How Can Surgeons Hide the Stitches from a Facelift?
- Asked by caesarboy in southn Florida
- 4 years ago
Is there any way that the surgeon can put the stitches from a Facelift inside the ear? You can always tell someone has had a lift from those tell-tale incision scars in front of the ear.
Hiding Facelift Incisions
Indeed face lift incisions can be placed inside the ear. The post tragal incision is commonly used. With this approach the Facelift incision begins in the temporal hairline and continues along the edge of the upper ear and behind the small cartilage projection, (tragus), which is in front of the ear canal. This incision then continues around the ear lobe and up behind the ear. This type of incision is used by many plastic surgeons and helps prevent the straight vertical scar in front of the ear. The post tragal incision can provide fine, inconspicuous scars if closed carefully.
This incision presents very few problems in women, however in men it can advance the hair follicles of the beard onto the tragus. Men need to understand this can occur. A man may then need a hair removal procedure to eliminate this undesirable side effect.
Discuss the pros and cons of each type of incision with your doctor before your procedure.
Hiding stitches in a facelift
Only a potion of the incision can be placed inside the ear but there is a potion that will have to run around the ear lobe and behind the ear. Meticulous detail to closure is the key.
The key to facelift incisions is to have equivalent shaping to the incisions so there are no straight lines and it matches one of the natural skin creases around, inside the ear, and behind the ear. The goal is to blend the incision with the natural creases so they become almost inconspicuous over time.
The planning for a facelift incision is a critical step in scar concealment. Some steps for scar concealment:
- location and placement of the incision
- keeping the hairline intact and avoiding hair loss
- keeping ear position and alignment
- avoiding excessively wide scars by avoiding tension on skin (lift should be on deeper tissues)
Web reference: http://www.shahfacialplastics.com/facelift.html
Making facelift scars inconspicuous
The incision for a facelift is placed along the tragal edge of the ear, as it is very well camouflaged in this area. Other techniques performed during a facelift to minimize scaring, are to not place any tension along the incision lines so that the incisions do not fall apart and leave wide hypertrophic scars. Another technique is to remove the sutures quite early, day 4 or 5 after the surgery, to prevent railroad tracking along the incision lines.
Web reference: http://www.seattlefacial.com
Ways to hide facelift incisions
Good facelift incisions are placed in areas where the scar will be camouflaged or hidden from view. We like to place the temporal incision within the temporal hair region. The incision behind the ear is placed such that the ear and the hair behind the ear will cover the scar. The incision in front of the ear is placed in a skin crease and goes behind the tragus ("inside the ear") in women and in front of the tragus in men.
The reason we don't like to place the incision behind the tragus in men is we don't want facial hair skin to be pulled into the ear. Regardless of where the incisions are placed, meticulous and tension free closure of the wound is critical to good wound healing, resulting in a good cosmetic result.
With very rare exceptions, the scars are placed within the ear. I feel the only reason for placing the incision in front of the ear is that it is easier for the surgeon. In men , where the sideburn hair could be pulled into the ear, the underlying follicles can be destroyed at the time of surgery or later with the use of electrolysis or laser hair removal.
Facelift Sutures Hidden Scar Line
Question: How can surgeons hide the stitches from a Facelift?
Answer: All incisions should be closed meticulously and without tension. I always place temporal incisions with closure within the anterior temporal hairline. A number of surgeons place these incisions in front of the hairline (in front of the side burn); I disagree with this placement as I feel that it too often presents a conspicuous scar line. Despite my placing the incisions and performing a closure within this hair bearing skin region, I intentionally avoid raising the side burn hairline.
If the incision line is continued behind the tragus (cartilage in front of the ear) and then placed just where the earlobe meets the facial skin, the scar line is relatively inconspicuous. Carrying the incision line in the crease behind the ear and then high into the hairline behind the ear, lining up the hairline, the incision line is relatively inconspicuous.
For the five to seven days that the stitches are present, they may be noticeable on close inspection. However, they may be hidden with the use of judicious hair styling in women (as well as in men). The scar line just under the chin is relatively noticed but the stitches may be seen on close inspection. Keeping the ends of the suture short and the use of clear sutures may be helpful.
Surgical skills are the most important
Regardless of whether the incision is behind the tragus ( inside the ear) or in front, if it is closed meticulously and without tension there will be no visible scars.
All being equal the most important factor is the surgeons surgical skills.
How can surgeons hide the Facelift scar?
The Facelift scar is but one component of a well executed procedure.
The LENGTH and LOCATION of a Facelift scar depend on how many areas are treated and where the excess skin laxity will be the most obvious. In mild cases, the scar can stay on the anterior face but as skin excess increases, we need to extend the scar to behind the ears to better redistribute the skin.
After sagging face structures have been raised and repositioned in a more youthful location and the excess skin is resected, the front scar is closed under no tension along the junction / border of the side burn and cheek skin, the upper ear and cheek skin, the side or back of middle ear's TRAGUS (the raised cartilage nubbin covering the opening of the ear canal and then along the junction of the lower ear and jaw skin to finally end up under the ear lobule (the round hanging soft part of the ear which holds earrings) WITHOUT pulling on it (that causes the forward pulled obvious PIXIE EAR deformity).
In men, we make an effort to de-fat the akin that covers the tragus to remove hair follicles to prevent having you needing to shave that part after surgery.
The key to an inconspicuous Facelift scar is a TESNIONLESS CLOSURE (which does NOT pull forward the tragus (making it possible to look into the ear canal from a forward position), that pulls the ear lobule forward (PIXIE EAR) or that causes scar widening.
Pick a detail obsessive Plastic surgeon who you like and you will not regret it.
Peter A Aldea, MD, FACS
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.