Stigmata of face lift surgery are one of the main concerns of the esthetic surgery patients. Failing to preserve the natural look of the tragus and the pretragal depression can betray the best and most innovative rejuvenation procedure. A relative simple technique to preserve the pretragal depression has been applied to all the patients that underwent rhytidectomy in our practice. The standard face lift incision we use extends from the sideburn in a slightly curvilinear fashion to the root of the helix and than down into the marginal tragal area and around the earlobes retroauricularly. After completing the subcutaneous dissection and before closing this incision the component added includes separation of the SMAS fascia attachments from the cartilage in the preauricular area. Than this fascia is sutured over the anterior SMAS with several interrupted 4-0 Prolene sutures. The pretragal depression is further defined with the anchorage of one or two 4-0 Prolene suture from the tragal flap to the depression created in the preauricular area. The cutaneous flap is inset with a 4-0 Prolene continuous suture. With this small addition the natural look of the pretragal depression is preserved. This technique was implemented with good results in more than 300 patients that underwent rhytidectomy over the last 5 years. In conclusion: we suggest that the addition of this simple technique to rhytidectomy help to preserve the natural pretragal depression and avoid one of the most visible postoperative stigmata frequently observed after face lift.

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