Fig. 31.12 Cogged threads

lobe, then making a snug fit around the lobe as scars tend to migrate downward and drag the ear lobe down. Subcutaneous sutures should be inserted to remove tension which is important to the final result. Staples

are inserted in the posterior hair-bearing area and the temporal wound. The rest are sutured with fine 4/0 Monocryl. Subcuticular sutures are preferred in front of the ear.

31.6 Dressings

Vaseline gauze is applied to the wounds, followed by 4 × 4 dressings, cotton wool is applied, and a 4 in. crepe bandage is meticulously applied and secured with 1 in. elastoplast.

31.7 Results

Final results are shown in Figs. 31.14–31.16.

References

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Baker DC. Lateral SMASectomy, plication and short scar facelifts: indications and techniques. Clin Plast Surg. 2008;35(4): 533–50.

Berry MG, Davies D. Platysma-SMAS plication facelift. J Plast Reconstr Aesthet Surg. 2010;63(5):793–800.

Caplin DA, Perlyn CA. Rejuvenation of the aging neck: current principles, techniques, and newer modifications. Facial Plast Surg Clin North Am. 2009;17(4):589–601.

Gassner HG, Rafii A, Young A, Murakami C, Moe KS, Larrabee Jr WF. Surgical anatomy of the face: implications for modern face-lift techniques. Arch Facial Plast Surg. 2008; 10(1):9–19.

Jones BM, Grover R. Reducing complications in cervicofacial rhytidectomy by tumescent infiltration: a comparative trial evaluating 678 consecutive face lifts. Plast Reconstr Surg. 2004;113(1):398–403.

Mendelson BC, Freeman ME, Wu W, Huggins RJ. Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold. Aesthetic Plast Surg. 2008; 32(2):185–95.

Mentz III HA, Ruiz-Razura A, Patronella CK, Newall G. Facelift: measurement of superficial muscular aponeurotic system advancement with and without zygomaticus major muscle release. Aesthetic Plast Surg. 2005;29(5):V 353–62.

Prado A, Andrades P, Fuentes P, Eulufi A, Cuadra A. The use of intra-SMAS absorbable barbed sutures to reinforce a highvector pull during rhytidectomy. Plast Reconstr Surg. 2008;122(6):215e–6e.

Schaverien MV, Pessa JE, Saint-Cyr M, Rohrich RJ. The arterial and venous anatomies of the lateral face lift flap and the SMAS. Plast Reconstr Surg. 2009;123(5):1581–7.

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van der Lei B, Cromheecke M, Hofer SO. The purse-string reinforced SMASectomy short scar facelift. Aesthetic Surg J. 2009;29(3):180–8.

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32.1 Introduction

A substantial amount of skin can be presented to the temporal area with the vertical facelift and lateral subcutaneous brow lift. The challenge is to excise as much skin as needed while maintaining hair follicles, minimizing scars, and eliminating unsightly anterior gathering of the skin. The significant advantage of the anterior hairline incision lies in the amount of vertical lift that can be provided to the lateral brow. There is a large amount of skin that can be removed from this area while continuing to allow the growth of hair anterior to the incision. This combination results in a natural-appearing vertical pull on the lateral face and less obvious scarring than previous techniques. The major criticism, and rightly so, is the possibility of unacceptable scarring.

Proper planning of the incision and skin excision can minimize the problems of scarring in the temporal area by paying attention to vector points in the hairline. The rationale for this procedure is based on the position of the hairline and the underlying anatomy and the orientation of the hair follicles [1, 2].

The purpose of this chapter is to address the scarring issue and present a surgical strategy to possibly

M.E. Lester ( )

University of Florida, 100286, Gainesville, FL 32610, USA e-mail: medmlester@yahoo.com

R.C. Hagerty

Medical University of South Carolina, 261 Calhoun St., Suite 200, Charleston, SC 29401, USA

e-mail: dukehagerty@aol.com

J.C. Crantford

Medical University of South Carolina, 375 Hoff Ave., Charleston, SC 29407, USA

e-mail: crantfo@musc.edu

decrease the negative ramifications of the anterior temporal hairline incisions. The senior author has routinely used this technique over the past 5 years in over 200 cases. His experience over 1 year is presented with 41 patients (Table 32.1).

32.2 Technique

It is important to first examine the patient from the frontal view and delineate the leading point for skin excision. The leading point should be placed 0.5 cm posterior to the hairline, just inferior to the receding hairline of the temporal area. The more skin that needs to be removed, the more lateral the leading point is placed in the temporal hairline. It is critical to preserve at least 2 cm between the eyebrow and the hairline (Fig. 32.1). This may mean removing hair-bearing skin. The scar must not be obvious from the frontal view, so the more laterally it is placed, the less conspicuous it will be.

The incision is further planned by placing a 4 cm line at about a 45° angle from the lead point into the receding hairline. The skin is incised at a 45° angle to preserve hair follicles. The rest of the temporal incision in the preauricular area is made with a W-plasty type incision incorporating hair follicles with the excised skin (Fig. 32.1). A limited incision can be carried around the lobule to the posterior auricular space depending on the amount of neck lift needed. The majority of the improvement in neck appearance is from the vertical pull for the neck lift. Very little neck skin is pulled in a diagonal vector as described below. Next, a subcutaneous lateral brow dissection is performed extending superiorly to the forehead over the temporalis muscle, medially to the lateral canthal