Face Lift - Looks Awful Behind the Ears?

I live in the Madison, WI area and am seriously considering a face lift. The main thing holding me back is how bad it looks behind the ears...even after months/years. I've had a few friends do it and they have "bunching" and prominent, white scaring behind their ears. I've also talked to a few in the industry and apparently this is common? It seems I must decide between sagging or wearing my hair down for the rest of my life?

Doctor Answers 43

Facelift scars

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The facelift procedure involves incisions that skirt the contour of the ears, using the anatomy of the ear to help conceal them. For a full facelift, the incision starts in the sideburn area, follows the contours of the junction of the ear with the face, curves behind the earlobe into the recess between the posterior ear and the neck/scalp, and then extends into the hairline posteriorly at the top of the ear. When I make these incisions, I design them so that, once fully healed, they may be difficult for even a hairdresser to detect. That goal can often be achieved, and it requires meticulous attention to every centimeter of the closure.

Following surgery, many surgeons, myself included will offer complimentary V-Beam laser treatments to help speed healing and minimize scarring.  Most plastic surgeons also make  topical silicone gel treatments available to help minimize scarring. Close monitoring following surgery is imperative. If scars start start to thicken, they can be treated with steroid injection. But early treatment is key.  You don't want to wait until a scar is a problem before you begin receiving treatment 

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Research Surgeon Carefully to Avoid Bad Facelift Scars

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While there is always a risk of scarring after ANY surgical procedure including Face Lift, seek a board certified facial plastic or plastic surgeon with experience, training, expertise, and credentials to provide the best surgery for you. I say to my patients "Good Facial Plastic Surgery doesn't look like surgery, it just looks good!" Face lift scars from a well performed surgery should be virtually invisible - white, flat and well placed behind the ear so that a patient can wear even close-cropped hair and all everyone will notice is their gorgeous rejuvenated face. Find a surgeon with before/after books you admire and previous patients you can consult with. Good luck with your surgery!

Benjamin Bassichis, MD, FACS
Dallas Facial Plastic Surgeon

Proper incision placement and flap distribution prevents tell-tale scars.

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It all comes down to having a good plan, good experience and good execution.  If any one of these three factors go awry, a bunched scar can result.  Often the attempt to make a facelift scar too short is the culprit.  The effort to make the scar less apparent (shorter) backfires and it is more conspicuous (bunched).  Tell your surgeon, you'd rather have a longer great scar that is concealed by hair than a shorter visible one.

Ritu Chopra, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Minimizing facelift scars

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Facelift scars can be minimally visible, or keloidal and obvious, or anything in between.

Experienced surgeons have better scars.  There is a certain ability that comes after a surgeon has done 1000 facelifts that is simply not present in a doctor who has performed 100.

Skill level of the individual surgeon often goes hand in hand with experience, but not always.

The technique chosen also determines how scars will appear.  Hairline techniques will always disturb the hairline and be more visible than scars behind the hairline.  Short incision techniques may inherently bunch skin more.  "High on the side" techniques will always create a rise in the lateral facial tissues that is not matched by a rise in the central facial tissues.  Skin-only facelifts closed very tightly inherently will place large tension on the incision closures, resulting in worse scars. 

Follow-up is very important.  Are patients applying the creams or silicone sheeting the surgeon recommends, and avoiding sun exposure?  Hopefully.

Some patients simply heal worse.  Patients with darker skin types tend to form keloids more readily than light skinned patients.

If scars do thicken despite best efforts, is the surgeon willing or able to perform injections, laser treatments or revision of the scars?  It is often necessary, even in the best of hands.  The surgery is not over when it is over, it is over when the patient is healed.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Face Lift - Looks Awful Behind the Ears

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The healing process in general can take up to one month for the majority of swelling to subside, incisions to close, sutures to come out, and for bruising to completely go away. #Recovery time from a #facelift varies from person to person, but patients can generally expect to be presentable within three weeks from surgery. Patients should expect swelling, bruising, and discoloration of the skin during this phase of recovery (swelling normally goes down after 48 hours; most bruising will go away within two weeks). When the skin is separated from the underlying tissues during surgery, small sensory #nerves are cut. Varying degrees of numbness will be present after surgery and will improve gradually as the nerves reconnect to the skin. This process can take from 2-6 months for face, neck and cheeks, and to 9-12 months for the forehead and scalp. Muscle weakness may also be present around the mouth especially if liposuction is used. This typically recovers fully in the months after surgery. 

As the nerves regenerate, the itching, burning, tingling and shooting #sensations will occur. Ice, moisturizers and gentle #massaging are helpful during this phase of the #healing process. Frequently there is a tight feeling in the neck, jawline and cheek after a facelift. During surgery, not only the skin but the underlying muscles are tightened to create a better and longer lasting result. Additionally, the #swelling will move downward in the first week and the neck will feel even tighter. Do not be alarmed: the sensation will decrease during the first month. 

