2.3. Skin marking

With the patient in supine position, we firstly draw a slightly curved line from the lower pole of the earlobe to the lateral margin of the ipsilateral alar base. On this line, point A is marked 3 cm from the ear lobule, and point B is marked 6 cm from the ear lobule. Point C represents the malar eminence. Point D locates at the lower temporal region within the hairline 2 cm above the root of the zygomatic arch. The lines that connect points A-D, B-D, and C-D represent the vectors of elevation. The incision marking starts at the lower pole of the ear lobule, ascending up along the preauricular crease, to reach the tragus. Turn the incision marking forward at the top of the tragus, then angle the marking 60 degrees backward when reach the posterior hairline of the sideburn. The marking then follows the inferior temporal hairline and turns upward at the superior limit of the helix, finally ends approximately 2 cm in the hairline (Fig. ​(Fig.2).2). A small preauricular incision is made to eliminate the lobule deformity when needed.

Illustration of skin anchoring points, skin incision and dissection region. On the line between the earlobe and alar base (purple line), anchoring point A is 3 cm from the earlobe, and anchoring point B is 3 cm from point B. Anchoring point C represents the malar eminence. Point D is 2 cm above the root of the zygomatic arch. The lines (blue lines) that connect points A-D, B-D and C-D represent the vectors of elastic lift. Skin incision (red line) starts at the earlobe and ascends up along the preauricular crease to reach the tragus, where it forms a triangle and then turns upward to end approximately 2 cm in the hairline. Blunt dissection is centered on the top of the tragus to form a fan-shaped region with a radius of 3 to 4 cm (yellow line).