Is it possible to do a neck/lower face lift by placing the incisions behind the ears only?

At 52, I am so ready for a lower face / neck lift to remove sagging jowls, but, like most patients, I absolutely fear the ugly scars. I work with A-list celebrities here in Los Angeles and although they have access to the best plastic surgeons in the world, I have yet to come across someone whose front-of-ear scars aren't a dead give-away, especially when the incision has been made inside the Tragus and it looks even weirder. So, is there really no technique that allows for behind-the-ear cutting only?

Doctor Answers 20

Well-Done Facelift Doesn't Leave Visible Scars

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Sadly, celebrities can be the worst possible advertisements for facial plastic surgery, as they often have procedures that are poorly done or over done. However, you have probably encountered some A-list celebrities whose facelifts were expertly handled, but didn't realize it because their scars are virtually imperceptible. Read the recommendations on this site, quiz women your age who look good but seem to have had no work done, and meet with a number of facial plastic surgeons until you find one who can give you the results you want. I hope this helps.

Yes - if your skin laxity is minimal

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A neck lift (or platysmaplasty) can be performed through a small incision under the chin in a natural skin crease. This involves suturing the platysma muscle bands/edges back together the way they used to be. It helps restore your neck profile as well as soften the bands that develop with age when these muscles separate. In the right candidate, this may be all that is needed to improve the aging neck. An ideal candidate would have very little excess skin in the neck, good skin elasticity (recoil), and little to no laxity in the lower face (…lower face looseness contributes to neck looseness).

When there is poor skin elasticity or excess skin in the neck, that skin will need to be removed/tightened in order to achieve a desirable result. This is usually done by making incisions that may start at or below the tragus (the cartilage in front of the ear canal), extend behind the ear in a crease, and then along the edge of the hairline.

If there is looseness in the lower part of the face, this will contribute to the laxity that occurs in the neck. Very often, a facelift (specifically a lower facelift), is combined with the neck lift (platysmaplasty) to achieve a pleasing result. A lower facelift will require incisions that typically start in the hair in front of the top of the ear and will course in a skin crease or follow the curvature of the front of the ear, go under and around the ear lobe, into the fold behind the ear, and continue along the hairline. These incisions can vary based on the surgeon and the type of facelift being performed (ie mini facelifts will usually have smaller incisions).

There are many face and neck tightening procedures that can be performed in addition to these. They include non-invasive/no-incision procedures, minimally invasive/tiny incision procedures, mini-face lifts, mini-neck lifts, SMAS facelifts, and deep plane facelifts. All of these can also be performed safely, comfortably, and successfully without the need for general anesthesia.

The best approach can only be determined during an in person consultation where a treatment plan is specifically tailored based on your needs and individual aging pattern.

Mark Karolak, DO, FAOCO
Bridgewater Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

A Facelift Should Be Imperceptible

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I'm not sure who has performed the surgery you have noticed, but a well done facelift should NOT have such tell tale signs.
The referral patterns in this business are very strange and unpredictable.  Celebrities are very secretive and therefore their access to information can be limited.  This sometimes leads them to make terrible mistakes when choosing Plastic Surgeons or "Cosmetic Surgeons" (which is a nonsensical term).
There are some terrific surgeons in the LA area and I suggest you try to find one.  Maybe you can get one of them to tell you what kind of incisions would be best in your particular case.
Good Luck!

Thomas P. Sterry, MD
New York Plastic Surgeon
4.8 out of 5 stars 23 reviews

Facial scar can look good if facelift not too radical

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Hi.  There are 2 main problems with a scar limited to behind the ear.  The first is that it will only address the neck and not the lower face which usually defeats the purpose in my opinion.  The neck and lower face are intimately associated and if you need a lower face lift as well then addressing the neck alone will result in a poor outcome.  The second is that inevitably if you use a scar only behind the ear and you do a neck lift it will actually make the extra skin in front of the ears worse as the lower face is partly suspended but no skin is excised.  With respect the Hollywood A listers probably aren't looking for a natural result.  If you don't want a radical facelift and an experience surgeon does it so there is minimal tension on the skin at the end then the scars in the grooves in front of the ear can be very difficult to see.  Hope this helps.

Back of the Ear incisions for Facelift

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Most of the time in my experience, a facelift that will transpose a fair amount of skin from the lower neck will necessitate some type of a scar around the lobule and into the front of the ear region. There are procedures using a suspensory suture technique that can raise the muscle with the skin still attached. These procedures however do not remove a lot of skin. The scar in front of the ear has never been an issue in my practice. I think but sometimes while shorter incisions seem better in the patient's mind, a less than adequate result may seem worse. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 58 reviews

Facelift Incisions

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A highly skilled Plastic Surgeon will place the scars in such a way that they are not seen or noticed when healed.  A good place to start is locating a board certified plastic surgeon through the American Society of Plastic Surgeons (ASPS).  Experience speaks volumes in Plastic Surgery.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 reviews

Neck lift with SMAS

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Yes it is possible to perform a neck lift with behind the ear incisions only, in selective good candidates. Consider what other findings there are in your face by a board certified ASAPS plastic surgeon in consultation. There is a string lift that just uses behind the ear incisions that can give short term excellent results,. A full face lift with SMAS will last longer and may require anterior incisions that rarely are visible in my male and female patients. Good luck...

Larry Weinstein, MD
Morristown Plastic Surgeon
4.9 out of 5 stars 11 reviews

Neck lift incisions

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For a neck lift, incisions need to go in front of the ear only up to the tragus.  In front of the ear the incision would be hidden in the base of the lobule and then cut into the posteior tragus so the would be minimally noticeable.  This may be an option for you.   

Facelift candidate

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At age 52 with jowls, an incision in front of the ears is required.  The jowls cannot be be tightened from behind the ears.  It is very important to place all of the tesion on the SMAS layer underneath the skin and place no tension on the skin in order have nearly inconspicuous incisions in front of the ear.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Is it possible to do a neck/lower face lift by placing the incisions behind the ears only?

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  Hi, I understand your concerns reagarding the scars following a facelift.  I have performed many facelifts for 30 years and I'd like to have you do the following exercise as a demonstration.  Look in the mirror, take you hand and run it along the jawline from the chin towards the ear lobe pulling the skin up and backwards at an approximate 45 degree angle.  You will see that this creates excess, bunched up skin in front of the entire ear.  This is what happens with a proper facelift that tightrens the underlying SMAS layer.  The curved incision around the front of the ear is required to remove this excess, bunched up skin.  There is no way to do this through an incision isolated to the posterior ear crease alone.  You can and should however consider a short-incision, minimally invasive facelift technique.

 If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured. 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 Perlane) or facial implants
•most patients fly back home to parts all over the world in as little as 3 days post-op
Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

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