The Preauricular Portion of the Rhytidectomy Incision

Objective: To evaluate the best placement of the preauricular portion of the rhytidectomy incision in the female patient from the aesthetic point of view. Design: Blind, randomized review of close-up photographs of the ear area in 36 patients after rhytidectomy. Setting: Office surgical suite, accredited by Accreditation Association of Ambulatory Health Care. Participants: Two facial plastic surgeons and two plastic surgeons, all skilled rhytidectomy surgeons. Interventions: None. Main Outcome Measures: Participants received close-up photographs of the ear area of 36 patients at least 6 months after rhytidectomy. Eighteen patients had posterior tragal edge incisions and 18 patients had pretragal incisions. Cases were randomized. Participants were asked to rate the preauricular portion of the rhytidectomy incisions overall as to aesthetic results. The categories were excellent, good, average, acceptable , and poor . Results: Results of surveys were collated. Three categories of results were determined: best, acceptable , and poorest . Posterior tragal edge incisions scored higher than pretragal incisions. Those incisions that scored in the best category tended to have a normal contour of the tragus and normal pretragal sulcus. Incisions that scored in the poorest category tended to have a flat posttragal edge with obliteration of the pretragal sulcus. Conclusions: The incision at the posterior edge of the tragus is preferred over the pretragal incision for female rhytidectomy patients except those with a large, prominent or angulated tragus. (Arch Otolaryngol Head Neck Surg. 1994;120:166-171)