title: Modified Rhytidectomy that Produces a More Natural Look: Experience with 110 Cases.
abstract: BACKGROUND
  Recognition of the effects of aging on the ear and the mechanisms leading to ear deformity associated with facelift procedures aid in achieving improved aesthetic results. In 2009, the author developed a novel rhytidectomy technique to provide more natural-looking results than those achieved through other facelift procedures, which often result in facial and ear distortion/deformity. This technique is designed to optimize aesthetic outcomes by employing incisions hidden within the ear, autologous fat transfer to restore normally lost facial volume, and absorbable bidirectional sutures, all of which allow less skin removal and shorter, more concealable scars within the inside perimeter of the ear, and thus less-distorted facial contours. In this retrospective study, the author added one important modification to this previously described approach for preventing ear deformity.
  
  
  OBJECTIVE
  The author will show that this modified rhytidectomy technique has many benefits over a traditional rhytidectomy, and it results in a natural-looking facelift.
  
  
  METHODS
  The author modified the original technique to secure the ears in a way that prevents inferior drifting. The modified technique involves the placement of two parallel strands of 3-0 Monocryl sutures under the scalp and over the skull and running from one side of the head to the other side using a 6-inch blunt needle. The absorbable strands are passed from the inferior part of each earlobe-one in front of the ear and the other in back of the ear. The strands are tied with knots under moderate tension under each earlobe, securing the ear back in the anatomical preoperative position. This secures the bottom of the ears and prevents caudal drifting.
  
  
  CONCLUSIONS
  The use of 360° round-block, inside-the-ear incisions is advantageous. These incisions have much less lymphatic derangement of the skin, because the overall cut is shorter and the skin is not cut as extensively as in other methods that use longer incisions to get rid of more excess skin in facelifts.
  
  
  RESULTS
  This modified rhytidectomy technique has many benefits over a traditional rhytidectomy: the incisions are hidden inside the ears, so there are almost no visible external incisions, and there is no deformity of the ears and earlobes, because the ears do not drift downward. The ear canal is not distorted, there is no hairline distortion, and most importantly, it results in a natural-looking facelift without the commonly seen deformity of any noticeable pulling.
  
  
  CONCLUSIONS
  This modified approach to rhytidectomy achieves natural looking, aesthetically pleasing results.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: , 851 Meadows Road, Suite 222, Boca Raton, FL, 33486, USA. drdanielman@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Man
mesh_terms: D000368:Aged; D002921:Cicatrix / Q000517:prevention & control; D015331:Cohort Studies; D004954:Esthetics; D005149:Facial Expression; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods* / Q000639:trends; D015595:Skin Aging; D016896:Treatment Outcome
keywords: Blepharoplasty; Endoscopy; Facelift; Lymphatic derangement; Rhytidectomy; Superficial musculoaponeurotic system