Moving the skin flap

After the completion of adequate tightening of the deep fascia, which will provide a long-term foundation for the changes made, you can perform the necessary movement and modification of the skin flap. You can see, with minimal tension, an excess of skin that covers the ear in the rearward direction. The anterior skin moves predominantly posteriorly and slightly upward, so that the temporal bundle of hair is not pulled too high. The neck skin rises behind the ear posteriorly and, mainly, upward, so as not to create a large step-like deformation of the hairline behind the ear. When the skin is fixed high behind and in front of the ear, an adaptive incision is made and a brace is applied. The skin along the hair behind the ear and on the occiput is successively cut obliquely; Surgical brackets are used to compare these scalp tissues. The skin in the behind-the-hair areas without hair is sewn with a continuous seam with overlapping catgut thread 5/0. Since there is no tension, deep seams are not superimposed. The ear is fixed in place by Vicryl 5/0 deep seams and the skin is cut so that the ear moves upward. Often it is important to raise the ear to the top, so that the ear does not fall down after healing and tissue displacement. The dull ear looks like the ear of a satyr, and represents an obvious postoperative deformation. Fabrics in front of the ear are cut off in accordance with the cut before the operation. The goat flap is left unnecessarily redundant, so that after it is sewn into the ear there is absolutely no tension. The goat flap is shaped like a patty, forming a new, excess tragus. When everything is healed, it will contract, it will look very much like a normal one, and will not be pulled forward, as would happen in a scarring contraction, after reckless truncation of the flap. The skin in front of the ear is closed by a continuous suture with overlapping catgut thread 5/0. The temporal incision is sutured, like the occipital scalp, with the help of surgical staples. Before full suturing, a 4 mm drainage for active aspiration is inserted into the incision hidden in the hair of the occiput. Drainage is brought to the level of the anterior angle of the lower jaw. Then the excess of the sub-chin, if any, is cut off by a lunate incision so as not to create "dog ears" on the sides or excess skin.

Before applying bandages in the operating room, the patient's hair is untwisted and laundered from all residual blood. The antibacterial ointment is applied to the non-drying bandage around the ears. On the area where the rags were cut, a few napkins ("ten", 10 x 10 cm) are applied, then an elastic cotton bandage is freely wound through the chin and parietal area. It is held in place by a minimally squeezing elastic chinstrap. Do this carefully so as not to squeeze the displaced skin flaps.

The patient is transferred from the operating room to the postoperative ward. After the normalization of the patient's condition, the patient is accompanied to the car and taken home. Before discharge, the patient must be able to move with someone's help and must spend the night in someone's presence. It is important to contact the patient on the phone in the evening after the operation. It should also remain within 15-20 minutes by car from the operating room in case of immediate need for postoperative care. The patient is asked to return the next morning, 12-18 hours after the operation. Then the bandage is removed, usually the drainage is removed and for another 24 hours an easy chin bandage is applied. The patient is recommended to take a shower once a day, keep the wounds clean and treat them with a solution of hydrogen peroxide, then apply an ointment containing an antibiotic. A week after the operation, the stitches and braces are removed.

The patient is asked to come 10-14 days after the operation for a second inspection, when he will meet with a make-up specialist. At this meeting, he or she is instructed about applying make-up that hides residual bruises, as well as skin care. A make-up specialist offers appropriate moisturizers, cosmetic and sunscreen products, informing the patient about how he should take care of the skin further in order to maintain the results of a facelift. It is necessary to examine patients after 1 month, 3 months, 6 months and 1 year after surgery to monitor the results. From the second to the fourth week, the patient often requires emotional support, as he or she will adjust to his new appearance and re-integrate into the system of working and social relations. A person experiences a lot of postoperative sensations, since those minor healing features that he was told about are forgotten and it is necessary to reassure him that everything is going as expected. Repeated confirmations of postoperative instructions and expectations are extremely important for creating a sense of success in patients with cosmetic surgeons. Your office should be the place where patients feel comfortable calling by phone or coming in the postoperative period. They should feel that you are there for them, for answering questions and re-examinations. This is necessary in order for them to be satisfied for a long time.

[1], [2], [3], [4], [5], [6]