title: The anchor tragal flap: a method of preserving the natural pretragal depression during rhytidectomy.
abstract: BACKGROUND
  The delicate shape of the tragus and the pretragal depression are fine landmarks on the face that are usually lost during conventional rhytidectomy. A relatively simple technique to preserve the natural pretragal depression after face lift has been implemented in the authors' practice. It provides an almost invisible incisional scar and avoids tragal distortion.
  
  
  METHODS
  Incision starts around the sideburn in a curvilinear fashion toward the helix and continues vertically down into the tragal margin and around the earlobe retroauricularly. The pretragal depression is created by separating the facial attachments and deepening the space anterior to the tragal cartilage and external auditory canal. The facial attachment is turned over and sutured over the parotid fascia with several 4-0 polydioxanone sutures. The base of the tragal flap created to fit into the tragus is anchored to the deep tissues in front of the tragus with two sutures of 5-0 polypropylene. The rest of the skin is closed in two layers and the tragal flap is inset without tension.
  
  
  RESULTS
  The addition of this component to the operation implemented in more than 300 patients did not significantly elongate the operative time. Complications encountered included partial necrosis of the skin that healed with secondary healing (two patients), pretragal indentation that was released under local anesthesia (two patients), and loss of the pretragal definition (three patients). Preservation of the natural appearance in the tragal and pretragal area was mentioned by the patient as a positive feature.
  
  
  CONCLUSIONS
  Re-creation of the natural tragus and pretragal depression without some of the surgical stigmata resultant from the loss of these delicate landmarks during a face lift has improved the aesthetic outcome of the authors' rhytidectomy patients.
authors.affiliation: John Hopkins University, Baltimore, MD, USA. oscar@ramirezmd.com
authors.forename: Oscar M
authors.initials: OM
authors.lastname: Ramirez
authors.forename: Lior
authors.initials: L
authors.lastname: Heller
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012060:Rejuvenation; D015361:Rhytidoplasty / Q000379:methods*; D013524:Surgical Flaps; D013536:Suture Techniques