Aesthetic Units and Zones of Adherence: Relevance to Surgical Planning in the Head and Neck

BACKGROUND: Aesthetic units (AUs) and zones of adherence (ZA) have been previously described in the face; however, a systematic classification of AUs and ZAs together with a unified approach to planning surgery has not been previously described for head and neck surgery. The five principles of surgical planning necessitate respect for AUs, ZAs, and flexion creases; correct scar orientation; and replacing tissue “like for like” by adhering to the four “Ts” of reconstruction (tone, texture, type, and thickness of skin and subcutaneous tissue). METHODS: Images of male and female patients and stock images (from iStock) were reviewed and analyzed. RESULTS: AUs and ZAs were described and tabulated. CONCLUSIONS: Surgical planning necessitates respect for AUs and ZAs and avoidance of maneuvers that will transgress aesthetic unit interfaces or eliminate AUs. An aesthetic atlas of AUs and ZAs is useful for planning surgery, preventing errors, and optimizing aesthetic results.