The skin is marked before injection of a vasoconstrictor. The incision begins approximately 1,5 to 2 cm superior to the zygomatic arch just posterior to the anterior extent of the hairline (Fig. 11-2). The incision then curves posteriorly and inferiorly, blending into a preauricular incision in the natural crease anterior to the pinna (same position as in the preauricular approach to the temporomandibular joint, see Chap. 12). The incision continues under the lobe of the ear and approximately 3 mm onto the posterior surface of the auricle intead of in the mastoid-ear skin crease. This modification prevents a noticeable scar that occurs during contractive healing of the flap, pulling the scar into the neck. Instead, the incision is well hidden by the ear, it curves posteriorly toward the hairline and then runs along the hairline, or just inside it, for a few centimeters.
A vasoconstrictor is injected subcutaneously to aid hemostasis at the time of incision. One should not inject local anesthetics deep to the platysma muscle because of the risk of rendering the facial nerve branches nonconductive, making electrical testing impossible
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