The goal in facial surgery is to achieve the best result in a natural way, respecting the local anatomy and reducing, as much as possible, the scars without harming the final result. Facing these situations before the big nasty scars that takes effect as the falling of hair in the scar has begun the search for scar reduction avoiding the scalp. So with reduced scar surrounding the ear, while respecting the chop and invading modestly retroauricular scalp, has provided us with a good and lasting result, as proposed by Stochero with the periauricular cerclage, complemented by other smaller details that value the immediate and long term results.
Methods/Technique:
The mixture of 40ml of 2% lidocaine, 200 ml physiologic solution and 1 mg of 1:1000 epinephrine, resulting in the anesthetic lidocaine 0.39% with epinephrine 1:240000 solution, called " 241 solution ". We use a spinal needle n.24 that facilitates for being long and flexible and allows the advantage of fatty infiltration that is poorly innervated and takes fewer bites and produces less pain. At a distance equal to 5cm we infiltrated across and around the ear including scalp. The entire skin incision matter to the subcutaneous tissue and starts at the upper pole of the implantation of the ear where the flow comes toward the natural curves of the meandering groove pre headset, respecting the tragus without touching it. Suffers a reflection surrounding the earlobe, and continuing on along the shell in his ear to the backside when the edge of the helix crosses the line of hair implantation. Describes the curve at an angle of about 60 degrees and is directed into the scalp in a length dependent on the necessity imposed by excess skin to be removed. At the chop level that accompanying its base and respecting their size, we implemented a horizontal incision in its most anterior point totals in right angle and back in 45-degree angle until you find the line that comes from the free skin edge keeping a strait angle to the anterior line. This design proposed earlier in the book of Dr. Melega (PHOTO 1). We Took off the temporal region to about 5 cm above the zygomatic arch, and proceed in the caudally to near the tendon over the orbicular eye muscle, then including and following the boundaries of the parotid taking off slightly near the greater auricular nerve to the sternocleidomastoid we return cephalic in the retroauricular fascia just to the scalp in their subcutaneous tissue beneath the roots of the hair. We used the casagrande’ needle for the passage of the wire into the scalp. Drilling trough this structure and continuing trough the subcutaneous we take the needle tip to the highest part of the detachment above the zygomatic, there seek the wire tail (Mn 2-0) that we bring to near the point that we used to introduce the instrument and we take the wire for the highest portion of the retroauricular detachment and there we leave that the wires attaches’ so they don’t move. With the needle from the cord pass trough the sites that want to pull the skin, the design sets the amoeboid shape when normalized by the pull of the wire it will be more active in the most advanced and with less effect in the intervals. The wire is securely tied so as not to undo the knot that must be dipped in the firmer tissue of the region. The other suture is applied to the space behind the lobe near the gonial oval parallel to the jaw in order to produce more traction in the line whose benefit is to increase the definition of the mandibular lip line. (PHOTO 2). Results/Complications:
The traction of the skin is up on the front of the ear where the proposed triangle facilitates the accommodation of the skin, reducing the volume of the temporal skin and enhances its removal leaving the skin suture without tension. Now we see that the pulled skin and has pulled a posterior superior turn. To finish the surgery wash the head and hair with chlorhexidine soap and dried it immediately before applying a bandage that involves head chin, neck, forehead and temporarily cover the eyes that are kept with ice packs for the upper and lower blepharoplasty. (PHOTO 3-5)
Conclusion:
We use this technique for almost all patients and always removed the skin. The addition of small pockets in places described has been very useful and has allowed favorable late results and long lasting. There were those who had to make the grants in time apart as retouching complement to prolong the satisfactory results when evaluated by the censorship of the patient.