This step of the operation is done by pulling the cutaneous flap posteriorly and superiorly (Fig. 39.13). Using Pitanguy's forceps (Fig. 39.13) to mark the projection of the incisions on the skin, we do a temporary
direction of the neck and the excess is incised with a knife. b After the incision, the excess skin is pulled upward behind the ear and a temporary stitch is done
stitch on the projection of the anterior border of the ear in order to block the skin flap as emphasized by Pitanguy [21-24], providing a natural result avoiding the stigma of the surgery. Afterwards using three forceps, we pull the cervical skin flap upward following the direction of the neck and again the excess skin is marked and incised (Fig. 39.14a) and a temporary stitch is done posteriorly on the mastoid area (Fig. 14b).
Once the cutaneous flap has been pulled, the redundant skin is excised with a knife all around the ear. The amount of traction which is applied depends on the state of the skin and the nature and degree of correction required. It is time to emphasize that rhytidoplasty is a palliative procedure since the aging process does not stop. Fore this reason the operation should achieve a natural and smooth result (Figs. 39.11-39.15).
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