What is the least scarring face lift? Can it all be hidden in the scalp?

I thought I read a few years ago about someone in LA doing small targeted incisions in the scalp that pulled at strategic places and did not have any visible scars even around the ear. It's the one thing keeping me from doing it. My scars are pink keloid and take ages to disappear

Doctor Answers 23

What is the least scarring face lift? Can it all be hidden in the scalp?

All surgical facelift techniques involve incisions, but how these incisions are designed, where they are placed, and then closed can be very different from surgeon to surgeon.  It is wrong to consider a facelift technique based on the length of the incision, where dubious marketing claims have made many prospective patients incorrectly think a shorter incision is better--results and studies have proven otherwise.  

Proper facelift techniques require long enough incisions to allow proper re-positioning of the SMAS layer and removal of redundant skin in a smooth fashion.

The attached link provides more information.

I hope this helps.  

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 64 reviews

Facelift Scars Are Very Minimal, Rarely Visible

There are some surgeons offering lifting procedures with minimal access incisions, but the only thing that can be done through those incisions is elevation of the deeper tissues via sutures. Since tissues are not truly repositioned but only dragged to a new position, they are totally dependent on how long the stitches hold. Studies we performed at Northwestern University indicated that one technique similar in concept gave very short-term results: only a few months.

Even in patients with a history of poor scarring and keloid formation, the scars at the visible portion of the ear (in front) are at the edge of the ear and closed under no tension. They are virtually never visible after 2 to 3 months, even in men or women who wear their hair pulled back. The scars behind the ear are easily hidden, but sometimes in patients who are prone to have pink and highly visible scars, they do need to be revised. I would suggest you consult with more than one experienced surgeon and ask to see patient examples with early scars, as well as scars that have matured. I find that once patients have seen a number of postoperative photos, they are comfortable with the scars, which are hidden at the edge of the ear and not visible.

Thomas A. Mustoe, MD, FACS
Chicago Plastic Surgeon
4.8 out of 5 stars 95 reviews

Small scalp incisions vs traditional facelift incisions

Your specific concerns about your appearance should be discussed before you decide on incision size or placement.

Although the advantages of a small and hidden incision may sound appealing, this may not be correct for you.

If your aging changes involve your neck and jowl, these areas are less likely to be improved with a small hidden scalp incision.  An attempt to correct these distant areas may increase the risks of nerve injuries, and place too much tension on the small incision, creating an area of alopecia.  It may shift your hairline posteriorly.

 Smaller incisions don't allow for the same amount of skin draping. 

Traditional, around the ears, incisions allow for more effective undermining, redraping and excision of skin excess.  It also has the ability to address the underlying tissues, such as the SMAS.  It is a more direct route to the jowl and neck.

Traditional incisions are longer and therefore have a higher risks of scarring including ear distortion and hairline shifts.  If performed correctly they should be difficult to notice.

Consult a Specialist in your area to determine your needs.  Consider your goals before you choose the incision type.  If your risks of scarring are too great ask your doctor about other options such as filler, Botox, Kybella, skin treatments used in combination.

Ernest Robinson, MD
Aliso Viejo Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Smaller Lifts Lead to Smaller Scars

Generally, smaller scars are associated with less aggressive lifts. While this certainly can be done on any patient, it may not be the best procedure for everyone. People with more significant jowls and excess skin will require a more aggressive technique to obtain a satisfactory result. During your consultation, it is important to show your plastic surgeon scars that were present from other procedures. He will be able to determine your potential for poorly healing scars and the technique that will give the best results for your face.

Louis C. Cutolo, Jr., MD, FACS
New York Plastic Surgeon
4.6 out of 5 stars 13 reviews

Least scarring face lift? Can it all be hidden in the scalp?

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts. Facelift lifts and pulls the tissues upward at a 45 degree angle. Incisions are placed around the front of the ear in order to allow removal of excess skin.   

Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front. Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin. Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face. I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Choose a board-certified plastic surgeon who is experienced in performing facelifts.

Scarring after a facelift procedure is a common concern for many people, but the truth of the matter is that because it is a surgical procedure, some scarring will be necessary in order to achieve the dramatic results you want. However, a skilled and experienced plastic surgeon should be able to carefully place each incision in such a way that they will be virtually unnoticeable and hidden. Typically, facelift scars are placed behind the ears or near the hairline of the forehead, where they can be easily camouflaged. I would suggest consulting a board-certified plastic surgeon in your area to address these concerns and get a better idea of the quality of results you can expect.

Brian Vassar Heil, MD
Pittsburgh Plastic Surgeon
4.8 out of 5 stars 19 reviews

Facelift Scars

Thank you for your question.   There are many marketing ploys out there claiming to make short scars, invisible scars or even no scars at all for a face lift.   The reality is each surgeon has a different approach, however to perform a face lift you need to make an incision somewhere.   Don't do a face lift or choose your surgeon based on who will make the smallest scar as that may not be the right procedure for you.   Find a board certified plastic surgeon, go in for a consultation and ask to look at before and afters of their work to see the scars.   A face lift is a great operation with a high success rate and the scars typically heal quite well.   Make a good decision overall, not just based on the scars.   Good luck!

Facelift scars.

Great question! The best place to place the scars are behind the ears in the retro auricular groove, and behind the tragus of the ear, since this will hide 100% of the scar. Some surgeons make it anterior to the tragus and this is a mistake because this scar will be very visible. A small portion if the incisions are made in the scalp and this is done in a way that it does not destroy the hair folicules, so it will not kill those hairs, and it will hide perfectly this portion of the scar. Also, the best way to avoid a keloid is to leave the skin without any tension and suture it in place. I do this by placing all the sutures in the fascia that envolves all the facial muscles, the SMAS; this way when I suture the insicions, the skin will be totally tension less, and this will avoid the production of hyperthrophic scars and keloids. With the SMAS Facelift you can rejuvenate your face from 15 to 20 years in my experience. Have a good day

Luis Pedroza, MD
Colombia Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

Facelift scars

All face lifts require an incision in front of the ear and some need an incision behind the ear.  It is only with these incisions that the excess skin can be removed to tighten the face and neck.  This is was a "facelift" is all about.   These incisions are placed in strategic positions near the scalp and in skin creases to conceal the scars.  The scars are not usually a issue if not placed under excess tension.  Find a board certified surgeon for the best outcome.  Good luck.  Donald R. Nunn MD  Atlanta Plastic Surgeon

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 47 reviews

facelift incisions

  With a incisions for a facelift are placed inconspicuous  underneath the temporal tuft hairline, behind the tragus, and into the hairline and behind the ear. Placement of the incisions is critical for detectability. In addition, the amount of tension placed on the skin and the length of time the sutures are left in place also increased detectability. In addition,  the amount of loose skin will determine how long the incisions are. A well executed face and neck lift incisions will be minimally detectable. Look for a surgeon who can create natural results.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 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.