The posterior incisions should be designed to accommodate the skin elevation obtained in some cases where the neck skin is not in excess. The scar can remain behind the ear sulcus and not enter the mastoid area, which is then a very good advantage.
A low placement of the scar in the mastoid will help in lifting the neck skin; however, in young persons keloids can develop if the scar is low and oblique. The scar should be made at the limit of the scalp and be in a zigzag fashion to prevent keloid formation. A high incision may be the cause of postauricular bald area and should be avoided; a very large flap excision is necessary when a large amount of excess tissue is present. One should be extremely careful in these cases not to raise the hairline too high in the posterior auricular mastoid area (Fig. 65.6).
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