture visibility and extrusion.

29.4.1 Hematoma

Major hematomas are a true emergency. Immediate surgical drainage is necessary to avoid flap necrosis. Often no discrete bleeding vessel is identified during surgical exploration. Direct evacuation of minor hematomas is preferred if the hematoma is detected early and is easily reachable through an existing incision. Otherwise, minor hematomas may be treated with serial needle aspirations and pressure dressing. Antibiotic prophylaxis is suggested.

29.3 Postoperative Care

The use of drains is controversial. If desired a JacksonPratt drain can be placed through a small stab incision in the occipital portion of the flap and passed into the neck. It can be removed in the first postoperative day. ABD and Kerlex dressing can be applied. It should not be so tight as to cause pain or place pressure on the flaps. Excessive pressure can lead to flap necrosis. The dressing is removed in 24 h. Sutures are removed in 1 week and staples at 7–10 days. Patients can be placed on a Medrol Dose pack if there is no contraindication. This can help with postoperative edema.

29.4 Complications

Complications following rhytidectomy can be devastating, particularly because of the elective nature of this procedure [4]. As with all surgical procedures, complication prevention is paramount. Proper patient selection, mastery of pertinent anatomy, attention to meticulous surgical technique, and conscientious postoperative care are all important factors in preventing face-lift surgery complications.

Complications may include (1) hematoma, (2) nerve injuries, (3) infection, (4) skin flap necrosis, (5) hypertrophic scarring, (6) alopecia and hairline/earlobe

29.4.2 Nerve Injury

If a motor nerve is knowingly transected, immediate microscopic neurorrhaphy is indicated. If nerve injury is noted postoperatively, institute expectant management. Eliminate anesthetic effect. Transient paralysis is more likely than permanent paralysis.

29.4.3 Infection

Major infections requiring intravenous antibiotics are rare. The predominant organisms causing infection are staphylococci. Patients with minor hematomas may warrant oral antibiotic prophylaxis.

29.4.4 Skin Flap Necrosis

Treat partial-thickness injury with moist surgical bandage, occlusive ointments, or both. These injuries may result in normal healing, hypertrophic scar formation, or abnormal pigmentation. Treat full-thickness injury with conservative debridement and healing by secondary intention.