Post vs Pre Tragus incision?

After looking at many facelift pictures I have decided that I would prefer the incision along my ear to be in front of the tragus, pre-tragus, rather than post-tragus. I realize that doctors to the post tragal incision to hide the scar, but it seems to almost make the tragus disappear since the skin texture will look thicker. This looks so unnatural to better than having a scar that will improve over time. Will most ps do a pre tragus incision if the patient requests it?

Doctor Answers 33

Post vs Pre Tragus incision?

In general, a post-tragal incision (even in male patients) is better because the scar is hidden.  Loss or blunting of the tragal cartilage and contour can typically be avoided and is not an issue for experienced, meticulous surgeons.

The attached link provides more information.

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

Pre versus post travail incisions

In most facelifts an incision is required in front of the ear to remove excess facial skin. In my practice 90% of the female facelifts have post tragal incision lines performed. But that does leave 10% who want the incision in front of the tragus and if you desired that approach and I was treating you then you would have that option.

Thomas Romo, III, MD, FACS
Manhattan Facial Plastic Surgeon
4.8 out of 5 stars 55 reviews

Facelift incision pre-tragal or post-tragal

This is a very good observation on your part.  Most patients are quick to assume that the post-tragal technique will always be the better option since the incision is "hidden."

In reality it is only about a centimeter or two of the overall incision that has a different pattern.  Both techniques are great, each with their own pros and cons.

You will find that the post-tragal technique is more common, but if you know the signs to look for you will also see that the post-tragal technique is far too easy to mess up unless done exactly the right way.  This causes issues with the final appearance.  Some of these are obvious and distort the tragus significantly.

In other situations the issues are more subtle, but they can still give the overall impression that the appearance in that area just doesn't seem right for some reason, and that is one of several factors that lead to a facelift looking like work was done even to the casual observer like a friend or coworker who is not analyzing you like a surgeon would.

David W. Rodwell III, MD
Charleston Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Pre vs postragal incision

Both are acceptable.  I generally use the pos-tragal in female's and some men who lack thick bearded hair.  In males you do not want to advance hair into the ear.  Both inciisions should camophlage themselves over time.

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

You are correct and there is no right answer

You are correct and there is no right answer. For many patients I will do a post tragal incision but typically someone who has a fuller face, you are absolutely correct, that you can efface that gentle concavity in the pre auricular area and it may be noticeable. Done well by an extremely experienced surgeon that should not be the case. I choose to use pre tragal incisions in male patients and certain female patients. Attached please find a video discussing and showing the above.

Edwin F. Williams, III, MD
Latham Facial Plastic Surgeon
4.8 out of 5 stars 22 reviews

Facelift Incision placement in front of the ear

Women tend to do best with an incision that is post-tragal rather than in front of the tragus. The key is meticulous thinning of the skin to allow for a natural tragal contour. Many patients also benefit from a small suture that is placed beneath the skin in front of the tragus to create a subtle pre-tragal depression.  

Subtle surgical nuances are what ultimately make for happy patients. Make sure your surgeon can tell you exactly what he or she intends to do to camouflage your incisions and help you avoid the stigmata of an "operated face."

Steven M. Daines, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Facelift Incisions

Facelift incisions can vary from Doctor to Doctor depending on their experience and preference. A post-tragal incision usually heals up very well and it can be performed in such a way as to avoid any blunting and look like a natural ear.

 When you visit a doctor that you are considering having perform your facelift, ask them to see before and after photos of their work. Be sure to see enough photos to where you feel comfortable with the incisions, procedure and expected results. 

Jacob D. Steiger, MD
Boca Raton Facial Plastic Surgeon
5.0 out of 5 stars 62 reviews

Pre vs post-tragal incision

Thank you for a really insightful question!  I almost always use a tragal incision, hugging the edge of the tragus precisely.  This is almost imperceptible when done CORRECTLY, and obviates all of the issues with the pre-tragal and the post-tragal incisions.  All experienced facelift surgeons have their preference, though.  My best advice is to not let this one issue overshadow the entire facelift, since there are many other components and complexities involved.  Seek out a board certified plastic surgeon with expertise in facelifting and address these issues during the consultation, specifically delineating what you find unnatural or suboptimal with a particular incision.  Spend time looking at their pre and post-op photos to see if their aesthetic sense matches yours, and base your decision on the whole picture.  Best wishes for a beautiful result!

Alyson Wells, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 24 reviews

I would prefer the incision along my ear to be in front of the tragus, pre-tragus, rather than post-tragus.

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts. There are many nuances, when performing facelifts, including placement of the incision and thinning out the skin above the triages once the excess skin has been removed.  I have always thinned the skin (post excision) over the triages and placed a dissolvable suture to keep the natural looking "tarsal dip" in front of the ear.  You can have the incision placed in front of the tragus if you prefer. 

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

Pre tragus is not better

A post tragal incision gives a superior result if done correctly. the skin needs to be thineed and a stitch needs to be placed to recreate a natural looking tragus. If not, I agree that a pre tragal incision looks better. Look at your surgeons results and see how his or her incisions look. that will help you with your choide.
all ghe best

Michael E. Kelly, MD
Miami Plastic Surgeon
5.0 out of 5 stars 12 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.