Facelift with Previous Scars Can Affect Operative Plan, NC*

Face lifting can improve the jawline and neck and involves separating the overlying facial and neck skin from the underlying muscles, altering the muscle and then removing excess skin. The underlying muscles called the platysma muscle in the neck and the SMAS (superficial musculoaponeurotic system) in the face play a key role in facial and neck reshaping. Scar quality and wound healing depend upon good blood flow which generally is abundant in the face. History of smoking or prior scars can affect the blood flow to the remaining skin after skin removal and must be taken into account in operative planning. This 70-year-old woman desired improvement in her jowl and neck. She had a previous skin cancer in the middle portion of her right cheek and this was removed in the past with a resulting vertical scar near her sideburn. The previous scar interrupts blood flow and can effect the degree of skin removal and repositioning. A more conservative facelift may be necessary to avoid healing problems. This patient underwent a full facelift but had to have some modifications to ensure good healing of the scars in front of her ear. She was very pleased with the improvements made in her neck and jowl. She did not have any wound healing problems. Face lifting is not a straightforward procedure and knowledge of anatomy as well as experience in dealing with previous facial scars is very important in achieving a good result.