Face Lift - Looks Awful Behind the Ears?

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!

Properly placed incisions around the ears should leave little or no scarring.  in a woman, the incision should go behind the ear and needs to be placed up on the ear cartilage.  After healing it should pull back into the groove.  In a mini-lift, the incision will end behind the ear.  Good candidates for a mini-lift shouldn't have any bunching.  Those who have too much extra skin in the neck and get a mini-lift instead of a full lift, will have bunching.  Finally, those who have a full lift, the incision should fall right at the junction of the hairline and the neck and be hidden in this transition.  Please go to my facelift before-and-after photos on the website for close-up views of the scarring seen behind the ears.  Everyone scars differently, but in the vast majority of cases, very minimal scarring should be seen.

The incision that is made behind the ears during a facelift varies from one patient and surgeon to another. Each surgeon makes their incisions in a slightly different way and will often customize the incision for each individual patient. Patients do heal differently, and some patients will develop widened scars from any surgery, not just facelift procedures. Occasionally there is some bunching of the tissue behind the ears, but this is more common with 2nd or 3rd facelifts rather than a 1st procedure.
In my practice, the incisions are hidden along the hairline and the incision is made in such a way that the hair grows through the incision in order to hide the incision as much as possible. Many patients still feel comfortable wearing their hair up once the incisions have healed.
Also, there are "mini lifts" or "short incision" lifts (the terminology will vary from one surgeon to another) that may not require an incision along the hairline. The tradeoff with these techniques is that in some cases it is not possible to tighten the neck as much as one might like. Be sure to discuss concerns regarding incisions and different available techniques with your surgeon.
All the best,

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.

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.

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.

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!

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!

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.

If the incisions behind the ears are planned correctly, the skin is pulled and trimmed in a correct way, and repaired appropriately, the incisions heal extremely well in most circumstances and you can style or pull your hair any way you wish.

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.