1. Introduction

    Rhytidectomy is a reconstructive plastic procedure in which the skin of the face and neck is tightened, wrinkles (rhytid) are removed, and the skin is made to appear firm and smooth. In the preoperative area, the surgeon marks where the planned incisions will be made; before incision, the surgeon localizes the area. Typically, lidocaine 1% with 1:100,000 epinephrine is infiltrated along the incision lines, and lidocaine 0.5% with 1:400,000 epinephrine is infiltrated into the anticipated dissection line.

    The facelift incision begins in the temporal scalp area about 5 cm above the ear and 5 cm behind the hairline, curves down parallel to the hairline toward the superior root, and continues caudally in the natural preauricular skin crease. The dissection begins in the temporal hair-bearing area; dissection continues through temporoparietal fascia and down to the loose areolar layer. The facial nerve branches and enters the facial muscles on their deep surface; dissection during this procedure must be done carefully. The only large sensory nerve that is important is the great auricular nerve. This nerve crosses the surface of the sternocleidomastoid muscle below the caudal edge of the auditory canal and is found posterior to the external jugular.

2. Preoperative assessment and patient preparation