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Question of the week: facelift scars

Where are facelift scars located, and can they be positioned so that they are invisible to the eye?
- patient

facelift scar question
Dr David Sharp

Dr Sharp:

Facelift scar visibility and prominence is determined by surgical technique, patient’s pre-existing anatomy, patient’s scar predispositions and self-care and engagement in scar treatments after surgery. Even with the best clinical measures in place, it is not possible to guarantee that scars will be imperceptible. I customise each facelift procedure to the individual patient’s anatomy and their age, degree of skin laxity and hair line, so incision line placement will differ from patient to patient.

Most standard facelifts that I perform usually involve an incision inside the hairline adjacent to the temple, down the earlobe and around the back of the ear, tracking along the hairline down to the nape of the neck (as shown below by the dotted line on the face diagram).

Note: the patients in this article are shown at 3-5 months post facelift surgery with Dr Sharp. For full before and after images, please visit our facelift gallery.  

Sometimes the incision is shorter, especially in my shorter-scar Sharp Lift procedure, more common among people in their late 30’s and 40’s who want to redefine their jawline and remove early jowls.

With the evolution of surgical techniques, incisions for facelift procedures are now strategically placed to be less noticeable than in the past. Choosing an experienced specialist plastic surgeon is key, as their anatomy training provides the best basis upon which to build their facelift surgery skills.

facelift incisions scar

Facelift incision placement

Wherever possible, incisions are placed within the hair or along the hairline, although this can be dependent upon the thickness of the hair, the position of the hairline and how much skin is removed. Some people have thin hair, others have receding hairlines and others have hairlines that sit forward on the face.

Incisions and Hairline Considerations

Facelift incisions can affect the temple hairline and the earlobe. The incision’s path into the temple hairline allows for the elevation of the lateral cheek’s skin and access to deeper cheek structures. Adjustments in the SMAS layer of the cheek, necessary for tensioning mid-face structures, may result in excess skin near the ears that needs trimming. This might lead to alterations in sideburns positions or the hairline’s appearance – for both men and women.

Choosing the Pretrichial Approach

For patients with significant skin laxity, the pretrichial approach is often preferred. This involves placing the incision around the edge of the hairline and the sideburn, extending into the temple. This method prevents the hairline from being shifted back, maintaining the natural hairline and preserving all hair. The resulting fine scar line at the hair-face junction is usually discreet, preventing the loss of the hairline.

Balancing Scar Visibility and Skin Removal

The decision on incision placement is a balance. If minimal skin removal is required, the incision can be hidden in the temple hairline, covered by hair, with no visible scarring around the sideburn or temple. In cases requiring more skin removal, placing the incision within the hair may lead to an undesirable retraction of the hairline. In such scenarios, a fine scar at the hairline border can be a preferable outcome, maintaining the hairline’s youthfulness, though it may sometimes be visible if not covered by hair.

Incorporating the Earlobe in Facelift Incisions

The approach to the earlobe is also crucial. The facelift incision is designed to encompass the area where the earlobe attaches to the face. If the earlobe is naturally attached, slight modifications during surgery can prevent an unnatural post-surgery earlobe position. Detaching the earlobe slightly allows for the incision to run under the earlobe, ensuring any potential scar migration remains concealed.

Post-Surgery Earlobe Adjustments

While most patients adapt well to these changes, some may have preferences regarding their earlobe shape. In such cases, the earlobe can be adjusted in a minor follow-up procedure, ensuring the overall facial appearance is not compromised by any initial skin shifts. This approach allows for a less conspicuous scar and a more anatomically natural earlobe post-surgery.

What do facelift scars or incisions look like?
mini facelift scar

We understand that scars are one of the most common aspects of facelift surgery that deter people from undergoing the procedure. It’s one of the first questions that patients raise; however, post operatively, we find it’s rarely a source of concern.

How you scar is largely dependent upon your body’s natural predispositions; your ethnicity and genetics play a role in scar colour and texture. Read more here. 

Due to neck movement and the pressure on incisions when lying down or turning your head, ir wearing your hair pulled back tightly, sometimes the scars behind the ears and along the hairline of the neck can be placed under tension, which will make them thicker and wider for the first 24 months.

The scar’s appearance will change over the 24 month maturation process, but there are things you can do during this time to avoid them widening, and to treat them if they are very dark or prominent.

We take a very proactive approach to scar reduction; all of our patients have Fraxel scar reduction laser as a complimentary component of their facelift post operative care with us, and are asked to participate in our 6 week scar program in clinic, which includes regular visits and LED therapy.

Along with daily massage using the scar reduction gel suppled in our facelift post op support bags, Fraxel laser speeds up the scar maturation process, optimising their appearance and helping to reduce their visibility as quickly as possible.

Due to neck movement and the pressure on incisions when lying down or turning your head, sometimes the scars behind the ears and along the hairline of the neck can be thicker and wider for the first 24 months, but once you reach the 2 year mark post operatively, most patients find their scars no longer look or feel prominent.

Preoperatively, it is important to consider how you might feel if your scars are visible after your facelift surgery, and this is something that Dr Sharp will discuss with you before you commit to undergoing the procedure.

This insight aims to shed light on the intricacies of facelift incision techniques. For more detailed information on facelifts, explore the facelift page.

Right side view, facelift patient after procedure 1b

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The above information is general in nature and does not constitute medical advice. All surgery carries benefits and risks, and we recommend visiting the specific page related to the procedure you are interested in to learn more. 

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