The arterial supply of the face lift flap.

The cutaneous arterial circulation of the face lift flap was investigated using multiple anatomic techniques in fresh cadaver specimens. Perforation sites of the transverse facial and submental arteries were preserved or transected according to protocol during bilateral rhytidectomy prior to selective injections with ink or lead oxide. It was observed that the transverse facial perforating artery provides the major direct blood supply to the lateral cheek and preauricular area following rhytidectomy if preserved. This perforator occupies a constant anatomic location 3.1 cm lateral and 3.7 cm inferior to the lateral canthus with 95 percent tolerance limits of +/-1.1 cm. There is greater variability in localizing the submental perforating artery; however, this perforator also contributes significantly to lateral facial blood supply. Both perforator locations are within the area of "standard" undermining for rhytidectomy; however, they may be preserved during this procedure if desired. Transection of the lateral facial perforators leaves vascularization of these cutaneous areas dependent on collateral flow from the pedicle of the face lift flap. The ability to preserve optimal blood supply to the lateral face lift flap may be useful in the clinical setting of a vascularly compromised or smoking patient.