Limitations of blood supply to the skin flap in face lift surgery. An anatomical study

Background. Besides nerve injuries or hematomas, one of the main risks of face lift surgery is the development of skin necrosis. We therefore investigated which arteries contribute to the blood supply of the face lift skin flap and how extensively mobilization can be performed before arterial cutaneous circulation is endangered. Material and method. In six cadavers, selective dye injections into the branches of the carotid external artery were performed to determine the location of their vascular territories in relation to the face lift region. In another 12 cadavers, face lift flaps were raised with different extension of the undermined skin area before dye injections were performed. Results. It was shown that the facial artery provides blood supply to the area of the face lift flap by perforating vessels in the paranasal, perioral and submental regions and the transverse facial artery by a perforating vessel below the malar bone prominence. Although the perforating vessel of the transverse facial artery was transected by standard mobilization, the face lift flaps were sufficiently perfused via the paranasal and perioral perforating vessels of the facial artery alone. Conclusion. We conclude that undermining of the face lift flap should not exceed the nasolabial fold to preserve the perforating vessels of the facial artery in the centrofacial region.