what the best way to reduce inflamation on ear lopes after a neck lift

Abstract

Background: The telltale signs associated with facelift procedures, including tightening of the lower face (lateral sweep), visible scars, a distorted hairline, and the "pixie ear" deformity are grounds for concern among both patients and aesthetic surgeons. It is the writer's conventionalities that facelift results can be improved with correct positioning of the ears, so that these signs are reduced or eliminated altogether.

Objective: The purpose of this paper is to report the causes of ear deformity and describe the advantages of the author's technique for the prevention of ear deformities in facelift surgeries.

Methods: Between January 2005 and Nov 2007, the writer performed facelifts on 106 patients using a technique that included autologous fatty injections to meliorate facial volume, hidden incisions in and around the ear, and absorbable bidirectional barbed sutures. Patient charts and photographs were reviewed retrospectively. Pre- and postoperative angles were measured with respect to the ear and face and were documented to make up one's mind the caste of improvement or deformity.

Results: Pregnant improvement of the specified angles was noted in 70% of cases post-obit facelift surgery; in these cases, the ear position was elevated. No change in ear position occurred in ten% of cases. Some distortion and lowering of the ear was seen in the remaining cases.

Conclusions: Recognition of the furnishings of aging on the ear and the mechanisms leading to ear deformity associated with facelift procedures tin can assist in achieving improved aesthetic results. The advantages of the writer'south technique include shorter incisions, a diminished need to remove redundant peel, ear meridian, and a smoother repair with improved contour. Farther investigation of long-term results is necessary.

Patients are frequently enlightened of and concerned about an unnatural appearance resulting from facelift surgery. The nigh obvious characteristic of this "artificial" issue is an unnatural tightening of the lower confront, frequently called a "Joker's line" or "lateral sweep." ¹ The hairline can frequently become distorted, revealing obvious facelift scars, and in that location tin also exist visible scars both in front of and in dorsum of the ears. In addition, elongation of the tragus and earlobe may occur. This particular deformity is referred to as a "pixie ear" deformity (Effigy ane). The writer presents a method for avoiding ear deformities by which he believes such deformities tin exist reduced or completely eliminated.

Figure i

The "pixie ear" deformity. A, Preoperative view of a 55-year-sometime patient. B, Postoperative view ane year afterward facelift.

The classical facelift, South-lift, short scar, and minimal access cranial suspension (MACS) lift techniques unremarkably involve repairing loose tissue through an incision effectually part of the ear and into the hairline, elevating and tightening the superficial muscular aponeurotic system (SMAS) and repairing the cervix. Regardless of whether the facelift is achieved with the apply of a SMAS elevation or imbrication, information technology may still event in ear deformity because the force of summit of the SMAS or plication may cause the ear to be distorted. The added effect of the traction lines acquired by the various vector repair procedures (Effigy 2) can result in the aforementioned artificial-looking tightening of the lower face. This "pulled" expect is undesirable to both patients and surgeons. There have been many attempts to right these deformities, but the distortion of the earlobe tragus (and drooping of the ear related to changes in its longitudinal axis) are often considered inevitable.

Figure 2

Forces distorting the ear.

The effect of the traction involved in vector repair may distort the lower confront and ears past emphasizing and elongating facial shadows (V. Lambros, MD, personal phone communication). Some of the vectors, as shown in Effigy 2, increase deformity, specially if the patient has thin or sun-damaged pare. The unnatural look oft becomes exaggerated if the patient has horizontal, static sleep lines or deep wrinkles. The angle of these lines changes and thereby exacerbates the unnatural, "pulled" await of the operated face. Changes in the shape, length, or angulation of the ear crusade this deformity to go even more obvious. Any attempt to tighten the SMAS to the surrounding periauricular fascia with vertically- or horizontally-oriented vectors causes further baloney of the ear. This deformity of the ear can be seen before placement of the final suture in the classical facelift technique, while the patient is nevertheless supine on the operating tabular array and before gravity worsens the deformity.

