Why Do They Cut the Nap of Your Neck when Having a Facelift

I had a facelift about 3 months ago and in the process of this the back of my neck or nap . Is this normal? Any information would help.

Doctor Answers 16

A Facelift incision is normally placed on the neck behind the ear but should be hidden in the hair

A Facelift incision is normally placed behind the ear and down along the nape of the neck but it must be hidden in the hair above the hairline along the neck so that it is not visible.

This incision is necessary to adequately tighten the neck and re drape the tissues properly after the facial skin is tightened and the excess removed.

This "posterior " aspect of the face;lift incision should not be visible and should be concealed by the hair at or above the hairline of the neck


In some cases, yes – absolutely an incision could be hidden in the scalp. It really depends on the amount of skin laxity and excess that must be corrected. Which is fine, as long as your surgeon has proficiency with appropriate surgical techniques which can produce faint to even invisible surgical scars.
One of the big differences between a great facelift and a not-so-great facelift is the result in the neck. The face and neck are connected and continuous structures, and they are in most cases rejuvenated simultaneously.
Several aging issues may need to be addressed in order to produce a youthful neck contour: skin laxity and excess, subcutaneous fat excess, sub-platysmal fat excess, platysma laxity and bands, and submandibular salivary gland prominence. The approach to the necklift part of a facial rejuvenation surgery should be specifically tailored to each patient’s individual needs.
Face and neck skin laxity is improved by undermining the skin, advancing it superiorly and laterally, and removing the excess around the ears. Facial skin excess is removed primarily in front of the ears, and neck skin laxity is removed primarily behind the ears. ‘Short scar’ facelifts and ‘weekend facelifts’ almost always fail to completely correct significant (and sometimes even mild) submandibular and neck area skin laxity and excess.
In addition to skin undermining, the SMAS (deep connective tissue layer of the face) and platysma (neck muscle layer deep to the skin) – which are connected and continuous structures – can be elevated and advanced laterally/superiorly to assist with skin advancement. SMAS/platysma lifts not only facilitate removal of skin excess, and help to produce longer-lasting and more natural-appearing facial rejuvenation results, but also take tension off of the skin closure, leading to better quality (i.e. much fainter) surgical scars.
For patients with a lot of inferior and lateral skin laxity, more skin will need to be removed in the area behind the ear. The ideal scar configuration is a scar that courses up the crease behind the ear and then turns posteriorly at a point ABOVE the visible bare area of skin behind the ear (mastoid area). The scar then runs along the hairline of the occipital scalp for whatever distance is necessary to remove the neck skin excess. Any other approach will create easily visible scars and/or distort the hairline behind the ear.
Obviously not all scars are created equal, and it really boils down to the planning, precision and experience of the surgeon. A scar along the occipital hairline should be invisible or almost invisible, and should not prevent a female patient from wearing her hair up. It should also be completely acceptable for women and men with short hair styles, who do not have hair to drape over behind-the-ear scars in order to hide them.
The occipital hairline incision should be beveled (cut at an angle) to preserve hair follicles, and it should be closed using suturing techniques that leave no telltale suture marks. If correctly performed, hair follicles in most cases some will actually grow across the scar itself, making for a scar that is invisible from a short distance away. Even on close-up inspection it still should be an almost invisible scar; my personal goal is to create scars that are difficult to impossible for a patient’s hair dresser to detect.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 120 reviews

Nape of the neck incisions

Depending on how much laxity there is in the neck it may be necessary to make incisions towards the back of the ear/ neck, but rarely all the way to the very back

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Facelift Incisions

A facelift incision typically extends along the back of teh ear and into the hairline It is important to make sure that the incision is well concealed in the hariline so that it is not visible after it has healed.

The lengthof the incision in the nape of the neck is largely dependent on the amont of exces skin that needs to be removed. If a large amount of skin needs to be trimmed it is actually beneficial to extend the incision so that you don't get scar irregularities such as a dog-ear deformity.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Incision does not typically exit onto the neck

Typically no, the incisions for a full Face Lift and Neck Lift start in the temple scalp, curve around the front of the ear, continue in the crease behind the ear and enter the posterior scalp but do not exit the hair onto the neck.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Incision along nape of neck for facelift

It is not uncommon to make an incision between the hairline and skin behind the ear (pretrichal) for patient with excessive neck skin that must be removed.  Otherwise, the incision is typically made into the hairbearing skin of the scalp behind the ear to more easily camouflage the incision.

One downside to this pretrichal incision is potential scar widening.  I would wait 4-6 months for the scar to mature and discuss revision with your surgeon if necessary.  I recommend close followup with your surgeon to make the appropriate recommendations.

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 87 reviews

Extent of Facelift Incisions

As other Surgeons have correctly noted, the length or extent of the Facelift incision into the hairline depends on the amount of skin redundancy present at the time of surgery; your incision is not unusual.  Generally, I use an incision that initially follows the occipital hairline, then at a defined lower position, enters the occipital hairline.  This allows for removal of a greater amount of non-hair bearing skin.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 95 reviews

Unusual scar after facelift? No.

Without a photograph it is difficult to tell exactly what you are talking about. I am assuming that you're talking about a vertical scar in the absolute back of your neck. This is not usually part of a facelift but if someone has excessive amounts of skin in their neck it has to be removed somewhere or cause bunching. The "somewhere" in this case is at the back of the neck. Generally this scar is preferable to bunching of the skin

Andrew Kaczynski, MD (retired)
Sacramento Plastic Surgeon
4.9 out of 5 stars 110 reviews

Facelift with incision in the back of the neck.

This is only done if there is an extreme amount of skin hanging in the neck. Otherwise the incision can be placed in the hair or along the hairline behind the ear.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Faeclift incisions

Facelift incisions can be designed in  many different ways depending upon what the patient needs. Sometimes this includes extending it to the posterior hairline along the back of the neck in severely loose necks.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.