Is it possible to do a mid-facelift with a hairline incision?

Question

Is it possible to effectively lift the midsection of the face without a scar in front of the ears? If the incision site is hidden in the hairline, does this rule out the possibility of deep plane (if a deep plane lift is the most effective way to reposition the malar region)? Considering a younger patient, who likely doesn’t have excess skin etc.

Steve Laverson, MD, FACS · Answer

The answer is YES, it is possible to mobilize mid-face skin and soft tissue in the deep plane and to reposition these structures upwards without a scar in front of the ears.  My approach for this powerful lift is at the lower eyelid margin with a completely hidden scar.  Elevated mid-face structures are secured to bone with deeply placed sutures.

Erman Ak, MD · Answer

Lifting the midface without a visible scar in front of the ears is possible in select cases, especially for younger patients with good skin quality and minimal laxity. However, if a deep plane facelift is required to effectively reposition the malar (cheek) region, an incision near the front of the ear is typically needed for optimal access and long-lasting results. Incisions can often be placed discreetly and heal very well. Erman AK, Dr. MD, Plastic Reconstructive & Aesthetic Surgeon

Lucian Ion, FRCS · Answer

Thank you for your question. There are degrees of change that can be effected for facial rejuvenation or a refreshed appearance of the facial features in someone younger. You are entirely accurate in saying that skin excess does not occur so early in life. The technique of minimal access facelift, also referred to as a gliding facelift, is applicable in a situation like yours.

The scar can be limited to the sideburn area, or can extend also in the temple hair and it involves mobilising the tissues in the midface and towards the cheeks. While it does not have the same amount of impact as a deep plane facelift, it carries less scarring and is therefore an appropriate intervention for someone who does not require a significant amount of change.

Ronald J. Edelson, MD · Answer

Most facelifts require an incision in front of the ear. Fortunately those scars heal very well.  There have been attempts to avoid that scar but the results are not good at all.

Benjamin Gelfant, MD, FRCSC (retired) · Answer

Hello from Canada,
The answer to your question is a qualified yes.We usually do not make incisions in front of the ears for facelifts. My routine incision begins in the temple at the hairline and yes, continues around the ear, but runs from the top of the ear in and out of the nuances of the ear ( "retro-tragal"), leaving that portion pretty much invisible. Older incision designs usually involved continuing down in front of the ear but surgeons have used the retro-tragal design for most patients for decades.The term "deep plane" facelift has been a little misused in the last few years. It was coined by Sam Hamra, a surgeon in Dallas, in about 1992, and referred to not going under just the skin very far, but going deeper ( under the SMAS) very soon after making the incision. This has some benefits and some detrimental effects. In some patients who have good skin, it is the right way to go, but many patients have significant skin looseness and need to have the skin lifted and tightened independently of the deeper tissues ( a "composite" facelift) Proper pre-surgery diagnosis will determine the best approach, but clearly a deep plane facelift is not appropriate for everyone, nor is it anything new.
If by your question you really intended to ask, whether this deep approach be done via incisions only in the temple, the answer is no. If by "hidden in the hairline" you actually mean within the hair ( not the margin of the hair, which is the hairline) that incision location is also used along with the extensions I described above. But it results in removal of a segment of temple hair-bearing scalp, elevation and backward displacement of the hairline, and can contribute to an operated upon look.
For details please see my website, along with the accompanying facelift video 
Best wishesBenjamin Gelfant MD FRCSC
remember, these online answers are not a substitute for an in-person consultation with a certified plastic surgeon

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

It is very important to understand that face lifting is most effective for the brow, the jawline and lower face, and neck.

The factors of pull for the midface require an incision at the level of the ear.  It is possible to hide the incision inside the ear canal behind a structure called the tragus which eliminates the visible incision in the non-hair bearing area of the cheek.

Be aware however that even with the best face lift to rejuvenation of the midface ultimately requires filler injections in the midface as the factor of pull during a face lift is somewhat limited in the midface region.

Is it possible to do a mid-facelift with a hairline incision?

Answers (6)

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