Some degree of firmness or lumpiness under the skin is normal after surgery and will resolve with time. Local #massage of the areas may accelerate the resolution of this problem, which normally takes 2-4 months to disappear completely.
The marks from a facelift can easily hidden with “camouflage” make-up which you can learn how to apply. The scars from a facelift mature within six to twelve months from the surgery date. It is during this time that the rejuvenating effects of the facelift will become apparent and the real result will be seen. If you have certain concerns about the procedures and #healing process, it is recommended to call your board-certified surgeon or their medical staff and discuss those #concerns.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Facelift Scars

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Thank you for your question. In most healthy people without a history of healing irregularities, the surgical scars resulting from a well-performed facelift are rarely an issue. Incisions are designed to result in scars that are concealed within natural curvatures around the ear and hairline. Most patients consider those scars to be acceptable with makeup within 1-2 weeks, although full scar maturation takes many months. Once mature, most scars are imperceptible in normal social interactions, although not entirely invisible upon closer scrutiny.

Lasting bunching is rarely encountered when the incision length is appropriately designed and performed. Some surgeons may attempt to minimize the length of the scar. This may be to shorten the procedure duration or as in response to patient request or perceived preference. When an appropriately long incision is utilized, bunching is minimized. Once patients are educated about this, most understand and approve of the trade-off between a longer incision but less bunching and an often superior result.

The appearance of white scars behind the ears may be minimized by extending the incision high behind the ear and into the post-auricular hairline. This may result in a longer scar, but a more easily camouflaged one. Again, once educated, most patients approve of this trade-off between a longer incision but less visible scar.

A well designed and performed facelift incision, which is appropriately cared for after surgery, generally results in a favorable scar which is rarely a source of patient concern.

Ultimately, the vast majority of patients consider the results of the facelift and appearance of facial rejuvenation to be a very acceptable trade-off for typically inconspicuous scars.

James M. Pearson, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 137 reviews

Facelift scars

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There is an an art to planning a facelift which includes incision placement as well as technical precision of the scar.  All scars go through three phases of healing with an initial redness phase followed later on by rebuilding and maturation of the scar.  Most scar and wound experts agree it takes about a year for a scar to fully mature.   Facelfit scars are commonly seen as red and can be hypertrophic.  Treatment of scars depends on the type of scars seen and can include the following treatments: -laser treatments to help both scars and redness of scars  -injections of kenalog or a combination of kenalog and 5-FU  -scar revision if poorly positioned scar The key to great scars after a facelift is to avoid tension on the skin and lift the deeper layer of the face.  Placing too much tension on the skin can make scars wider than ideal.  Meticulous closure technique can also aid in scar appearance.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

The most important thing when it comes to scarring after a facelift is surgeon technique.

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The most important thing when it comes to scarring after a facelift is surgeon technique. An experienced, double board certified facial plastic surgeon who performs thousands of facelifts will generally have the knowledge, technique, and skill necessary so that the patient ends up with nearly invisible, unnoticeable scars. After care is very important too, making sure to apply any topical treatments your surgeon gives you and staying out of the sun. I recommend researching facial plastic surgeons and looking carefully at their before and after photos to see if you can notice the scarring, read patient testimonials, and of course go in for an in-person consultation before deciding on a surgeon. You should not have to choose between sagging skin or terrible scarring!

Facelift - looks awful behind the ears?

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Hello! Thank you for the question! It is common for scars to fully mature for up to a year. In the meantime, there are a few things that may help to ameliorate your incision/scar. The most proven (as well as cheapest) modality is simple scar massage. Applying pressure and massaging the well-healed scar has been shown to improve the appearance as it breaks up the scar tissue, hopefully producing the finest scar as possible. Other things that have been shown to add some benefit, albeit controversial, are silicone sheets, hydration, and topical steroids. In addition, avoidance of direct sunlight to the incision will significantly help the appearance as they tend to discolor with UV light during the healing process.

If unsightly scars are still present after approximately a year's time, other things that your surgeon may consider are intralesional steroid injections, laser, or just surgical revision of the scar itself.

Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Scarring depends on many things...

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Scarring from facelift surgery varies from patient to patient and is dependent upon a multitude of variables. These include the type of facelift performed, the wound healing characteristics of the patient and the technical skill of the surgeon.
The surgeon can influence several of these variables, but unfortunately has no control over the patients wound healing biology. For these reasons plastic surgeons make every effort to place scars where they are well hidden when performing facelifts.
The facelift incision typically starts in the hair above the ear. Its then carried in front of the ear and then curved around the tragus and then extended downward to the ear lobe.It’s then carried onto the back of the ear and them posteriorly into the hair behind the ear.
Occasionally adverse scarring may occur in the area behind the ear following facelift surgery.In many cases this scarring is associated with bunching and gathering of the skin. This phenomenon typically occurs when a discrepancy exist between the lengths of the two opposing wound edges.This situation arises when surgeons make a conscious effort to keep the incisions behind the ear short.Under these circumstances scarring may result which may ultimately require a scar revision.
In the vast majority of facelift patients wounds heal nicely and scars are difficult to see. When wound healing is complicated the scars are often well hidden by incision placement. After surgery, scars are often extremely red and raised. With the passage of time these scars usually flatten and lose their redness.This improvement becomes noticeable in about six to eight weeks, but takes 12 to 18 months to reach completion.
Massage and topical agents can sometimes facilitate wound healing and are often recommended in the post-operative period.With these maneuvers most patients are happy with their results, but occasionally a rare patient will require a scar revision.

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.