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John H. Hartley, Jr., MD Timothy J. Marten, MD John William Little, MD Brunno Ristow, MD Editor's note: My thanks to the moderator, John H. Hartley, Jr., MD (board-certified plastic surgeon and ASAPS member, Atlanta, GA), and to panelists John William Little, MD (board-certified plastic surgeon and ASAPS member, Washington, DC); Timothy J. Marten, MD (board-certified plastic surgeon and ASAPS member, San Francisco, CA); and Brunno Ristow, MD (board-certified plastic surgeon and ASAPS member, San Francisco, CA), for sharing their opinions and clinical experiences. Dr. Hartley: The first patient is a 44-year-old woman who wants facial rejuvenation surgery (Figure 1, A). She usually wears her hair swept up. Dr. Marten, where would you put your incisions on this patient? Figure 1 A, Lateral view of a 44-year-old woman who wants facial rejuvenation surgery. B to D, Panelists’ incisional techniques: B, Dr. Marten; C, Dr. Ristow; D, Dr. Little (“omega incision”). Illustrations by Martha Garrison. Dr. Marten: In choosing where to make the temple portion of the face lift incision, the existing amount of temporal “skin show” must be considered in conjunction with the amount of cheek laxity. This allows an estimate to be made of the degree of sideburn displacement that will occur when the face lift flap is shifted. If a large shift is predicted, placement of the incision along the temporal hairline should be considered. If the shift is small, the incision can be placed in the “traditional” location on the temple scalp. This patient has modest cheek laxity and sideburn hair that sweeps posteriorly. Although the choice would and should be hers, an incision on the temple scalp probably represents the best compromise. Preauricularly, it would sweep down in the groove between the helix and cheek, along the margin of the tragus around the lobule, and back up in … |
