Evaluation of 100 Cases

The vertical approach has been used since April 2000. The first 100 cases [4], from April 2000 to July 2001, were carefully evaluated and the results are as follows.

The 100 consecutive patients, ranging in age from 44 to 80 years, were operated on either for primary or secondary face lifts. The subjects included 94 women and six men. Total excision of excess cervical skin ranged from 6 to 14 cm, with an average of 8.4 cm

(i.e., 4.2 cm on each side). The distance between the retroauricular sulcus and the hairline was measured at the Frankfurt line level in ten patients before and after surgery. The backward displacement ranged between 0 and 3 mm. In these ten patients, the mean displacement between the ear and the hairline was therefore only 1.5 mm (Fig. 47.9). The early complications were limited.

Among our 100 patients, two partial retroauricu-lar skin sloughs occurred, one in a heavy smoker (two packs a day) and one in a nonsmoker patient who developed sloughs in all undermined areas, temporal

Fig. 47.9. Clinical example of vertical retroauricular closure. Top left: Extensive superficial undermining to 6 cm from the sulcus. Top center: Hairline is realigned at B, with a moderate pull and upward displacement of the posterior scalp flap. Top right: Above B, there is a discrepancy between the anterior scalp edge (3 cm) and the posterior edge (4-5 cm). Bottom left: The posterior flap will be pushed upward. Bottom center: After pushing upward behind the ear, a key point stitch is placed at D. The skin discrepancy is now mostly between B and D. Bottom right: The thin retroauricular skin adjusts well after multilayered closure. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)

Retroauricular

Fig. 47.10. Early folds in thick skin. Left: Eight days after a U-incision face lift with 5.5 cm retroauricular displacement in a 54-year-old male patient. Center: Two months later, the skin folds have disappeared. Right: Six months later, the retroau-

ricular scar is not visible. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)

Fig. 47.10. Early folds in thick skin. Left: Eight days after a U-incision face lift with 5.5 cm retroauricular displacement in a 54-year-old male patient. Center: Two months later, the skin folds have disappeared. Right: Six months later, the retroau-

ricular scar is not visible. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)

and retroauricular, with no known disease or coagulopathy symptoms. The first patient developed a hidden retroauricular hypertrophic scar, and the second had some visible scars below the ear lobe. Two hematomas requiring evacuation occurred, but only two patients required aspiration of fluid in the cervical area. One postoperative cervical infection on the ninth day was observed on one side. The retroauricu-lar incision was opened by a general surgeon for evacuation of the abscess, drainage, and irrigation; it healed uneventfully.

The scar remained well-hidden, being restricted to the retroauricular area. In five patients, retroauricu-lar skin folds were observed, especially at the beginning of our experience. These gradually improved, and only one required revision (Fig. 47.10). There was no hair loss in the undermined retroauricular scalp area, whereas some temporary hair loss was observed in the temporal area in about 10% of patients. Two hypertrophic scars were observed, creating a few folds. No patient complained of pain or sensitivity problems in the retroauricular area.

Thirty-five patients were reviewed for follow-up at 6 months. The scars were of extremely good quality in the retroauricular sulcus. The vertical component between the sulcus and the hairline was well-hidden by the ear in all cases, and it was necessary to pull the ear outwards and lift the hair to see it. The scalp portion was also of good quality. There were no cases of enlarged or distended scars (Figs. 47.11, 47.12).

In most patients, the retroauricular area was flat, with a linear scar. In five patients, there were a few posterior folds. They were all well-hidden behind the ear, and only one patient requested revision, which was easily done by elevating the posterior edge and resecting the extra skin.

The overall result of the face and neck lift was good, equivalent at the neck level to the previous approach with a transversal incision (Figs. 47.13, 47.14). The patients expressed their satisfaction at having no visible retroauricular scars. This was true not only for the primary cases (26 out of the 35 cases reviewed) but also for the nine secondary cases.

Papular Retroauricuular
  1. 47.11. Left: Five days after vertical incision in a 60-year-old female patient; 5 cm retroau-ricular displacement. Right: Six months later, the scar is linear and the retroauricular area is smooth. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)
  2. 47.11. Left: Five days after vertical incision in a 60-year-old female patient; 5 cm retroau-ricular displacement. Right: Six months later, the scar is linear and the retroauricular area is smooth. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)
Abces Retroauricular
  1. 47.12. Left, top: One month postoperatively Left, bottom, and right: Six months after U-incision face lift in a 45-year-old female patient; 4.5 cm backward displacement. The wide retroauricular area and the pulled-back hairstyle make it essential to avoid a visible scar. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)
  2. 47.12. Left, top: One month postoperatively Left, bottom, and right: Six months after U-incision face lift in a 45-year-old female patient; 4.5 cm backward displacement. The wide retroauricular area and the pulled-back hairstyle make it essential to avoid a visible scar. (Reproduced from Marchac et al. [4], with kind permission of the editor of Plastic and Reconstructive Surgery)
Top Reconstructive Ear Surgeons

Fig. 47.13. Left: A 58-year-old female patient. Right: Six months Center: The ear must be retracted forward to see the vertical after U-incision face lift with a vertical retroauricular scar and scar. (Reproduced from Marchac et al. [4], with kind permis-

temporal downward triangle. The temporal horizontal scar is sion of the editor of Plastic and Reconstructive Surgery) not visible, hidden by the downward movement of the hair.

Fig. 47.13. Left: A 58-year-old female patient. Right: Six months Center: The ear must be retracted forward to see the vertical after U-incision face lift with a vertical retroauricular scar and scar. (Reproduced from Marchac et al. [4], with kind permis-

temporal downward triangle. The temporal horizontal scar is sion of the editor of Plastic and Reconstructive Surgery) not visible, hidden by the downward movement of the hair.

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