Face Lift - Looks Awful Behind the Ears?

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!