Periauricular face lift incisions and the auricular anchor

There is one problematic part of the facialplasty procedure that has been addressed with relative infrequency in the plastic surgery literature. This is the aesthetic management of the periauricular incisions and the resultant wound. The following problems associated with the design and closure of the periauricular incisions are recognized: (1) wide, hypertropic, or hypopigmented scars; (2) excessively elevated temporal hairline and a postauricular hairline "step" deformity; (3) "hidden" or "buried" tragus; (4) low, visible mastoid skin scars; and (5) deformed ear lobule or "pixie ear" deformity. Prevention of these undesirable results of facialplasty and cosmetic enhancement of the periauricular area for the facialplasty patient is the surgical challenge about which this article is concerned. The author's approach to the management of the periauricular area has been used successfully on 770 patients since 1985. This approach includes a unique incision design as well as a technique for internally splinting the periauricular incision at the time of wound closure. The incision design can eliminate the problems of elevated temporal hairline, disruption of the postauricular hair-line, and visible mastoid skin scarring. The incorporated internal splinting technique reduces skin level closure tension to improve the quality of the skin scar formation. This approach further allows for retaining a natural-appearing shape of both the tragus and the lobule of the ear. The biomechanical basis for the internal splinting technique was examined by measuring the forces required to transpose facialplasty flaps to the periauricular area. The auricular cartilage was demonstrated to be a remarkably stable structure to which these flaps could be anchored.