How to Avoid Temporal Hairline Incisions with Vertical Lifting

Goals/Purpose: Many techniques of facial rejuvenation surgery lift deeper structures in a vertical direction. Although this may move structures of the cheek and jaw border to a natural position, vertical lifting produces a bunching of skin in temple.

One possible solution is a long incision along the temporal hairline, extending superiorly from the anterior aspect of the sideburn. Although the surgeon may attempt to hide this incision by beveling in back of the hair follicles in the hope of encouraging hair growth in front of the line of closure, these long temporal incisions may often be more visible than patient and surgeon would like.

The author describes an approach to correct the temporal skin excess that results from vertical lifting without the need for long anterior hairline scars.

Methods/Technique: A typical face lift incision is constructed that follows the contour of the ear and extends along the base of the sideburn and posterior hairline. Subcutaneous undermining exposes the underlying structures of the cheek and jaw border and lifting is accomplished. The surgeon will then notice a bunching of skin above the level of the sideburn. A short vertical incision is made behind the temporal hairline much higher than the level of the sideburn. This incision is carried to the level of the deep temporal fascia, and the surgeon undermines at the level of the deep temporal fascia to allow for fixation. The surgeon then place a suture in the subcutaneous plane to catch the superficial fascial network. It is important to note that this is above the level of the superficial temporal fascia to ensure mobility. The suture is anchored in a superior direction to the deep temporal fascia and tightened. This eliminates much of the redundancy that result from the vertical lifting. A short backcut at the anterior aspect of the sideburn incision completes the correction.

Results/Complications: This technique has been used in over 500 patients and has allowed the author to avoid long temporal hairline incisions with vertical lifting.

Conclusion: The temporal slider technique allows for correction of temporal skin excess that results from vertical lifting without the need to resort to long hairline incisions.