Circumauricular incision (water-drop shape) for mid- to lower face lift.

The conventional method of mid- to lower face rhytidectomy that involves removing a strip of occipital scalp always creates a conspicuous transverse scar crossing the postauricular skin, which may leave a stair-step deformity at the occipital hairline. The author has designed a new face lift method using a circumauricular incision, shaped like a water droplet, that curves around the auricle. In this new method, the upper part of the "O" shape is modified to the tip of a water droplet. The dissection of the cheek and neck is performed as in the conventional method with light-retractor assistance. The temporal region above the deep temporal fascia is managed under endoscopic control. This dissection can extend to the forehead region lateral to the supraoptic nerve and around the lateral orbital rim to release the arcus marginalis. A mesentery of superficial temporal fascia is created cephalic to the zygomatic arch. The postauricular dissection is performed beneath the galea in the upper part and beneath the occipital scalp and neck skin in the lower area. The lifting vector is upward and backward for the anterior skin flap and upward for the posterior skin flap. The excess skin is trimmed around the ear. The wound at the upper pole of the incision is closed in a V-to-Y advancement fashion. The dog-ear is left above the normal hairline, and there is little or no hairy scalp to be removed. The skin pleating in the postauricular region will settle down spontaneously after several months. The dog-ear in the scalp will become smaller and flat as well. The scar around the ear is quite inconspicuous and well covered under the upper pole of the auricle. From the author's experience, the new "water drop" circumauricular incision is a good alternative for the mid- to lower face lift. It can also be used in conjunction with endoforehead lift for full-face rejuvenation.