THE POST-TRAGAL FACE LIFT INCISION

By ARMANDO HERNANDEZ, M.D.

Plastic Surgery Department, Hospital Mexico-Americano, Guadalajuru, Jalisco, Mexico

THE usual face lift incision runs in the pre-auricular fold in front of the tragus. Following the operation, the fold is of course obliterated and replaced by a scar. Many women find this objectionable and continually adopt a hair style to cover it. If the skin incision follows the posterior aspect of the tragus however this problem does not arise.

There is great variation in the size and shtipe of the tragus and it is important that the original form be maintained.

FIG. I. The line of incision marked.

FIG. 2. The skin over the tragus raised keeping the cartilage intact.

FIG. 3. A and B. The excess skin is marked and excised and the wound closed in stages.

Address for reprints: Lopez Mateos Norte 449, Guadalajara, Jal, Mexico.

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THE POST-TRAGAL FACE LIFT INCISION 363

TECHNIQUE

The incision running behind the tragus is marked in Figure I. The skin over the tragus is raised by sharp dissection avoiding any damage to the cartilage (Fig. 2). When the undermining of the skin of the face is complete the skin is pulled upward and backward over the ear and the excess excised in stages: above the tragus first, the tragus next and around the lobe last (Fig. 3). The skin which will cover the tragal cartilage has its subcutaneous fat removed with scissors to maintain the contour of the tragus (Figs. 4 and 5).

Typical results are shown in Figures 6 and 7. Precision in thinning the skin over the tragus is essential; if excessive. the skin may necrose; if inadequate, a bulky tragus results.

FIG. 4. The subcutaneous fat is removed from the skin which will cover the tragus.

FIG. 5. The skin has been sutured over the tragus.

FIG. 6. :I and B. Pre- and postperative views. Note how the shape of the tragus, peculiar to this patient. has been preserved.

FIG. 7. A and B. Pre- and postoperative views of another patient with a quite differently shaped tragus