Direction of the Traction of the Cutaneous Facial and Neck Flap and its Resection

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

determine the excess of skin to be resected. b An incision is done with scissors where a temporary stitch is carried out
Versajet Method
Fig. 39.14. Peroperative photographs showing the traction and resection of the excess skin of the neck similar to Pitanguy's rhytidoplasty. a Using three forceps, we pull the cervical cutaneous flap on the left side pulled upward following the axial

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

Neck Traction Before And After
Fig. 39.15. A 63-year-old patient presenting skin and muscle flaccidity with adipositias on the face and neck. a, b, c Before surgery. d, e, f One year after rhytidoplasty with plication of the platysma laterally combined with lipoplasty

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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