How Can Surgeons Hide the Stitches from a Facelift?

Most surgeons place the incisions in front if the ear in away that will leave the most inconspicuous scars.  I think what is equally important is to place the incisions in a way that the ears do not look distorted, which is a common problem.

Thank you for your question. In most healthy people without a history of healing irregularities, the surgical scars resulting from a well-performed facelift are rarely an issue. Incisions are designed to result in scars that are concealed within natural curvatures around the ear and hairline. When you state 'inside the ear', you may be referring to the 'retro-tragal' approach, which avoids the 'tell-tale' incisional scar in front of the ear (pre-auricular incision) for one that follows the inside curvature of the 'tragal' cartilage just in front of the ear canal. Many surgeons prefer this incision for the very reason of its resulting in a less conspicuous scar.



Full scar maturation takes many months. However, most patients consider those scars to be acceptable with makeup within 1-2 weeks, and acceptable without makeup in 1-2 months. Once mature, most scars are imperceptible in normal social interactions, although not entirely invisible upon closer scrutiny. The design and performance of the facelift incision are some of the factors that influences a natural result and the desirability of a facelift surgeon.

#Incisions for a #facelift vary depending upon whether the patient is male or female, the hairstyles, hairline, age, previous surgery, and other factors. Generally, the incision starts in the temple, in front or within the hairline. It continues in front of the ear, sometimes partially hidden within the #ear. It then goes under the earlobe, behind the ear fold, and ends within the hairline or at the hairline behind the ear. The newer, shorter #scar techniques, which do not include scars in or by the hairline, can be used for most patients. Frequently another small and hidden incision is made under the chin in a natural skin fold. This allows fat removal and tightening of the platysma muscle in the neck if required.

The key to minimizing the appearance of the scar is to put it in the temple hairline, then curve around the top of the ear to just behind the tragus (the cartilage that sticks out in front) then in the crease around the earlobe to the crease just behind it. I have moved to a short scar technique called the Lite Lift in which the scar ends behind the earlobe and does not extend along the hairline in the back so you can wear your hair back

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)

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.

 For more than 30 years we have placed the scar inside the ear so that it does not show. We, like you, found this scar in front os the ear to be objectionable. Find a surgeon who does it this way. 

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 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.