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 41

Facelift scars

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 110 reviews

Research Surgeon Carefully to Avoid Bad Facelift Scars

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
4.7 out of 5 stars 40 reviews

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

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 29 reviews

Minimizing facelift scars

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 136 reviews

Facelift 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.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 144 reviews

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

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?

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 24 reviews

Scarring depends on many things...

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.

Do all face lift scars look awful behind the ears.

I have performed face lifts for over 20 years and not all face lift scars look bad behind the ears.  Bunching is more an indication of an inadequate sized incision placed in the posterior scalp.  This causes bunching of the skin as it's redraped prior to its removal.  Newer minimal incision face lifts do not have this incision but replace it with a small incision under the chin.  Less skin, of the neck, can be removed so there's always a trade off.  You should have a few consultations for evaluation and recommendations.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Appropriate incision placement for facelift

It is imperative that you seek out a board certified plastic surgeon well trained in facelift surgery.   There are skillful methods to prevent the obvious signs of facelift patients.   Although assymetries and poor scarring may occur in the best of hands, an experienced facelift surgeon can carefully place incisions both in front and behind your ears that should be very difficult to perceive after appropriate healing time.

Widened scar is typically due to tension on the skin closure.  A properly performed facelift places the tension and pull on the underlying muscle, such that the skin can be closed ina tension free manner.  In addition, proper placement of the incision behind the ear in a natural crease will reduce visibility.   Lastly, early suture removal or use of dissolveable sutures help prevent suture track visibility. 

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 84 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.