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Face Lift - Looks Awful Behind the Ears?

I live in the Madison, WI area and am seriously considering a face lift. The main thing holding me back is how bad it looks behind the ears...even after months/years. I've had a few friends do it and they have "bunching" and prominent, white scaring behind their ears. I've also talked to a few in the industry and apparently this is common? It seems I must decide between sagging or wearing my hair down for the rest of my life?

Doctor Answers 37

Facelift scars

The facelift procedure involves incisions that skirt the contour of the ears, using the anatomy of the ear to help conceal them. For a full facelift, the incision starts in the sideburn area, follows the contours of the junction of the ear with the face, curves behind the earlobe into the recess between the posterior ear and the neck/scalp, and then extends into the hairline posteriorly at the top of the ear. When I make these incisions, I design them so that, once fully healed, they may be difficult for even a hairdresser to detect. That goal can often be achieved, and it requires meticulous attention to every centimeter of the closure.

Following surgery, many surgeons, myself included will offer complimentary V-Beam laser treatments to help speed healing and minimize scarring.  Most plastic surgeons also make  topical silicone gel treatments available to help minimize scarring. Close monitoring following surgery is imperative. If scars start start to thicken, they can be treated with steroid injection. But early treatment is key.  You don't want to wait until a scar is a problem before you begin receiving treatment 

Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 48 reviews

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Minimizing facelift scars

Facelift scars can be minimally visible, or keloidal and obvious, or anything in between.

Experienced surgeons have better scars.  There is a certain ability that comes after a surgeon has done 1000 facelifts that is simply not present in a doctor who has performed 100.

Skill level of the individual surgeon often goes hand in hand with experience, but not always.

The technique chosen also determines how scars will appear.  Hairline techniques will always disturb the hairline and be more visible than scars behind the hairline.  Short incision techniques may inherently bunch skin more.  "High on the side" techniques will always create a rise in the lateral facial tissues that is not matched by a rise in the central facial tissues.  Skin-only facelifts closed very tightly inherently will place large tension on the incision closures, resulting in worse scars. 

Follow-up is very important.  Are patients applying the creams or silicone sheeting the surgeon recommends, and avoiding sun exposure?  Hopefully.

Some patients simply heal worse.  Patients with darker skin types tend to form keloids more readily than light skinned patients.

If scars do thicken despite best efforts, is the surgeon willing or able to perform injections, laser treatments or revision of the scars?  It is often necessary, even in the best of hands.  The surgery is not over when it is over, it is over when the patient is healed.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 103 reviews

Research Surgeon Carefully to Avoid Bad Facelift Scars

While there is always a risk of scarring after ANY surgical procedure including Face Lift, seek a board certified facial plastic or plastic surgeon with experience, training, expertise, and credentials to provide the best surgery for you. I say to my patients "Good Facial Plastic Surgery doesn't look like surgery, it just looks good!" Face lift scars from a well performed surgery should be virtually invisible - white, flat and well placed behind the ear so that a patient can wear even close-cropped hair and all everyone will notice is their gorgeous rejuvenated face. Find a surgeon with before/after books you admire and previous patients you can consult with. Good luck with your surgery!

Benjamin Bassichis, MD, FACS
Dallas Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Do all face lift scars look awful behind the ears.

I have performed face lifts for over 20 years and not all face lift scars look bad behind the ears.  Bunching is more an indication of an inadequate sized incision placed in the posterior scalp.  This causes bunching of the skin as it's redraped prior to its removal.  Newer minimal incision face lifts do not have this incision but replace it with a small incision under the chin.  Less skin, of the neck, can be removed so there's always a trade off.  You should have a few consultations for evaluation and recommendations.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Proper incision placement and flap distribution prevents tell-tale scars.

It all comes down to having a good plan, good experience and good execution.  If any one of these three factors go awry, a bunched scar can result.  Often the attempt to make a facelift scar too short is the culprit.  The effort to make the scar less apparent (shorter) backfires and it is more conspicuous (bunched).  Tell your surgeon, you'd rather have a longer great scar that is concealed by hair than a shorter visible one.

Ritu Chopra, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 17 reviews

Appropriate incision placement for facelift

It is imperative that you seek out a board certified plastic surgeon well trained in facelift surgery.   There are skillful methods to prevent the obvious signs of facelift patients.   Although assymetries and poor scarring may occur in the best of hands, an experienced facelift surgeon can carefully place incisions both in front and behind your ears that should be very difficult to perceive after appropriate healing time.

Widened scar is typically due to tension on the skin closure.  A properly performed facelift places the tension and pull on the underlying muscle, such that the skin can be closed ina tension free manner.  In addition, proper placement of the incision behind the ear in a natural crease will reduce visibility.   Lastly, early suture removal or use of dissolveable sutures help prevent suture track visibility. 

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 50 reviews

Scars from a face lift

Unfortunately you see the bad resutls because they are visible but do not see the excellent outcomes because the scars are barely visible. Scars vary for several reasons only some of which can be controlled such as wound tension and smoking history.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 54 reviews

Small risk of scarring in facelift

This is not true. While scarring is always a risk of facelifts/necklifts, this should be a very small risk, and patients should not settle for surgeons who in fact routinely leave such scarring.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
5.0 out of 5 stars 62 reviews

Scarring behind the ears after a facelift should be minimal...

The incision behind the ears in a Facelift procedure should heal into a flat, barely visible incision that is placed into the hairline of the patient.  A  board certified plastic surgeon that is highly skilled in facial plastics has the experience to precisely close the incision around the ear, and the knowledge to ensure the skin lines up correctly so that bunching does not occur.  Every patient  heals differently, and a small minority of patients may be prone to thickening of the skin when healing.  Discuss your concerns with your surgeon.

Andrew Miller, MD
Edison Facial Plastic Surgeon
5.0 out of 5 stars 84 reviews

Facelift scars behind the ears

The bunching that occurs after a facelift is due to the wrong vector of pull with excess skin. The excess skin that is redraped behind the ear translated from the neck is then rotated closer up to the ear and bunching occurs. It is important the vector of pull when excising extra skin of the neck goes straight back from the neck to the mastoid area. The placement of incisions is also important so that the patient is still able to place the hair up in a bun after surgery. The incision is carried up behind the ear in the postauricular sulcus, carried across where the eyeglasses would ride, carried down at the hair line approximately ¾ of an inch, and curves upward back into the hairline for about another inch. This allows patients to put their hair up within a month after the procedure has been performed. The skin that is removed is non hair-bearing skin, therefore it does not shift or move the hairline posterior into the hair area.  

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

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.