Ask a doctor

Do Many Surgeons Make a Vertical Incision Behind the Ear when Doing a Facelift?

I ask this as I have seen some really horrendous scars with the horizontal cut behind the ear and wonder if the vertical incision would be best as it wouldn't be as noticeable?

Doctor Answers 18

Why Incisions behind the ear vary in different facelift techniques

If traditional facelifts re-draping of the skin of the lower face and upper neck and then a blank fashion.  Therefore the redundant skin Hess be removed behind the near which is why there is a vertical incision behind the ear and then horizontally into the hairline or obliquely along the hairline.  Mini facelifts or modified facelifts such as the Lite Lift or MACS procedure  provides: less scaring (short scar technique) where in addition to a similar incision in front of the ear and temple, there is only a short incision that typically ends behind the earlobe in the crease. Additionally there is a  quicker recovery
no need for general anesthesia
a more natural look (pull is vertical in direction)
Not everyone requires a traditional facelift to provide beautiful, long lasting results. The Lite Lift is a minimally invasive option that addresses aging of the face and neck.

Orange County Plastic Surgeon
5.0 out of 5 stars 65 reviews

Do Many Surgeons Make a Vertical Incision Behind the Ear when Doing a Facelift?

 This vertical portion of the incision that's behind the ear is the part, of a traditional Face Lift, when a full Neck Lift is to be performed.  I now use a minimal incision type Face Lift that does not use that extensive scar behind the ear...rather combines a small incision under the chin for neck skin removal.  This Face Lift offers smaller incisions, surgery time of 90 minutes or less with less tissue dissection which means less bruisin/swelling and recovery time.  

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

Designing the incision behind the ear during facelift.

The most common pattern for a facelift incision behind the ear is to pass vertically upwards slightly onto the back surface of the ear extending from the earlobe to the top of the ear.  At this point the incision can either end there or pass horizontally / diagonally backwards into the scalp for a variable distance.  The overall length of the facelift incision is determined by the amount of excess skin that needs to be redraped.  With mild aging a shorter incision that ends at the top of the vertical extension behind the ear will be sufficient.  With more advanced aging and larger amounts of sagging skin, a horizontal / diagonal incision passing into the scalp will be necessary in order to distribute the excess neck skin and avoid bunching or 'pleating'.  In these more severe cases, limiting the incision to the vertical crease behind the ear will leave a less than ideal result.   If the horizontal arm of the incision is placed high behind the ear and tension from the lift is supported primarily by the deep tissues and not the skin itself, then the scar should be acceptable.

Mario J. Imola, MD, DDS, FRCSC.


Mario J. Imola, DDS, MD
Denver Facial Plastic Surgeon
5.0 out of 5 stars 62 reviews

Scars behind ears in facelift surgery

I agree that I have also seen a lot of obvious scars performed elsewhere. It is certainly possible to place the scars well hidden in the crease behind the ear and then to have them extend back toward the hair out of view. This is something that people could certainly look into while selecting their surgeon.

What is the best incision placement for a facelift?

Great question. The scarring that occurs in a facelift procedure can be caused by several factors. Patients who smoke are at increased risk for scarring, diabetic patients with poorly controlled blood sugar are at increased risk, patients who use steroids chronically are also at increased risk for scarring complications.

From a surgeon perspective, it is critical to ensure that the strength and tension of the lift is placed on the underlying muscle and not on the skin. If the skin is closed properly, under no tension, then the incision should heal very well regardless of whether or not it is horizontal or vertical.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Behind the Ear Facelift Incision Design

The incision behind the ear is what completely controls how much neck improvement is obtained in a facelift. The horizontal extension of the postauricular facelift incision is what helps lift the neck. While using only a vertical incision can be done, the amount of neck improvement obtained will be more limited. It may be appropriate facelift incisional design in the right patient who has a more modest neck problem.

Scars for facelifts

will vary accordingly to how extensive a facelift is needed.  Full facelift will have scars that go into the hairline behind the ear.  Good surgeons will place this scar high so the ear covers it.  Others place it where they want and often, it is visible when standing next to that person.  Hairdressers know who do the best facelifts since they see the scars.  Ask yours for their opinion.

Curtis Wong, MD
Redding Plastic Surgeon
5.0 out of 5 stars 21 reviews

Flawless Facelift

When I do a Facelift, the goal is to rejuvenate the face by 10-15 years as flawlessly as possible.  This means making the incisions essentially invisible without any telltale signs of surgery.  The key is to hide the incisions in natural folds or creases, meticulous suturing with no distortion of the hairline.  The incision should be "ponytail" friendly behind the ear and maintain a perfectly normal side burn in front of the ear.  In order to create this, each patient is going to have incisions unique to their hairline so that the above goals are accomplished.  

Lorne M. Tarshis, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Facelift Incisions

There are surgeons who perform shorter scar facelifts.  You must be an appropriate candidate for that type of facelift.  Evaluation by a BC PS would give you that answer/

Dr. ES

Do Many Surgeons Make a Vertical Incision Behind the Ear when Doing a Facelift?

           This is just a finesse and skill issue.  I make the incision only around the ear.  The incision does not extend in front of the hairline or the posterior hairline.  Though this is a short scar variant, the results are maximal.  It is more difficult to get the result, because you are working in a tighter space.  Making the longer incisions makes the operation easier.  Find a plastic surgeon with ELITE credentials who performs hundreds of facelifts and facial procedures each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

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.