Face lifts with hidden scars: the vertical U incision.

The authors present their latest development of a strictly vertical retroauricular incision to minimize a sequela of a face lift, namely, a visible scar. The temporal preauricular vertical incision and the retroauricular vertical incision form two parallel arms of a U-shaped incision. Anteriorly, a downward rotation flap is made to maintain the horizontal temporal line at the right level, and posteriorly, the scalp is incised vertically, followed by extensive superficial retroauricular undermining. In both temporal and retroauricular areas, skin and scalp undergo a redistribution rather than resection, which is extremely limited. The authors' experience with 100 patients who were operated on with vertical U incisions since April of 2000 is described. A total of 35 patients were evaluated after a 6-month follow-up by using clinical and photographic examinations. There were very few complications because the extensive retroauricular flap has good viability. There were no problems with sensitivity, hair loss, or scar spreading, and the hairline was not displaced. The quality of the scar was excellent in the majority of cases. We experienced only a few hypertrophic but well-hidden scars. This approach can also be used in secondary cases when the primary scar is of good quality. The neck pull is as effective as that in the classic approach with a traverse retroauricular incision. The nondetectability of the retroauricular scar is of special interest in young patients and in men. The authors believe there is no contraindication for this technique. It does not significantly prolong the operating time. It includes a large undermining in the retroauricular area (6 cm from the sulcus), but this dissection is easily performed in the superficial plane. In addition to using fibrin glue in the undermined areas, the authors drain the neck. They do not use dressings. Recovery was fast, and there were only two instances of hematomas and two instances of subcutaneous cervical fluid collections in which patients required treatment.