# Short-Facelift Approach in Temporal Artery Biopsy: Is It Safe?
## 5 Discussion  
According to the American College of Rheumatology, the diagnosis of GCA requires at least three of the following five criteria: age > 50 years, new-onset localized headache, temporal artery tenderness, ESR > 50 mm/h and a positive result of temporal artery biopsy (TAB) [8]. Nevertheless, a positive temporal artery biopsy still represents the gold standard in the diagnosis of GCA. The debate about how and when to sample the artery is still open: giant cell arteritis often causes a patchy inflammatory status leading to so-called skip lesions. Due to this \begin{table}
\begin{tabular}{l l} \hline \hline
**Parameters** & **Results (Mean)** \\ \hline Length of specimen (cm) & 2.60 cm \\ \hline Pathology Report (\%) & 73.91 \% positive for GCA \\ \hline Scar quality (VAS) & 4.04 \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Postoperative Results. \begin{table}
\begin{tabular}{l l} \hline \hline
**Postoperative Complications** & **Results (Mean)** \\ \hline Hematoma & 2 (8.69\%) \\ \hline Infection & 1 (4.34\%) \\ \hline Partial Wound Debiscence & 2 (8.69\%) \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Postoperative Complications Results. Figure 3: Preoperative and postoperative view. pathological pattern, evaluation of short artery specimens may miss the affected areas, leading to false negative results [9; 10]. Furthermore, the temporal artery biopsy procedure is not complication free: in fact, the close proximity between artery and frontal branch of the facial nerve puts the patient at risk of facial palsy. This complication has been reported in the literature mainly as case series articles, and most of them described biopsies taken in the frontal area. Damage to the frontal branch of the facial nerve can cause paralysis with drooping of the eyebrow, loss of eyebrow elevation, and loss of eyelid closure with varying recovery rates [11]. In 2012, [PERSON] et al. [12] published a prospective analysis of 75 temporal artery biopsies discovering that there is a 16.0% incidence of postoperative frontal branch of facial nerve damage, which fully recovers in over half of the patients. Furthermore, they found that incisions closer to the orbital rim and eyebrow were more likely to have facial nerve damage, supporting the description of an anatomical danger zone in which surgical incisions for TAB should be strongly discouraged [7; 13]. In order to avoid incisions in the danger zone, alternative surgical approaches for TBA have been proposed both at the scalp level [14; 15] and at the level of the preauricular wrinkle crease [16]. In 2019, [PERSON] et al. [17] conducted a retrospective study on 137 temporal artery biopsies with incisions at the level of the temporal hairline without injury to the facial nerve. Facelift incision has been extensively described for cancer interventions such as parotidectomy and neck dissection as it results in cosmetically improved outcomes [18; 19; 20]. In this article, we have described the use of a short-facelift incision in temporal artery biopsy; this surgical approach combines the advantage of avoiding incisions within the dangerous anatomical area, minimizing the risk of facial nerve damage, with an acceptable complication rate and a good final aesthetic result that avoids visible scarring. A possible limitation could be represented by the fact that our case series is smaller than the previous works described, but the data we have collected are encouraging. Finally, it can be of great help for trainees to become familiar with the cosmetic facelift surgical procedure. Conceptualization: M.F. ([PERSON]) and F.C. Methodology: G.P. Validation: I.P. Investigation: R.G. Data curation: M.F. ([PERSON]). Writing--original draft preparation: M.F. All authors have read and agreed to the published version of the manuscript. This research received no external funding. Ethical review and approval were waived for this study, due to the fact that it is not an experimental study. Informed Consent Statement: Informed consent was obtained from all subjects.