Because a facelift procedure is chosen in order to enhance one’s appearance, unsightly scars are not acceptable. Therefore, the plastic surgeon performing your facelift will do everything possible to hide the resulting incision lines around the ear and in the hairline. The facelift scars may be noticeable for a few weeks before they fade. Most patients are concerned with the scars before a facelift; therefore we recommend that you ask your cosmetic surgeon if he has photos of previous patients available for view. Because of the male beard growth pattern, men’s facelift incisions are often placed in a slightly different location than in women. Again, discuss the incision placement and possible alternatives thoroughly with your plastic surgeon beforehand. Commonly, a small incision is placed in a natural crease below the chin where it will be virtually invisible. In general, have your plastic surgeon outline exactly the incision line for you so that you are not surprised after your facelift.
A general word of caution: It is surely not a good idea to ask your plastic surgeon to try something new on you in order to better address some of your concerns; rather have him stay with his facelift routine. It is the surgeon’s practice of having performed a specific cosmetic procedure hundreds of times that will minimize surprises after your facelift.
Your Hairline
Depending on the particular facelift incision and technique, the natural hairline may be significantly moved with a facelift. Sometimes, precious hair-baring scalp can be removed and discarded during the lifting procedure. In both male and female patients, hair becomes increasingly valuable because of progressive hair loss as we age. Therefore, it is important to ask your surgeon, what you can expect after a facelift, if your hairline will move and if he will excise hair-baring skin. Discuss alternatives to conventional facelift incisions, in which hair removal may be minimal and the hairline will not change.
In Front of the Ear
The facelift incision is always placed along the front of the ear. This incision line can be hidden behind the tragus – the little cartilage in front of the ear canal (“post-tragal incision”). This may further camouflage and minimize the line left after a facelift. Ask your plastic surgeon which incision he uses.
Length of the Incision
The length of the incision varies from plastic surgeon to plastic surgeon. In general, you can expect the incision from a full facelift to be longer than from a limited facelift (i.e. lifestyle lift, necklift etc.). The main differences of incision extent are in the temporal hair and behind the ears.
Behind the Ear
Commonly, the incision is designed so that it lies in the ear crease, travels upwards and then curves into the hairline. Some plastic surgeons favor incisions that run at the hair line behind the ears as apposed to within the hair. In addition, the length of the incision line as it leaves the ear crease varies widely depending on the cosmetic surgeon’s preferences and may be up to 5 inches. Discuss the incision line design with your facelift surgeon beforehand.
Facelift Incision Scaring
Most commonly, cosmesis of facelift incision lines is excellent. The line in front of the ear heals so well that it is rare for patients to be even aware of their existence after the normal facelift healing time.
In addition, the scar behind the ear is well hidden and rarely prevents women from wearing their hair up. Rarely, the scars behind the ear may widen a bit which is luckily well hidden because of the location. Abnormal scar production, a.k.a. keloid scars, is a rare condition more commonly found in people of darker skin color. Therefore, your plastic surgeon would counsel such patients about their particular risk constellation depending on the history. Keloid scars after facelifts in Caucasians are extremely rare, probably less then 1 in 1,000. Exact scientifically proven numbers are not available though.
