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Facial Plast Surg 2023; 39(02): 110-117
DOI: 10.1055/s-0042-1749409
Original Research

Arcade Sutures to Minimize Ear Displacement in Rhytidectomy

Manoj T. Abraham
1   Department of Otolaryngology, New York Medical College, New York, New York
2   Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai New York, New York
,
Jaclyn A. Klimczak 
3   Department of Facial Plastic and Reconstructive Surgery, Rousso Facial Plastic Surgery, Mountain Brook, Alabama
,
Hannah Hart
4   University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
,
Shirley Hu
5   Department of Facial Plastic and Reconstructive Surgery, Meridian Facial Plastic Surgery, Carmel, Indiana
,
Minali Abraham-Aggarwal
6   Arlington High School, Lagrangeville, New York
› Author Affiliations Funding None.
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Abstract

Ear deformities after rhytidectomy are not uncommon and have a significant impact on cosmetic success. We postulate the use of horizontal mattress suspension sutures in the anterior face anchored to the deep temporalis fascia (DTF) during rhytidectomy allows for a vertical lift while minimizing the risk to the frontal branch of the facial nerve and decreasing forward rotation of the ear. To compare auricular displacement during rhytidectomy using an arcade of horizontal mattress suspension sutures anchored to the DTF instead of the preauricular pre-parotid fascia, and evaluate outcomes with this modification at 1 year. This was a proof of concept prospective cohort study of 20 patients (40 sides) undergoing rhytidectomy by a single plastic surgeon (level of evidence 4). Intraoperative measurements were taken to determine the amount of auricular displacement with suspension sutures placed in the preauricular fascia compared with the DTF. To confirm longevity, we compared ear position preoperatively and at 1 year after rhytidectomy with our technique. There was significantly less auricular displacement when superficial musculoaponeurotic system (SMAS) suspension sutures were placed in the DTF 0.75 ± 0.69 mm compared with the preauricular fascia 9.71 ± 2.57 mm (p < 0.00001). With our technique at an average follow-up of 370.3 days, there was no significant change in auricular rotation compared with preoperative photos (p = 0.125).Our simple rhytidectomy modification allows for vertical resuspension of the SMAS in the anterior face in a safe manner while minimizing displacement of the auricle.

Keywords

deep temporalis fascia - vertical suspension - facial nerve - facelift

Authors' Contributions

All authors have read and approved this manuscript.




Publication History

Article published online:
12 July 2022

© 2022. Thieme. All rights reserved.

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