The Stork Lift: A Circumoccipital Extended Neck Lift

In this well-written and appropriately illustrated article, the authors have given us another look at the cervical–facial rhytidectomy (CFR) technique, initially described by Gonzales-Ulloa in 1962. I described the procedure 5 years later. I learned and modified the method from Mario Gonzales-Ulloa and Robert Wise, who was one of my teachers at Baylor College of Medicine. Both were great contributors to plastic surgery in their own right. Gonzales-Ulloa’s original description involved an extensive procedure using a bicoronal incision that circled the ear and extended to the nape of the neck. This lengthy operation in my surgical hands proved to be a ‘‘long haul for a short gain.’’ In the early 1960s, I found the lateral–posterior extension along the hairline to the nape of the neck to be useful when gross neck skin laxity was the patient’s primary problem. When combined with the standard temporal preand postauricular incision (the classic CFR operation), this technique provided great improvement [1]. The trade-off was the frequently a noticeable scar, particularly for the short-haired female. The procedure required extra time and resulted in occasional intraoperative morbidity (hypotension, nausea, and on rare occasions, retching) associated with maintaining the patient in an upright position. The fact that we are now performing the surgery for younger patients (with greater amounts of elastic tissue) is yet another reason why we can perform a lesser procedure and achieve the same results. In recent years, most surgeons extend the postauricular laterally into the occipital hair-bearing area rather than follow the hairline. Bunching and crimping of the postauricular closure is necessary to make up for the discrepancy between the upper and lower skin wound edges. By the 1970s, I had discontinued the extended posterior neck incisions and nape of the neck excisions as described by the authors for performance of the CFR. A further reduction in the total scarring associated with this operation is evident by the increasing popularity of the ‘‘short scar CFR.’’ However, I contend that the aphorism ‘‘function over form over scar’’ still holds true. In almost any operation, the patient will accept reasonable scarring if given the desired form. The authors state that they use the posterior nape of the neck extension for about 30% of their cases. I believe this technique has a place in our surgical armentarium when it is used as an isolated procedure particularly for males (See Fig. 11). The T-Z Plasty as popularized by Cronin and Biggs [2] should be another consideration especially for male patients whose only complaint is anterolateral neck skin redundancy. The importance of maintaining the residual scar directly in the midline posteriorly cannot be overemphasized. Midline scars are invariably less noticeable and more acceptable whether on the trunk or on the face. In performing the operation, I always ‘‘nick in’’ or ‘‘scratch in’’ the posterior hairline incision as well as the nape of the neck incision preoperatively with the patient in the upright, vertical position. M. Spira (&) Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, 1709 Dryden, Suite 1500, Houston, TX 77030, USA e-mail: rmspira@comcast.net