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I am now placing the
plication suture. First, we pass the needle through the tough tissue close
to the ear. In the diagram, the needle is black, the suture red, and
the tough tissue yellow.
This photo also shows the incision around the sideburn. In the diagram, I've traced the location of that incision in light blue, and I've colored her sideburn hair brown. In the face lift tutorial chapter entitled Scar Pitfalls, you'll see why it is so important to place the incision so that the sideburn stays down on the face while we lift the skin and place the sutures underneath. |
| Click on any image in this tutorial to see a greatly-enlarged version |
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Next, we pass the
needle through the tough tissue close to the jowl. The needle is
black. You can see the suture (red), which hasn't been tied yet, draped
across the wound and passing through the tissue. When we tie this stitch, the yellow dot,
adjacent to this pass of the needle, will be pulled closer to the blue dot,
which is adjacent to the first pass of our needle. That motion will slide the skin up along the jaw line
closer to the ear.
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The photographs above
and below this paragraph show the face immediately before (above) and after
(below) placement of
the plication suture. The metal retractors (green) are holding the skin
up so you can see better. The blue dot is where the stitch is passed close to the ear, and the yellow dot is where the
stitch is passed close to the
jowl. Below, you see how the yellow dot approached the blue dot when the stitch was
tied. As that suture is tied, the tissues underneath the skin plicate,
or fold, as we saw in the diagrams on previous pages.
As the stitch was tied, the skin moved up along the jaw line toward the ear. That movement also tightened the skin in the front of the neck. I have highlighted, with a gray line and a red arrow, the contour of the skin underneath the patient's chin. Immediately after we tie the knot, the movement of the skin has tightened that area underneath the chin, giving her a more distinct and youthful neckline. |
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I place at least three
of these plication sutures, although the first suture creates most of the
movement, and the rest of the sutures are to help hold the tissues in place.
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In the following chapter,
Skin Excision, we'll see how the excess skin is
removed after the plication is completed.
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Clear all red checks in the Face Lift Tutorial |
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