The writer's impression is that, at the completion of surgery, the superior aspect of the ear already drifts 0.v cm to 1 cm beneath the horizontal level of the eyebrow. This situation worsens with fourth dimension as the impact of gravity further affects the ear; the soft tissue of the ear is very delicate and may become elongated on its own. Heavy earrings tin also stretch the earlobe. In addition, the skin envelope is larger and more skin has to be discarded in a sunken face with lowered ears. The apply of longer incisions to remove the excess skin results in visible scars and distorted hairlines. In summary, distortion of the face resulting from classical facelift techniques is seen in the form of a flattened midface, changes in the shape and angles of the ears, and the presence of visible scars.

The writer recognized that in facelift procedures, reduced peel removal was associated with a shorter scar around the ear. In the writer's method, the flaps are elevated; repair of the neck and SMAS is performed according to the patient'due south need. Midface volume is augmented with autologous fat and the entire ear is elevated relative to its preoperative position. A face with more volume and ears that are positioned college requires less skin removal, allowing the apply of shorter incisions hidden more often than not inside the ear, with no baloney of the hair lines.

Many thin patients will do good from a combination of increased book and various vector tractions. In patients who nowadays with excess facial skin, a modified technique can be adapted, such equally the use of a V–Y advancement flap in the dorsum of the ear. Some other choice is removal of the hairless skin at the top of the ear.

Technique

Betwixt January 2005 and Nov 2007, the author performed facelifts on 106 patients. At the outset of each procedure, the patient's own fatty was harvested, and twenty mL to 30 mL of fat was injected into various compartments, such as the malar area, nasolabial fold, marionette lines, and lips. This replenished the facial volume that had been lost during aging and created an improved three-dimensional appearance of the confront. Hidden incisions were made using a 360° (round block) technique both inside and around the back crease of the ears (Figures 3 and 4).

Effigy 3

Incisions in the interior part of the ear.

Effigy 4

Incisions in the posterior part of the ear.

The connection between the inductive and posterior incision lines was achieved with a 90° incision over the top of the helix at the junction of the ear and the face, where in that location is hair-free skin. The skin flaps were elevated all the way down to the midline of the cervix, leaving a span of soft tissue (ie. a bulge of super- and subplatysmal fat).

Ear Elevation With the Shaped Stitch

In cases of preexisting pixie ear deformity, the pulled-downward lobe was released from its fibrosed ligament with scissors or cautery. A ii–0 Quill suture (Angiotech Pharmaceuticals; Vancouver, British Columbia, Canada) was placed at the base of the tragus, which became the new junior otobasion. Each of the Keith needles (Angiotech Pharmaceuticals) with 2–0 Quill sutures was allowed to run all the manner up to the temple—i in front of and one behind the ear (Figure 5). By controlling and distributing the tension in the periauricular area, the unabridged ear complex was advanced towards the temple in a 360° island round block technique. The typical descent and migration of the ear—forwards and downwardly—was reduced significantly. The anterior border of the ear canal was secured at a higher position without distortion.

Figure v

U-shaped sutures were used to elevate the ear. The red line illustrates hidden ear round block incisions. Inset: close-up view of U-shaped bidirectional absorbable spinous suture.

Cervix Repair: Submental Approach

Autopsy was performed through a 4-cm submental incision to the base of the neck. Using a long forceps and cautery, the fibrofatty tissue was removed, leaving the two edges of the platysma exposed. Removal of the axis super- and subplatysmal fat was performed with the use of the direct excisional method. Careful attention was paid to maintain hemostasis.

Using a U-shaped 2–0 bidirectional absorbable barbed suture, the edges of the platysma were approximated in the midline from the chin down to the base of operations of the neck, and then back upwards toward the midline. By returning a needle back from the base of the neck toward the midline, a purse-string result was obtained without bunching the skin and without any need to tie a knot.

The Quill polydioxanone (PDO) self-retaining system suture allows for an increase in both speed and reliability, therefore providing good strength to the repair. These sutures are fabricated with specific affront geometry parameters, creating a superior wound-belongings ability when compared with conventional sutures. Each suture contains a spiral array of barbs that are divided into ii equal but opposing segments. ² The barb wound closure device eliminates the need to tie a knot and enables use of running (every bit opposed to interrupted) sutures. Increased control of the tension within the wound as the suture is advanced is possible without creating any bulk.

In addition, 2 2–0 sutures were placed on each side of the cervix at the midline. The increased length of these sutures allowed them to run from the cricoid cartilage at a 90° angle to the midline forth the jaw line, providing better back up to the submandibular ptotic tissues. The suture was inched along the platysma upwardly to the mastoid fascia and the postauricular area, and as loftier as the temporal fascia. The needle was allowed to exit above the ear, outside of the occipital hair, where information technology was pulled under tension and cut short nether the skin and sunken so that it does non beetle.

