The effectiveness of occipital artery ligations as a priming procedure for extensive scalp-lifting.

Extensive scalp-lifting is a relatively new cosmetic scalp procedure that involves cutting both occipital arteries, which then allows undermining of the entire donor dominant scalp down to the hairline of the nape. Because of this more extensive undermining, dramatic improvements are accomplished even with one operation. Conversely, one can develop necrosis at the nuchal ridge because of a sudden curtailment of circulation in the occipital region. In an attempt to eliminate this complication, the author experimented with "horizontal incision ligations" of the occipital arteries 4 to 8 weeks prior to the surgery which resulted in a significant reduction in the average size of necrosis (from 3.1 cm2 to 1.6 cm2; P = .036) but no significant difference in the incidence (P = .49). When these patients did develop necrosis, it always occurred below the horizontal incisions--therefore, the procedure was changed to vertical incisions, which to date have yielded a significant protective effect when compared with the previous method of "horizontal incision ligations" (P = .014), and even greater significance when compared with the original method of no previous ligations (P = .012). Vertical-incision ligation performed 4 to 8 weeks prior to surgery is an optimal method for preventing the complication of necrosis after extensive scalp-lifting surgery.