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

Question

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?

Thomas P. Sterry, MD · Answer

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!

Jonathan Kulbersh, MD · Answer

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.

Mark Karolak, DO, FAOCO · Answer

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.

Damien Grinsell MBBS, FRACS (Plast) · Answer

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.

Larry Weinstein, MD · Answer

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...

John Michael Thomassen, MD · Answer

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.

Alejandro J. Quiroz, MD · Answer

When 
planning the surgery, we located the incisions the back of the ear to
approach  your neck area and the
incisions in front of the ear are to treat your face.  If you only need your neck done the incisions
can be located only in the back of the ear.

Harold J. Kaplan, MD · Answer

There is a procedure (posterior necklift) that uses only a posterior incision but if you have jowls which are very common this type of procedure will fall short of solving your problem. While no surgeon can promise no scarring most of the time standard facelift incisions heal quite well. I agree with you regarding the retro-tragal incision sometimes showing strange deformity and depending on the tragus in some patients I will actually place it in front of the tragus and it causes less distortion. You should be seen in consultation to fully discuss your options as the procedure chosen has to match the problems.

Raymond E. Lee, MD · Answer

Thanks for sharing.  A neck lift is performed with a continuous incision around the earlobe, up the back of the ear, back towards the hairline, and then down into the hairline.  There is also a small incision under the chin. With a Neck lift there are no incisions in the front of the ear.  However, there is minimal improvement in the jowls with a neck lift.  Also the neck lift result is actually better combined with a lower facelift (incisions in and around the front of the ear).  I do not feel that the lower facelift incision should be feared with a an experienced facelift surgeon.  Done properly the incision will not be noticeable and the tragus can be contoured naturally. Consult with several board certified surgeons experienced in face and neck lifting.  I have performed thousands of these procedures and complaints about facelift incisions just do not happen.  Best of luck.

Brian K. Machida, MD, FACS · Answer

It really depends upon how much you need.  Its possible to do a neck lift only with the incisions mainly behind the ears and in front of the earlobe only, but it will not lift the lower face as much as a more extended incision.  Incisions can be done in front of the tragus rather than behind, and this is especially true in men.

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

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