Face lift, part I: Extent of undermining of skin flaps

One theory in cheek-neck lifting is that it is necessary to undermine skin flaps widely to achieve adequate short and long term results. We have proven that extensive undermining allows no more skin to be excised than is permitted by more conservative undermining when snug skin closures are used. Another part of the theory is that a sheet of scar tissue ("favorable fibrosis") forms and that the larger sheet of scar from more extensive undermining maintains the improvement from the lift longer than would a smaller sheet from less undermining. Controlled studies presented here cast doubt on this part of the theory. Many years ago we ran a series on patients in whom one side had essentially twice as much undermining as did the other. Equal amounts of skin were removed on both sides. Short and long term results were essentially the same on the two sides.