References

1.Baker DC, Conley J. Avoiding facial nerve injuries in rhytidectomy: anatomical variations and pitfalls. Plast Reconstr Surg. 1979;64(6):781–95.

2.Mowlavi A, Majzoub RK, Cooney DS, Wilhelmi BJ, Guyuron B. Follicular anatomy of the anterior temporal hairline and implications for rhytidectomy. Plast Reconstr Surg. 2007;119(6):1891–5.

3.Hagerty RC, Scioscia PJ. The medial SMAS lift with aggressive temporal skin take out. Plast Reconstr Surg. 1998; 101(6):1650–6.

4.Hagerty RC, Mittelstaedt SJ, O’Neill P, Harvey TS. Lateral canthopexy using the hollow needle technique. Plast Reconstr Surg. 2006;117(4):1289–91.

5.McCord CD, Doxanas MT. Browplasty and browpexy: an adjunct to blepharoplasty. Plast Reconstr Surg. 1990;86(2): 248–54.

6.Knize DM. Limited incision forehead lift for eyebrow elevation to enhance upper blepharoplasty. Plast Reconstr Surg. 2001;108(2):564–7.

7.Miller TA. Continuing medical education examination–facial aesthetic surgery: lateral subcutaneous brow lift. Aesthetic Surg J. 2003;23(3):205–10.

8.Baker DC. Minimal invasive rhytidectomy (short-scar facelift) with lateral SMASectomy. Aesthetic Surg J. 2001;21(1):68–79.

9.Mitz V. Current face lifting procedure: an attempt at evaluation. Ann Plast Surg. 1986;17(3):184–93.

10.Hagerty RC. Central suspension technique at the midface. Plast Reconstr Surg. 1995;96(3):728–30.

33.1 Introduction

Short-scar cervicofacial rhytidectomy is an excellent approach to facial rejuvenation [1]. While it achieves fully advanced results as much as any extended scar facelift, it also achieves this result with a much shorter incision and lesser skin undermining that in turn decreases complications [1].

Historically, one of the earliest facelift publications [2] described use of a short preauricular incision and only very limited skin undermining. During the decades that followed, surgeons decided to undermine skin farther to achieve better results by removing more of the excess skin. Obviously this resulted in excess skin at the end part of excisions resulting in dog ears. The attempt to remove dog ears involved incisions at the temple and occipital area as conventional face-lift scars with often ill effects at temporal hair growth and anatomy and adverse alterations in hair line and its growth pattern in the occipital area. Some European surgeons had started to use short incisions with the elimination of occipital scar, but still using temporal scars [3]. In 1993, I started basic additions to this technique to make it usable in the majority of aging deformities even in patients in their seventies. Understanding these alterations will help the plastic surgeon to better utilize the technical detail that is to follow more efficiently.

H. Massiha

Department of Plastic Surgery, Louisiana State University, School of Medicine, 3939 Horima Blvd., Suite 216, Metairie, LA 70006, USA

e-mail: massihamd@aol.com

33.2Author’s Addition and Deletion to Short-Scar Technique

1.Elimination of temporal incision. At the present status of my technique there are no incisions at the hair-bearing areas of the scalp. Addition of incision at the sideburn area makes this change very easy to achieve.

2.Extended SMAS/Platysma dissection while keeping skin dissection to a minimum.

3.Skin undermining to a minimal and to the as needed level. Thus when SMAS is lifted and fixed at the appropriate level on the cheek and preauricular area, the skin of the neck, jowls, and neck line area is pulled up while still attached to the SMAS/platysma. The attachments of skin with SMAS/platysma are very firm due to fibrotic band that arises from SMAS/platysma and penetrates dermis [3]. This fact helps the skin move up together with the SMAS.

The benefits of this approach are:

1.Tension on skin per se is less.

2.Circulation to the skin is preserved better by not dissecting it.

3.The vectors of lift are different for SMAS and skin. Since SMAS is more pliable than skin and excision of it in any direction does not cause visible scarring the vectors could be fashioned to achieve the most natural aesthetic outcome. But, skin excision vectors could be fastened in such a way that while being aesthetically pleasing, the scars could be kept short and well hidden [1].

4.Posteroanterior vectors of lift at the postauricular and mastoid area.