Post vs Pre Tragus incision?

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.

Good question and it borders on the limits of 'reasonable' requests proposed by patients to their surgeons. I have never had a patient ask me to do this, as i always place the incision post tragal, unless its a male. I would definitely listen to your requests and then decide with you and as long as you understood the risk of a more obvious scar when placed this way, then it would be ok with me. So have a discussion with your surgeon and let them know your preference, should be something that can be easily agreed upon. 

You really make a great case for the pretragal approach and I could not agree with you more.  I almost always use the pretragal incision.  The problem with the retrotragal incision is that almost always distorts the shape of the ear and can be seen from far away.  The deformity it creates is much more visible than the scar.  It is very important to maintain a normal shape to the ear which is accomplished better with the pretragsl incision.  I have seen some pretty weird looking ears from retrotragal mcisioms by very well respected plastic surgeons.  I always will respect a patient’s desires if they prefer the retrotragal approach, but you make the best argument I have heard for the pretragal and I agree completely.

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.

Most surgeons would probably be fine doing the incision that you request. For men, most surgeons already do a pre-tragal incision to prevent beard tissue from being pulled into the ear canal. Your concerns regarding a post tragal incision are justified. That said, a careful facial plastic surgeon will minimize tension in the area of the tragus as well as thin the skin to help prevent a deformity here. When these maneuvers are performed, a natural appearing tragus should be the result.

Either incision works very well.  However, the best option is to do a post tragus incision but to make a point to thin the skin enough that it does not flatten or hide the tragus.RegardsDr. J

Yes, It's no problem to do the incision in front of the tragus if desired.  It's very easy to hide that incision well and I've done these for a long while.  Of course, if well done, a post tragus incision is also very hard to find.Best of luck!

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.

I am always happy to accommodate my patients wishes and preferences.  While a well done post tragus incision should leave no deformity to the tragus and hides the scar best, an incision in front of the tragus can also hide the incision line exceptionally well.  Male facelift incisions are placed in front of the tragus and look excellent.  Your plastic surgeon can cover this in detail at your consultation.  Always see a board certified plastic surgeon.

Based on the responses you can see most surgeon prefer a post-tragal incision for a female patient.  While that is the surgeon's preference to decrease the visibility of the incision, if you feel very strongly about a pre-tragal scar that is not an unreasonable request by any means.  It is important to follow the natural contour of the skin and structures around the tragal area to minimize any visibility and close the incision without tension.