Correction of the Aging Face

The facial flaps that were elevated at the commencement of the procedure were inspected and hemostasis was obtained with care. The jowls were trimmed. A long, U-shaped, double 4–0 Quill suture was fixed to the deep temporal fascia at the starting bespeak, 0.5 cm higher up the zygomatic arch and 0.5 cm in front of the helical rim cartilage of the exposed ear. Intendance was taken to avoid injury to the superficial temporal vessels and nerves. One needle was directed toward the tragus, parallel to the anterior edge of the ear vertically. Firm bites one cm to 2 cm apart were used to drag the loose SMAS tissue. The bidirectional affront sutures controlled and distributed the tension of this loose tissue.

The repair continued down to the region of the mandibular angle. At this signal, the beginning needle was turned vertically upwardly to the superior portion of the preauricular area, facilitating a purse-string issue and elevating sagging tissue. This needle was brought back to the starting point diagonally, toward the trimmed jowls, gathering the SMAS. Careful attending was paid to taking bites in the superficial fascia to eliminate any danger of injury to the facial vessel and fretfulness. The needle was then redirected diagonally back to the starting point in a zigzag fashion. Note that, at this time, both the vertical oblique and horizontal laxity of the facial tissue has been corrected. Some tissue protrusion appeared to exist present between the suture materials.

The 2d needle was and then directed from the original starting point, thereby correcting the tissue profusion and turning a "hill and valley" into a smooth plain. The full length of the suture was used, bringing the second needle dorsum to its starting point. At this point, all the loose tissue had been gathered, flattened, and repaired, creating a total midface and malar mountain. In the end, the ii needles were brought to the starting point, then the suture was cut and knotted together.

Finally, an boosted 4–0 Monocryl suture (Ethicon, Somerville, NJ) was placed at the starting betoken; this suture was used to further even out any irregularities left behind by the Quill sutures.

Skin Reposition and Resection

Unlike the classical facelift repair, the vector of the midface repair in this process was more often than not vertical and only partially horizontal. Information technology did not compromise or lower the ear. This was possible because the ear had been secured with the U-shaped bidirectional barbed suture, upwardly into the temporalis fascia. The peel flap was subjected to moderate vertical tension and any skin backlog was determined and addressed (Figure 6).

Figure 6

Insert of the flap.

Measurements

Through the retrospective examination of preoperative patient photographs, midface vectors and angles were calculated by measuring the angles created by the intersection vertical vectors with lines fatigued from the base of the nose (10) to the integral incision (I) and the subaurale (Due south) (Figure 7). These angles (equally they appeared in postoperative photographs) were recalculated at three months for all patients by an contained reviewer to determine the degree of improvement.

Effigy 7

Degrees of ear position improvement.

Results

A total of 106 patients were treated using this technique between January 2005 and Nov 2007. The success rate in preventing ear deformities and achieving a natural look was pregnant. In 70% of patients, the angles between points I, S, and Ten increased by an average of 9.0°. The entire ear was elevated, creating a better advent (Figures 8 to 10). In 10% of patients, the ear remained at the original site. In 20% of patients, the angles between points I, S, and X were reduced by iii°. In these cases, the ear was lowered, creating a pulled, deformed wait. Using the 360° round cake inside-ear incision technique resulted in a more natural-looking facelift. Eighty percent of patients surveyed at one yr by a patient educator during follow-upwards visits were pleased with the overall results.

Figure 8

A, Preoperative view of a 75-yr-former woman. B, Postoperative view nine months after facelift.

Figure 9

A, Preoperative view of a 53-yr-old woman. B, Postoperative view xvi months after facelift.

Figure 10

A, Preoperative view of a 61-year-quondam adult female. B, Postoperative view 24 months after facelift.

No hematoma or infection occurred in this serial. Twelve patients complained of transitory discomfort in their ears caused past initial swelling, which subsided in 2 to iii weeks. Two patients needed revision of the suspension suture repair; these were in the outset group of patients, in whom the repair was performed with iv–0 nylon sutures that were damaged or became loose. The author no longer uses these sutures. Healing proceeded in all patients without major sequelae. Nigh patients returned to normal activities in ten to 14 days.

Give-and-take

In the writer'southward opinion, most facelift techniques leave the superlative of the helix lower than the horizontal level of the eyebrow, while the bottom of the ear extends to the bottom of the mandible. Before surgery, there is no sign of such a deformity; it develops as the operation progresses.

Several different authors have discussed the anatomy, morphology, and repair of the external ear.^2–iv Connell ⁵ recommended resetting the earlobe and so that the "bending of the dangle" is rotated 12° to xv° posterior to the long centrality of the ear. Stuzin ^{half dozen} recommended converting a lobule without a dangle to one with a dangle by rotating the "O" point upwardly to circular off the front end of the lobe, thereby creating a slightly higher inferior otobasion. This is accomplished by removing a modest, triangular portion of the earlobe skin. A similar technique was also suggested by Lindgren and Carlin. ^seven Clevens and Bakery ⁸ ascertain a pixie earlobe as an attached earlobe that appears to be stretched and elongated caudally. It is an iatrogenic earlobe deformity in which there is increased tension at the earlobe skin flap junction or incorrect placement of the base of the earlobe, and information technology is normally seen after a facelift.^{4,half-dozen–15}

Although various approaches, discussions, and solutions have appeared in the literature, a consummate explanation of the cause of this deformity is still lacking. In the author'south opinion, the ear deformity is brought most by the repair of the SMAS, the cervix, and the distortion of the hairline.

The author kickoff discussed ear deformity in 1996, ^nine noting that the ear's original position can modify every bit a consequence of diverse facelift techniques that impose a loftier degree of tension on the soft tissue of the ear. Even without this tension, the ear drifts caudally as the patient ages.

At first, the author connected the ear's island round block sutures with a buried iv–0 nylon suture. This suture was connected to the island sutures at the 12 o'clock position using a long needle, with interrupted incisions in the scalp over the calvarial bone. These island sutures were placed under tension, either elevating the ears or preventing them from drifting down. Considering the unabridged ear was elevated, a bottom corporeality of facial pare flap had to be removed and there was no change in the hairline or the shape of the ear. Furthermore, the hidden incisions prevented any pull on the earlobe and the helix. The logic behind this was that the occipital os is the only stable structure in the head that will not "give," so deformity of the ear and face would be prevented.

This technique was time-consuming and required the use of suture knots that could be palpated and exposed. With the appearance of the bidirectional Quill barbed suture, the repair could be achieved without knots. This suture allows progressive control (and fifty-fifty tension) on the tissue. It is not necessary to laissez passer these sutures over the entire calvarium; instead, they are threaded to the temporalis fascia, pulled through, and cutting off. This technique significantly shortened the amount of time needed for the operation.

The results presented in this manuscript are preliminary; a long-term (three-year) follow-up is nevertheless under way and a complete analysis of the data has not yet been undertaken. Thus far, we have non encountered any deterioration of the repair other than that acquired past the normal aging process. Further information, including an assessment of the long-term results using the Quill sutures, are still needed.

Conclusions

An explanation of the mechanism leading to ear deformity associated with facelift procedures is presented. A facelift technique is described that uses autologous fat to ameliorate facial volume, hidden incisions fabricated almost totally inside the ear with a 360° round block technique, and absorbable bidirectional barbed sutures. The described technique allows less skin to be removed, while the remaining skin flaps heal remarkably. It also results in shorter and more concealable scars, and achievement of a smoother repair, improved contour, and a more natural look. Further long-term assessment of the results is necessary.

Acknowledgment

The author would similar to thank Vinod Podichetty, MD, MS, for his aid with research and manuscript preparation.

Disclosures

The writer has no disclosures with respect to the contents of this article.

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Author notes

Dr. Human being is a board-certified plastic surgeon and is in private practice in Boca Raton, FL.

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Source: https://academic.oup.com/asj/article/29/4/264/191494

what the best way to reduce inflamation on ear lopes after a neck lift

Abstract

Technique

Ear Elevation With the Shaped Stitch

Cervix Repair: Submental Approach

Correction of the Aging Face

Skin Reposition and Resection

Measurements

Results

Give-and-take

Conclusions

Acknowledgment

Disclosures

References

Author notes

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